Escolar Documentos
Profissional Documentos
Cultura Documentos
1 10/6/2016
Pain Management
What is pain?
A protective mechanism to warn of damage or
the presence of disease
Part of the normal healing process
Classification of Pain
By Onset and Duration
Acute pain
Sudden in onset
Usually subsides once
treated
Chronic pain
Persistent or recurring
Often difficult to treat
Major Sources of Pain
Source Area Involved Characteristics Treatment
Kidney vasodilation
NSAIDs
Mechanism
Inhibit both peripheral and central cyclo-
oxygenase, reducing prostaglandin formation
2 isoforms of COX
COX-1: Constitutive, physiologic
COX-2: Inducible, inflammatory
Mechanism of action of NSAIDs
depression of cyclooxygenases activity
decreasing of prostaglandins synthesis in
peripheral tissues and in central nervous system
decreasing of sensitivity of nervous endings and
depression of transmission of nociceptive
impulses on the level of CNS structures
pain-relieving action of non-opioid analgesics is
partly connected with their anti-inflammatory
activity
Common Pharmacological Effects
Analgesic (CNS and peripheral effect) may involve
non-PG related effects
Antipyretic (CNS effect)
Anti-inflammatory (except acetaminophen) due
mainly to PG inhibition
COX-1
COX-2
Steroids work
here
COX-3
Steroids work
here NSAIDs work
here
10/6/2016 15
NSAIDs
Properties
Nonspecific analgesics, but greater effectiveness
likely in inflammatory pains
Dose-dependent effects
Marked individual variation in response to
different drugs
Drug-to-drug variation in toxicities partly
determined by COX-1/COX-2 selectivity
NSAIDs
Properties
Adverse effects: GI toxicity, renal toxicity, bleeding
diathesis
GI toxicity reduced by proton pump inhibitors,
misoprostol, and possibly high-dose histamine-2
blockers
COX-2 selective inhibitors have better GI safety profile
Use with caution in patients with renal
insufficiency, congestive heart failure, or volume
overload
Paracetamol (Acetaminophen)
analgesic and antipyretic drug
maximal effect if the drug is introduced orally
after 2 hours, lasts approximately for 4 hours
in case of durable administration of big doses
damaging of liver and kidneys, production of
met-hemoglobin
Nonopioid Analgesics
Acetaminophen (paracetamol)
Minimal anti-inflammatory effects
Fewer adverse effects than other nonopioid
analgesics
Adverse effects
Renal toxicity
Risk for hepatotoxicity at high doses
Increased risk with liver disease or chronic alcoholism
No effect on platelet function
Paracetamol (Acetaminophen)
N-Acetyl-P-Aminophenol
Analgesia + + + +
Respiratory
depression +
Euphoria + +
Dysphoria +
Decrease GI
motility +
Physical
Dependence +
Mania,
hallucination +
Morphine CNS
Depressant effects Stimulate effects
Analgesia CTZ (nausea, vimiting)
Indifference to surroundings Edinger Wesphal nucleus (III
Mood and subjective effects nerve producing miosis)
Depression of respiration Vagal centre (bradycardia)
Cough centre
Temperature regulating
centre
Vasomotor centre
Morphine can be used as an analgesic
pain in myocardial infarction
pain associated with surgical conditions, pre- and
postoperatively (pre-anesthetic medication, balanced
anesthesia, surgical analgesia)
pain associated with trauma, burns
severe chronic pain, e.g., cancer
pain from kidney stones, renal colic, ureterolithiasis, etc
(pain may be valuable for diagnosis: should not be
relived by analgesic unless proper assessment of the
patient has been done)
traumas of thorax accompanied by cough (morphine
depresses central links of coughing reflexes)
Opioid Therapy: Routes of Administration
10/6/2016 70