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

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EXAMPLE 5: 51-year-old man with 2 year history of lower back pain. Sometimes radiates down his right leg. Fell recently and now having problems walking. 1. RECOGNIZE • Patient may not show outward signs of pain • Other people may think that the patient is avoiding work. • Ask the patient about his symptoms! 2. ASSESS • Pain may be moderate to severe • Chronic pain, musculoskeletal (non-cancer) cause • There may have been a recent new injury causing acute on chronic pain. • The pain may be difficult to localise and have both nociceptive and neuropathic features (e.g. burning, pins and needles) • Multiple factors may be contributing to the pain — Physical — Psychological and social 3. TREAT • Non-drug treatments — Rest is often not helpful in chronic back pain — Occasionally, there may be an acute on chronic problem that needs surgical treatment, (e.g. prolapsed disc) — Acupuncture, massage and physiotherapy may be helpful. — Psychological or social support • Work issues • Family issues PAIN MANAGEMENT EXAMPLES • Drug treatments — Regular paracetamol and NSAIM may be helpful, especially if acute on chronic pain. — In general, morphine is not helpful for chronic back pain. Occasionally, morphine may need to be added for more severe nociceptive pain. — Consider amitriptyline if features of neuropathic pain (especially if poor sleep) 38 ESSENTIAL PAIN MANAGEMENT
Summary Moderate to severe, acute on chronic non-cancer pain, mixed neuropathic and nociceptive mechanisms • Assessment may be difficult • Non-drug treatments are important • Regular simple analgesics • Morphine usually not helpful (unless severe nociceptive pain) • Amitriptyline may be helpful PAIN MANAGEMENT EXAMPLES ESSENTIAL PAIN MANAGEMENT 39
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 26 and 27: Drug effectiveness The effectivenes
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 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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