What is PAIN?

• Pain is a general term that describes uncomfortable

sensations in the body. It stems from activation of the
nervous system.
• Pain can range from annoying to debilitating, and it can
feel like a sharp stabbing or a dull ache. Pain can also be
described as throbbing, stinging, sore, and pinching.
• Acute pain can be mild and last just a moment, or it
might be severe and last for weeks or months.
• Chronic pain is pain that is ongoing and usually lasts
longer than six months.
THE FOUR MAJOR TYPES OF PAIN:

• Nociceptive Pain: Typically the result of tissue injury. Common types

of nociceptive pain are arthritis pain, mechanical back pain or post
surgical pain.
• Inflammatory Pain: An abnormal inflammation caused by an
inappropriate response by the body’s immune system. Conditions in
this category include gout and rheumatoid arthritis.
• Neuropathic Pain: Pain caused by nerve irritation. This includes
conditions such as neuropathy, radicular pain and trigeminal
neuralgia.
• Functional Pain: Pain without obvious origin, but can cause pain.
Examples of such conditions are fibromyalgia and irritable bowel
syndrome.
 Pain Perception Pathway

• Pain perception is essential to

human well-being and survival.
• The sensation of pain originates
through complex signaling pathways
which begins in the periphery,
ascends in the spinal cord or
brainstem (cranial sensory input),
and is ultimately interpreted in the
cortex of the brain.
 Characteristics of Pain:

• Provocation and Palliation: What were you doing at the onset? What
provokes it, what alleviates it?
• Quality/Quantity: What does the pain feel like and how often? Is it
sharp, dull, stabbing, crushing, throbbing, nauseating?
• Region/Radiation: Where is the pain located? To be specific, point to
the location of the pain or draw it on the diagram. Does it radiate
anywhere? If so, where and to what side? Is it equal if both sides are
involved? The more specific you can be the better.
• Severity Scale: How much does it hurt on a scale from 1-10?
• Timing: Does the severity or character of the pain change based on
time of day, activity, weather, time of year or position?
 Pain Assessment
• An overall appraisal of the factors that may influence a
patients experience and expression of pain (McCaffery
and Pasero 1999) acomprehensive process of describing
pain and its effect on function; an awareness of the
barriers that may affect nurses assessment
andmanagement of pain.
Nonopioid Analgesics (Salicylates &Non-Salicylates)

• Non-opioid analgesics encompass the non-steroidal anti-inflammatory drugs

(NSAIDs) and paracetamol (acetaminophen). The NSAIDs include
acetylsalicylic acid (ASA, aspirin), dipyrone (metamizole), and numerous other
drugs in diverse classes.
• The NSAIDs have potent anti-inflammatory, analgesic and antipyretic activity,
and are among the most widely used drugs worldwide.
• In palliative medicine, they represent the first step of the World Health
Organization’s analgesic ladder used for mild pain and they are an important
supplement to opioids and adjuvant drugs at higher steps of the ladder.
• The disadvantages of non-opioid analgesics include a ceiling effect for pain
relief and the risk of side effects.
• NSAIDs are also associated with an increased risk of adverse gastrointestinal,
renal, and cardiovascular effects and hepatotoxicity can result from
overdosing with paracetamol.
Difference Between Salicylates & Non-Salicylates
• Salicylates
• useful in pain management
because of analgesic, antipyretics
and anti-inflammatory effects.
Mechanism of action :
• lower body temperature by dilating
peripheral blood vessels
• -inhibit the production of prostaglandins
• -makes pain receptors less likely to send
pain messages
• -Aspirin prolongs bleeding time by
inhibiting aggregation of platelets
• Non-Salicylates
• use as aspirin substitute for
PT allergic to aspirin or who
experience gastric upset. drug
of choice in treating children
with fever and flu-like
symptoms.
Mechanism of action :
• doesn't posses anti-flammatory
action, doesn't inhibit platelet
aggregation, therefore is the
analgesic of choice when bleeding
tendencies are an issue
Salicylates
• Adverse Reactions:
• -GI System; gastric upset,
heartburn, nausea, vomitting,
anorexia, GI bleeding
• - loss of blood through GI tract
• - allergy may manifest in hives,
rash, angioedema, bronchospasm,
anaphylactic shock
Non-Salicylates
• Adverse Reactions:
• - skin eruptions, urticaria
• - hemolytic anemia
• -pancytopenia
• - hypoglycemia
• - jaundice
Salicylate used for: Non-Salicylate used for:
• Relieving mild to moderate pain • Treating mild to moderate pain
• Reducing elevated body temperature
• Treating inflammatory conditions, such as rheumatoid • Reducing elevated body
arthritis, osteoarthritis, and rheumatic fever temperature (fever)
• Decreasing the risk of myocardial infarction in those
with unstable angina or previous myocardial infarction • Managing pain and discomfort
(aspirin only) associated with arthritic disorders
• Reducing the risk of transient ischemic attacks or
strokes in men who have had transient ischemia of the
brain due to fibrin platelet emboli (aspirin only). This use
has been found to be effective in men (and women older
than 65 years of age only).
• Helping maintain pregnancy in special at-risk
populations (low-dose aspirin therapy). For example, it
may be used to prevent or treat inadequate
uterine–placental blood flow.
Salicylates Drugs example: Salicylates Drugs example:
• Aspirin (Acetylsalicylic • Acetaminophen
acid)
• Diflunisal
• Magnesium salicylate
• Salsalate
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Non-steroidal anti-inflammatory drugs (NSAIDs) are

