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Pain is the most common symptom which makes the patient visit doctor.
What is pain?
Unpleasant sensory and emotional experience associated with actual or potential tissues damage.
What is the response to pain?
Depends on:
1- Type of patients
2- Type of pain
What are the types of pain?
1- Acute pain
| 2- Chronic pain
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Identified easily |
Not easily identified |
It happened immediately after painful stimuli and resolves within hours or days |
Indeterminate duration |
Examples: after surgery, acute chest pain, renal colic , trauma etc. |
Examples: cancer pain , diabetic neuropathy, low back pain , post herpes zoster , chronic joint pain etc. |
Response: Sympathetic stimulation and release of catecholamine from the adrenal medulla causing: anxiety, increased heart rate, high blood pressure rapid breathing, elevated blood sugar and increased gastric acidity. |
Response: Change of the mood, depression, loss of appetite, tendency to sleep. Psychological and surrounding environmental factors play a very important role. |
How can we diagnose pain?
1- Acute pain
| 2- Chronic pain
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- Medical History and physical examination of the patient.
- Evaluation of pain severity. The most commonly used pain measurement method is the visual analog scale (VAS). The VAS is a 10-cm horizontal line labeled “no pain” at one end and “worst pain imaginable” on the other end. The patient is asked to mark on this line where the intensity of the pain lies. |
- A careful detailed history of pain: including onset , duration, nature ( sharp , stabbing, burning, throbbing, colic, dull etc.) location, intensity, radiation, course, what relieve and what exaggerate , associated symptoms ( e.g. depression, fatigue anxiety, etc.), previous use of analgesic drugs.
- Other relevant history: headache, fever, diabetes, weight changes, neurological symptoms, previous surgeries.
- A review of prior medical evaluation and treatment.
- Physical examination: face, mental status, gait, vital signs, systemic examination especially musculoskeletal and neurological systems.
- Thorough psychological and sociological evaluation.
- Investigations:
a. Laboratory tests b. ECG
c. Imaging studies are often necessary and include chest X-ray, CT, MRI and Bone Scan. |
How can we treat pain?
1- Acute pain: - Treatment of the cause e.g. postoperative pain is treated by Opioid analgesics :
A - Intravenous administration: for moderate to severe pain.
B - Intramuscular administration: for mild pain.
C - Patient- controlled analgesia: By using certain infusion pumps, we can control the delivered doses, the interval between doses and the maximum dose of Opioid given to the patient in a given period.
2- Chronic pain:
It needs cooperation of many specialties e.g. Anesthesia and pain management, Neurology, Oncology and sometimes Psychiatry.
A – Oral simple analgesics by using COX inhibitors: this group of drugs inhibits production of prostaglandin which directly activates free nerve endings. There are 2 types: COX-1 inhibitors which is wide spread throughout the body. It has side effects like hyperacidity. Examples of this group are: Salicylates, Acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs). COX-2 inhibitors like Celecosib are selective; concerned primarily with inflammation.
B - Oral narcotic drug:. This group is called narcotic analgesic because they are pain killers and cause sleepiness.
C - Transdermal fentanyl patches: These patches release fentanyl into circulation in a fixed rate depending on the surface area of the patch and the local skin condition. The serum concentration of fentanyl reaches a plateau level after 12-24 hours and remains constant for 72 hours. Thus it should be changed every 3 days.
D - Adjuvant drugs: e.g. Anticonvulsant, Antidepressant, sedatives, corticosteroids.
E - Physiotherapy.
Usually most of the patients with mild to moderate pain respond very well to this regimen.
F - In severe cases not responding to conventional treatment: Invasive procedures should be applied by injection of some analgesic and anesthetic drugs into the nerves responsible for pain. The most common technique is injection of anesthetic and analgesic drugs into the epidural space through an EPIDURAL CATHETER. The epidural space is located in the vertebral column and contains the nerve roots responsible for receiving sensation from different areas of the body. This procedure is indicated mainly for relieving pain originating from advanced malignant tumors of lower half of the body.
In Dr. Al Rustom Medical & Day Care Surgery centre, pain clinic is quiet active under supervision of Prof. Atef Demian (M.D), PhD, Prof. of anesthesia and pain management. Prof. Demian has long experience in management of all types of pain. The pain clinic is dedicated for management and follows up of patients complaining of chronic pain e.g. back pain, Diabetic neuropathy, Herpes Zoster, Trigeminal Neuralgia, Cancer pain etc. Also pain clinic is concerned about the patient’s ability to function and to maintain their quality of life. This specialty develops a treatment plan to relieve or minimize pain and help the patient return to every day activity quickly. If you need more information or if you want to contact our Centre for a visit or an appointment, do not hesitate to contact Prof. Demian via the reception on 043498800
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