Pain Management Topic Homepage
Pain Management Overview
Pain management is the specialty that diagnoses and treats pain with the aim to reduce patient suffering. Pain occurs for many different reasons; however, these can be broken down into three main groups: somatic, visceral and neuropathic pain.1
Somatic and visceral pain is often symptomatic of an underlying problem, either injury or illness, which reduces in line with recovery.1 The management of this pain...
... must consider the side-effects of any treatment. Management of short-term pain is primarily through analgesics such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). Despite being one of the most commonly prescribed drugs worldwide, NSAIDs may have serious side effects (gastrointestinal toxicity, dyspepsia and ulcers) and should not be used long-term.2
Neuropathic pain or chronic pain does not reduce following recovery from the initial injury; this hypersensitivity is caused by plasticity of the pain pathways.3 In Europe, one in five people are affected by chronic pain and many are unable to work. Healthcare and social benefit costs are substantial making this a serious public health issue.4
Chronic pain (osteoarthritis, rheumatoid arthritis [RA] and chronic lower back pain) is treated and managed in a variety of ways. The initial treatment for these conditions is NSAIDs, however the long term toxicity of these drugs limits the length of time for which they can be used.5 The introduction of cytoprotective drugs or proton pump inhibitors can reduce gastrointestinal toxicity and increase the length of treatment. The use of opioid drugs has been shown to be effective in the short-term; however there is little evidence for effective long-term use of these drugs, especially in RA.5
Pain management in palliative care differs from other pain management. The aim is to reduce the suffering of terminally ill patients, therefore long-term side effects, such as problematic opioid use, are not of concern.6
1. Hughes J. Pain Management: From Basics to Clinical Practice. Elsevier Health Sciences. 2008 : 1-5.
2. Oviedo J. et al. Therapy and prevention of NSAID-related gastrointestinal disorders. Therapy of Digestive Disorders. Elsevier Inc. Second Edition. 2006 : 291-314.
3. Ji R.-R. et al. Central sensitization and LTP:do pain and memory share similar mechanisms? TRENDS in Neuroscience. December 2003 ; 26 (12) : 696-705.
4. Patal S. Barriers to Rehabilitation and Return to Work for Unemployed Chronic Pain Patients: A Qualitative Study. European Journal of Pain. November 2007 ; 11 (8) : 831-840.
5. Stannard C. et al. Evidence Based Chronic Pain Management. Blackwell Publishing Ltd. 2010 : 69-120.
6. Ballantyne J.C. et al. Opioid Dependence and Addition During Treatment of Chronic Pain. Pain. June 2007 ; 129 (3) : 235-255.
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Neuropathic Pain
The Neuropathic Pain Knowledge Centre is a unique resource containing a wealth of current information in this field of medicine.
The nervous system (central and peripheral) constantly receives and interprets information about the body's surroundings and the body's own functioning, responding by sending out messages to tissues and organs.
The Knowledge Centre addresses the two types of pain: nociceptive and clinical. Nocicpetive pain aims to protect individuals from harm. Clinical pain results from damage or inflammation of a part of the body and consists of both spontaneous pain that may arise with no apparent peripheral stimulus, and from hypersensitivity to peripheral stimuli1 due to peripheral and central sensitisations.
Neuropathic pain is often described as a shooting, stabbing or burning sensation. Estimates suggest that neuropathic pain may affect as much as 3% of the population.
Different types of neuropathic pain exist depending on their origin, details of which can be found in the Knowledge Centre: Painful Diabetic Neuropathy, Herpes Zoster and Post-Herpetic Neuralgia (PHN), HIV Associated-Neuropathy (HIV-AN), Cancer-related Neuropathic Pain, Post-surgical/Post-traumatic Neuropathic Pain.
In the clinic, the diagnosis of neuropathic pain relies on an accurate history and examination and some pain evaluation tools are used.
As Neuropathic pain doesn’t respond to conventional therapy with analgesics, the different treatment regimens are antidepressants, anticonvulsants, opioids, topical agents and combination treatment.
To help physicians in the pharmacological management of this condition, recent guidelines are available.
Enter the Neuropathic Pain Knowledge Centre
References:
1. Ji R-R, et al. Central sensitization and LTP: Do pain and memory share similar mechanisms? Trends in Neuroscience 2003;26(12):696–705
Date of preparation: August 2012 PAIN/12/0003/EUd
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Pain Management Drug Data - A-Z
Possible searches include drugs or medicines (by brand, generic ingredient or drug class), diseases, conditions and more.
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... small blood vessels. The red blood cells in people with sickle cell disease behave differently under a variety of conditions, including dehydration, low oxygen levels and elevated temperature. Changes in any of these conditions may cause the cells to block small blood vessels and cause tissue infarction. Repeated episodes may result in organ damage.
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Online CME
Practical Solutions to Critical Topics in the Management of Chronic Pain: From Bench to Bedside
Apr 2013
... States that is both common and costly. A significant barrier to the optimal diagnosis and treatment of chronic pain is a lack of knowledge regarding the underlying causes of chronic pain and the optimal use of analgesic compounds. This activity uses an interactive format to update clinicians on the pathophysiology of chronic pain and the mechanisms of action of common classes of analgesic therapies. The activity also features two case studies to show learners how knowledge about the pathophysiology of chronic pain and the mechanism of action of analgesic compounds can be used in daily practice.
Chronic Pain: Communication and Evaluation Tools to Optimize Outcomes. A Case-based CME Activity--A 52-Year-Old Man with Chronic Low Back Pain
Apr 2013
... to work and carry out other activities of daily life, hampering sleep, exacerbating concomitant illness, and generally diminishing quality of life. For clinicians, managing long-term pain can be tremendously frustrating, and the subjective nature of pain perception means that even assessing response to treatment can be difficult. This case, focusing on chronic lower back pain, demonstrates how validated screening instruments for pain and concomitant conditions such as depression are valuable in pain assessment and management. It also provides insight on how knowledge of pain pathophysiology contributes to treatment decisions.
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