medicines that are widely used to relieve pain, reduce
inflammation, and bring down a high temperature.
• They're often used to relieve symptoms of headaches,
painful periods, sprains and strains, colds and flu, arthritis,
and other causes of long-term pain.
Classification of NSAIDs:
• Acetates: diclofenac, indomethacin, sulindac.
• Fenamates: mefenamic acid.
• Oxicams: piroxicam.
• Propionates: ibuprofen, ketoprofen, naproxen.
• Pyrazolones: phenylbutazone.
• Salicylates: aspirin, diflunisal.
NSAIDs should usually be avoided by people with the
following conditions:
• Peptic ulcer or stomach bleeding.
• Uncontrolled hypertension.
• Kidney disease.
• People that suffer with inflammatory bowel disease
(Crohn's disease or ulcerative colitis)
• Past transient ischemic attack (excluding aspirin)
• Past stroke (excluding aspirin)
Opioid Analgesics

• Analgesics are a class of medications designed

specifically to relieve pain.
• They include acetaminophen (Tylenol), which is available
over the counter (OTC) or by prescription when combined
with another drug, and opioids (narcotics), which are only
available by prescription.
• The opioid analgesics can be used for either short-term or
long-term relief of severe pain. In contrast, the anti-
inflammatory compounds are used for short-term pain
relief and for modest pain, such as that of headache,
muscle strain, bruising, or arthritis.
Types of Analgesia

• Paracetamol
• NSAIDS
• Opioids (Weak & Strong)
• Neurophatic Agents
Paracetamol
• Paracetamol, also known as acetaminophen, is a medication used
to treat pain and fever. It is typically used for mild to moderate
pain relief.
• Good for mild to moderate pain. Use iv route in severe acute pain.
• Contraindicated in severe hepatic impairment, dose reduce in mild
impairment (e.g. 500mg QDS).
• Generally safe (except in overdose) and can be used in
pregnancy
• Prescribe: Paracetamol 1g four times a day orally
• Regular is better than PRN as paracetamol acts in conjunction
with other analgesia (e.g. opiates) to increase efficacy
How does paracetamol work?

• Paracetamol seems to work by blocking chemical

messengers in the brain that tell us we have pain.

• Paracetamol also reduces fever by affecting the chemical

messengers in an area of the brain that regulates body
temperature.
 Opioid Antagonists
• An opioid antagonist, or opioid receptor antagonist, is a receptor antagonist that
acts on one or more of the opioid receptors.
• The two most commonly used centrally acting opioid receptor antagonists are
naloxone and naltrexone. Naloxone comes in intravenous, intramuscular and
intranasal formulations, and is FDA-approved for the use in an opioid overdose,
and the reversal of respiratory depression associated with opioid use.
The two most common opioid antagonist medications include:
• Naloxone: You can find naloxone in Suboxone®, a medication used to treat opioid
addiction as a measure to discourage misuse. Naloxone is also used as a rescue
medicine for opioid overdose and is commonly known by the brand name Narcan.
• Naltrexone: Some people in opioid addiction treatment take naltrexone to block the
effects of opioids. As a result, they don’t feel the effects of opioids if they relapse.
• These medicines help many people with opioid addiction manage their symptoms
or recover from an overdose. Medical professionals and non-medical professionals
can use naloxone to save the life of someone experiencing an opioid overdose.
 Anesthetic Drugs

• Anesthetic, also spelled anaesthetic, any agent that produces a local

or general loss of sensation, including pain.
• Anesthetics achieve this effect by acting on the brain or peripheral
nervous system to suppress responses to sensory stimulation. The
unresponsive state thus induced is known as anesthesia.
• General anesthesia involves loss of consciousness, usually for the
purpose of relieving the pain of surgery.
• Regional anesthesia is used to numb only the portion of the body that
will undergo the surgery. Usually an injection of local anesthetic is
given in the area of nerves that provide feeling to that part of the body.
• Local anesthesia involves loss of sensation in one area of the body
by the blockage of conduction in nerves.
Patient-Controlled Analgesia (PCA)

• Patient-controlled analgesia (PCA) is any method of

allowing a person in pain to administer their own pain
relief.
• The infusion is programmable by the prescriber. If it is
programmed and functioning as intended, the machine is
unlikely to deliver an overdose of medication.
• Indications :The primary indication for PCA is the patient
who requires parenteral analgesia (e.g. severe pain
and/or oral/transdermal/rectal route not useable)
• Has incident pain or other pain patterns that are not
predictable.
• The patient-controlled analgesia
(PCA) pump is a computerized
machine that gives you a drug for
pain when you press a button.
• In most cases, PCA pumps supply
opioid pain-controlling drugs such
as morphine, fentanyl, and
hydromorphone.
• The pump is attached to a thin,
flexible tube (intravenous or I.V.
 The End...
Thank You!!!