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FACULTY OF HEALTH SCIENCES RURAL HEALTH PROGRAM CLINICAL MEDICINE BLOCK M DAIMEN- SMO PHYSICIAN, MODGH INTERNAL MEDICINE- ADJUNCT LECTURER
PAIN
GENERAL SYMPTOMS IN MEDICINE
OUTLINE
Definition
Causes
Pathophysiology Classification/grading
Clinical description/features
Management Summary
References
DEFINITION
PAIN- is an unpleasant sensation/feeling in the body
ranging from mild discomfort/ache to an agonizing/excruciating distress as a result of potential or real tissue damage1.
ORIGIN OF PAIN
CONNECTIVE TISSUES- skin, subcutaneous tissues,
Causes
Injury- blunt/penetrating trauma, chemicals,
thermal
Infections- viruses, bacterial, protozoa,
fungal, helminthes
Poisons- stings & bites Spasms- chemical/electrolytes imbalances
M DAIMEN- SMO Internal Medicine, MADANG
Pathophysiology
Pain arises when there is presence of inflammation and
Stimulation of pain fibers Pain centre activation Certain actions in response to this discomfort.
M DAIMEN- SMO Internal Medicine, MADANG
Grading/Classification
MILD
MODERATE SEVERE
ACUTE/CHRONIC
Consistency- colicky/constant
Frequency- how often?; intermittent Aggravating factors- what makes it worse Relieving factors- what makes it cool down.
C-RP, Temperature.
Electrolyte imbalance- Ca++, Na+-
(spasms/cramps)
(WCC- white cell count, ESR- erythrocyte sedimentation rate, C-RP- C-reactive protein)
Management
This covers 3 things- INVESTIGATIONS,
tests must be ordered where appropriate- WCC, ESR, C-RP, ASOT, X-Rays, ECG, U&E, e.t.c..
ASOT- anti-streptolysin O titre, ECG- electrocardiograph, U&E- urea & electrolytes
Treatment
GUIDELINES FOR SUCCESS
Review and chart each pain carefully and individually
Explanation and reassurance contributes greatly to pain relief. Give regular analgesics rather than on an as required basis Choose the best route: PO/PR/SC/IM/IV/INHALATION/epidural Allow patients to be in-charge as this will promote patient well-being and
reduce misuse.
GRADE OF PAIN
MILD- aches/discomforts
Treatment
TREATMENT
Massages, acupunctures, physiotherapy NON-ADDICTIVE DRUGS: paracetamol NSAIDS- aspirin, indomethasin, ibuprofen, diclofenac NSAIDS SE: PUD, asthma, clotting problems, anti-coagulants drugs CAUTION: renal/liver impairment, pregnancy, elderly. Children no ASPIRIN.
MODERATE
SEVERE
As above
ADDICTIVE-DRUGSmorphine/diamorphin less additive Pethidine, fentenyl more addictive Adjuvant drugs- hyosin butylbromide, steroids, anti-depressives/psychotics for neuropathic pain. Local anesthetic/epiduralstings/bites/cancers/post-operative.
Education
Explanation and reassurance is very important in
pain management
Drugs side-effects education Prognosis of the cause of pain
Summary
Pain is one of those common symptoms you will
Reference
1. Oxford medical dictionary, 4th edition 2. Oxford handbook of clinical medicine, 7th
edition