Workshop Manual - Faculty of pain medicine - Australian and New ...

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Drug effectiveness The effectiveness of an individual analgesic drug depends on the type of pain. The WHO Analgesic Ladder (Appendix 4) was designed mainly for treatment of cancer pain, i.e. progressive pain requiring increasing medication. This stepwise approach does not work well for acute severe pain requiring immediate strong opioids (e.g. morphine). The ladder also does not work well for chronic non-cancer pain or neuropathic pain. In these situations, morphine is usually unhelpful. Amitriptyline and membrane stabilising drugs are much more likely to be effective. Table 1 shows the usefulness of some analgesic drugs for treating different types of pain. Acute nociceptive mild Acute nociceptive severe Paracetamol +++ ++ (in combination) Acute neuropathic Chronic non-cancer + + + Chronic cancer NSAIMs ++ ++ ± ± (e.g. bone pain) Codeine ++ + ± Morphine +++ ++ - +++ Amitriptyline - - ++ ++ ++ (e.g. neuropathic pain) Carbamazepine - - ++ + + (e.g. neuropathic pain) Table 1: Analgesic usefulness PAIN TREATMENT - Not usually useful ± Occasionally useful + Useful, mildly effective ++ Useful, moderately effective +++ Useful, highly effective 24 ESSENTIAL PAIN MANAGEMENT
BARRIERS TO PAIN TREATMENT Frequently, pain is not treated as well as it could be. Why does this happen What are the barriers where you work BARRIERS TO PAIN TREATMENT ESSENTIAL PAIN MANAGEMENT 25
Page 1: ESSENTIAL PAIN MANAGEMENT Workshop
Page 4 and 5: Essential Pain Management by Wayne
Page 6 and 7: INTRODUCTION Pain affects all of us
Page 8 and 9: WHY SHOULD WE TREAT PAIN CASE 1: Mr
Page 10 and 11: CLASSIFICATION OF PAIN Not all pain
Page 12 and 13: PHYSIOLOGY AND PATHOLOGY Understand
Page 14 and 15: The pain pathway 1. Periphery (Fig
Page 16 and 17: 2. Spinal cord (Fig 4) • The dors
Page 18 and 19: 4. Modulation (Fig 6) • The pain
Page 20 and 21: PAIN TREATMENT Because many factors
Page 22 and 23: Non-drug treatments Both physical a
Page 24 and 25: Where do analgesics work Local anae
Page 28 and 29: Possible barriers: • Patient fact
Page 30 and 31: 2. ASSESS To treat pain better, we
Page 32 and 33: 3. TREAT Treatment can be divided i
Page 34 and 35: PAIN MANAGEMENT EXAMPLES EXAMPLE 1:
Page 36 and 37: EXAMPLE 3: 24-year-old woman with a
Page 38 and 39: EXAMPLE 4: 12-year-old girl with bu
Page 40 and 41: EXAMPLE 5: 51-year-old man with 2 y
Page 42 and 43: EXAMPLE 6: 55-year-old woman with m
Page 44 and 45: CASE DISCUSSIONS CASE 1: A 22-year-
Page 46 and 47: CASE 3: A 5-year-old girl has advan
Page 48 and 49: DISCUSSION TOPICS TOPIC 1: Treatmen
Page 50 and 51: APPENDICES Appendix 1: WHO Essentia
Page 52 and 53: Appendix 2: Medicine Formulary for
Page 54 and 55: Pethidine Generally very safe As fo
Page 56 and 57: Appendix 3: Paediatric Medicine Dos
Page 58 and 59: Appendix 5: Using Morphine for Canc

Workshop Manual - Faculty of pain medicine - Australian and New ...

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