Acute Pain Management

Abstract

Acute pain management is improving steadily over the past few years, but training and professional education are still lacking in many professions. Untreated or undertreated acute pain could have detrimental effects on the patient in terms of comfort and recovery from trauma or surgery. Acute undertreated pain can decrease a patient's vascular perfusion, increase oxygen demand, suppress the immune system, and possibly risk increased incidence of venous thrombosis. Although acute postoperative pain needs to be managed aggressively, patients are most vulnerable during this period for developing adverse effects, and therefore, patient assessment and careful drug therapy evaluation are necessary processes in therapeutic planning. Acute pain management requires careful and thorough initial assessment and follow-up reassessment in addition to frequent dosage adjustments, and managing analgesic induced side effects. Analgesic selection and dosing must be based on the patient's past and recent analgesic exposure. There is no single acute pain management regimen that is suitable for all patients. Analgesics must be tailored to the individual patient.

Pharmacological pain control for human immunodeficiency virus–infected adults with a history of drug dependence

“…These authors argue that the acknowledgement of pain may be a starting point to discuss its management, particularly among patients with a history of substance abuse whose pain may have not been acknowledged by others. Case reports and surveys have also suggested a format for history taking among patients with a history of substance abuse who also have a history of HIV or HIV-related risk factors (see Table 2; Koo, 2003;Prater et al, 2002;Streltzer, 2001). Although supported through clinical experience rather than empirical evidence, the approaches outlined are intended to place the patient at ease while gleaning important information about past drug use behaviors that the clinician may wish to take into account.…”

“…Some authors have suggested that clinicians should begin encounters with a patient in pain with a verbal acknowledgement of the patient's report of distress (Koo, 2003;Prater et al, 2002). These authors argue that the acknowledgement of pain may be a starting point to discuss its management, particularly among patients with a history of substance abuse whose pain may have not been acknowledged by others.…”

“…Inquire openly about a patient's past personal and family history of substance use Include use of alcohol and over-the-counter preparations Solicit every history to eliminate profiling any patient or missing patients who do not fit a bdrug-abusing profileQ Complaints of chronic pelvic and rectal pain that may disguise a patient's history of sexual assault (Streltzer, 2001) Suggested questions to put the patient at ease, based on Koo (2003):…”

A Practical Approach to Headache Treatment

“…Analgesia from highdose NSAIDs has a ceiling effect, but higher doses can increase the duration, if not the pain-killing effect, of this class of drug. 74 Several headache medications contain combinations of simple analgesics, such as aspirin or acetaminophen, caffeine, ergots, or other vasoconstrictors and/or anxiolytics such as butalbital. Some of these combinations are also available with codeine.…”