Beruflich Dokumente
Kultur Dokumente
Dr Hicham Al Mawla
Er physician
Learning objectives
At the end of the workshop you will be able to:
management
Use validated tools to assist in assessing patients
pain
Outline strategies to manage pain with your
patients
Discuss pain medicines with your patients
What is pain?
Types of pain
Acute pain can be important for the body to tell the brain
sad?
Are you still visiting friends
or relatives?
Are you eating well?
REMINDER:
Use the same pain
assessment tool to keep a
detailed record of the
patients pain changes in the
clinic notes.
and suffering
To promote self-management
To relieve pain to a tolerable
level
exercise
Educate patients that there is a
difference between hurt and
harm when you have chronic
pain. Avoiding physical activity
can make their pain seem worse
over time.
Encourage patients to talk to
their family and friends and not
isolate themselves. Also get a
family member or friend involved
as their exercise buddy.
You may wish to suggest some
exercises to try e.g. walking,
swimming, gentle stretching
exercises. Remember to start
slow with exercise as they may
feel some discomfort initially,
especially if they have been
inactive for a long time.
Medicines
Key points:
Use a step-wise approach
to introduce pain
medicines (analgesics)
Prescribe regular doses of
analgesics
Plan a trial period with
clear and specific
instructions
Review the effects on
regular basis eg may need
more frequent review for
new medicines or when
dose changes
Diclofenac
Diclofenac Indomethacin Ketoprofen
Ketorolac Mefenamic acid Naproxen
Piroxicam Tiaprofenic acid
Cox-2 Inhibitors: Celecoxib Meloxicam
Parecoxib
What it
is used
for
How it
works
Adverse
effects
AMH 2010, CARPA 5th edition
Long-acting opioids
codeine
Modifies release
tramadol
Tramadol
Methadone
hydromorphone
Modified-release
hydromorphone
Immediate-release
morphine
Immediate-release
oxycodone
Immediate-release
tramadol
Modified-release
morphine
Modified-release
oxycodone
Transdermal
buprenorphine
PARACETAMOL +
Codeine 30 mg
What it
is used
for
How it
works
Adverse
effects
TRAMADOL
What it is
used for
Moderate to severe
pain
Slow release
formulations are
used for chronic pain
How it works
Adverse
effects
Chronic
Pain
Most
often treated with:
Anti-seizure medications
Anti-depressant
medications
NSAIDS
Implantable devices
Psychological therapy
Acupuncture
When all else fails and
benefits outweigh risks
Opioids
Responsible Opioid
Prescribing
Assess risk for opioid abuse or diversion prior to
prescribing opioid.
Risk factors for misuse or abuse of opioids
include the following
Males between 18 and 45.
A personal history of substance abuse
A family history of substance abuse
A personal history of preadolescent sexual abuse
A personal history of psychological disease
person
Recommend medicine only as part of an agreed