Pain

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Pain has sensory and emotional components and is often classified as acute or chronic

Acute  pain is frequently associated with anxiety and hyperactivity of the sympathetic nervous system (eg, tachycardia, increased respiratory rate and BP, diaphoresis, dilated pupils). Chronic pain does not involve sympathetic hyperactivity but may be associated with vegetative signs (eg, fatigue, loss of libido, loss of appetite) and depressed mood.

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Pain may be sharp or dull, intermittent or constant, or throbbing or steady. Sometimes pain is very difficult to describe. Pain may be felt at a single site or over a large area. The intensity of pain can vary from mild to intolerable.

People differ remarkably in their ability to tolerate pain. One person cannot tolerate the pain of a small cut or bruise, but another person can tolerate pain caused by a major accident or knife wound with little complaint. The ability to withstand pain varies according to mood, personality, and circumstances.

Prescription contains

NSAIDS:Paracetamol,diclofenac.aceclofenac.ibuprofen,ketoprofen,piroxicam,Naproxen,mefenamic acid,Aspirin,phenylbutazone,ketorolac.

Opioid analgesics:Morphine,Codeine,Hydromorphone,Thebaine.

Acute versus Chronic pain:

Pain may be acute or chronic. Acute pain begins suddenly and usually does not last long. Chronic pain lasts for weeks or months. Usually, pain is considered chronic if it does one of the following:

  • Lasts for more than 1 month longer than expected based on the illness or injury

  • Recurs off and on for months or years

  • Is associated with a chronic disorder (such as cancer, arthritis, diabetes, or fibromyalgia) or an injury that does not heal

When severe, acute pain may cause anxiety, a rapid heart rate, an increased breathing rate, elevated blood pressure, sweating, and dilated pupils. Usually, chronic pain does not have these effects, but it may result in other problems, such as depression, disturbed sleep, decreased energy, a poor appetite, weight loss, decreased sex drive, and loss of interest in activities.

During treatment for chronic pain, many people experience a brief, often severe flare-up of pain. It is called breakthrough pain because it breaks through in spite of regularly scheduled pain treatment. Typically, breakthrough pain begins suddenly, lasts up to 1 hour, and feels much like the original chronic pain except it is more severe. Breakthrough pain may differ from person to person and is often unpredictable.

Chronic pain can make the nervous system more sensitive to pain. For example, chronic pain repeatedly stimulates the nerve fibers and cells that detect, send, and receive pain signals. Repeated stimulation can change the structure of nerve fibers and cells or make them more active and can thus increase pain transmission to the spinal cord and brain. As a result, pain may result from stimulation that might not ordinarily be painful, or painful stimuli may be felt as more severe.

When pain occurs repeatedly, people may anticipate it by becoming fearful and anxious. These emotions can stimulate the body to produce substances that make pain feel more intense. An example is prostaglandins, which make nerve cells more likely to respond to pain signals. Fear and anxiety can also reduce the production of substances that reduce the sensitivity of nerve cells to pain. An example is endorphins, the body’s natural pain relievers. Fatigue can have the same effects on pain as fear and anxiety.

Counselling on side effects:

NSAIDS:

GI Adverse effects:Dyspepsia, Ulceration,Bleeding mostly occur in elderly patients,patients with history of ulcers or chronic disease and in smokers.

To minimise gi effects lowest possible  analgesic dose should be used.Aspirin available as enteric-coated product minimise adverse events.

Aspirin should be monitored when given with anticoagulants for risk of bleeding.

Opioids:

Dependence, Constipation, Nausea and vomiting, Sedation.

Next articlePathophysiology of Hypertension
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