logging in or signing up basil ppt pain basil05 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 136 Category: Science & Tech.. License: All Rights Reserved Like it (2) Dislike it (0) Added: August 31, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: basil05 (21 month(s) ago) send me your email and ill send you a copy, heres my email add dokbasilmd@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Slide 1: Aray................. Aray !!!!! Ang Sakit Sakit …….!!!!!!! Pain Management : Pain Management What is it? Emilio Rommel A. Basilio, MD Anesthesiologist and Pain Management Pain… : Pain… What is the real definition of pain? And what is pain management?? How can this information help me??? Pain : Pain Definitions: An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is whatever the experiencing person says it is. May not be directly proportional to amount of tissue injury. Highly subjective, leading to under treatment Pain… : Pain… Amplifies the body’s stress response to traumatic injury Causes endocrine and metabolic abnormalities Impedes a patient’s recovery from trauma and surgery Did you know… : Did you know… Pain is the most common reason individuals seek medical attention but only 1 in 4 receive proper treatment for their pain. Unrelieved pain has adverse physical and psychological effects (APS, 1999) Over 75 million Filipino suffer with pain each year Types of Pain : Types of Pain Acute: Relatively brief, pain that subsides as healing takes place. Characterized by: defined onset, self-limiting, tells you something is wrong, serves a purpose. Chronic: Can persist for months, serves no purpose, no change in vital signs Malignant (cancer) Non-malignant (non-cancer) Combination: Chronic with acute exacerbations Pain Language : Pain Language Subacute pain – from the end of the first month to the beginning of the seventh month of continued pain Recurrent acute pain – persists over an extended period of time but occurs mainly as isolated episodes Acute pain Chronic pain : Acute pain Chronic pain a protective purpose warns of danger injured/diseased body part signals the departure of pathology when the limiting condition resolves little protective significance persists despite normalization after injury/disease ultimately interferes with productive activity Major Categories of pain : Major Categories of pain 1. Nociceptive Pain: Results from ongoing activation of primary afferent neurons by noxious stimuli (intact nervous system) Somatic: Arises from bone, joint, muscle, skin or connective tissue: normally opioid sensitive Slide 20: Visceral: Arises from visceral organs, such as GI tract or pancreas. normally opioid sensitive Slide 21: 2. Neuropathic: Abnormal processing of sensory input by peripheral or central nervous system (lesion or dysfunction). - Abnormally process by the Nervous System Proposed mechanism: peripheral nervous system damaged in some way. Relatively opioid resistant. Treatment should include adjuvant analgesics. Slide 22: May be caused by injury (amputation and subsequent phantom limb pain), scar tissue from surgery (back surgery high risk), nerve entrapment (carpal tunnel), or damaged nerves (diabetic neuropathy) Unclear why depolarization and transmission of pain impulse are spontaneous and repetitive Slide 23: Herpes Zoster Infections -Shingles -Neuralgia Anatomy and Physiology of Nociceptive Pain : Anatomy and Physiology of Nociceptive Pain 4 Basic Processes Transduction—nociceptors free nerve endings with the capacity to distinguish between noxious and innocuous stimuli. When exposed to mechanical (incision or tumor growth), thermal (burn), or chemical (toxic substance) stimuli, tissue damage occurs. Substances are released by the damaged tissue which facilitates the movement of pain impulse to the spinal cord. Substances released… : Substances released… The substances released from the traumatized tissue are: prostaglandins bradykinin serotonin substance P histamine Major Nerve Distributions : Major Nerve Distributions Slide 27: Non-steroidal anti-inflammatories, such as ibuprofen, are effective in minimizing pain because they minimize the effects of these substances released, especially prostaglandins. Corticosteroids, such as dexamethasone used for cancer pain, also interferes with the production of prostaglandins. Process #2—Transmission : Process #2—Transmission Impulse spinal cord brain stem thalamus central structures of brain pain is processed. Neurotransmitters are needed to continue the pain impulse from the spinal cord to the brain—opioids (narcotics) are effective analgesics because they block the release of neurotransmitters Process #3—Perception of Pain : Process #3—Perception of Pain The end result of the neural activity of pain transmission It is believed pain perception occurs in the cortical structures—behavioral strategies and therapy can be applied to reduce pain. Brain can accommodate a limited number of signals—distraction, imagery, relaxation signals may get through the gate, leaving limited signals (such as pain) to be transmitted to the higher structures. Process #4—Modulation of Pain : Process #4—Modulation of Pain Changing or inhibiting pain impulses in the descending tract (brain spinal cord) Descending fibers also release substances such as norepinephrine and serotonin (referred to as endogenous opioids or endorphins) which have the capability of inhibiting the transmission of noxious stimuli. Helps explain wide variations of pain among people. Cancer pain responds to antidepressants which interfere with the reuptake of serotonin and norepinephrine . : Why treat pain? Tissue damage has the potential to elicit mechanisms that can create disabling, refractory, chronic situations that may prolong and even outlast the period of healing. Hedderich & Ness, 1999 Harmful Effects : Harmful Effects Cardiovascular and respiratory systems are significantly affected by the pathophysiology of pain adrenergic stimulation hypercoagulation, leading to DIC heart rate cardiac output myocardial oxygen consumption Harmful Effects : Harmful Effects pulmonary vital capacity alveolar ventilation functional residual capacity arterial hypoxemia suppression of immune functions, predisposing trauma patients to wound infections and sepsis Slide 35: Pain can kill you Slide 36: PRINCIPLES OF ACUTE & CHRONIC PAIN MANAGEMENT Slide 37: ROLE OF ANESTHESIOLOGIST YOUR INITIAL PAIN CLINIC VISIT obtain general medical history medical conditions and diseases medications (including supplements, herbals, OTCs, habits) Allergies obtain history specific to your pain onset, location, radiation, quality response to previous treatments review of medical records perform a physical examination Slide 38: ROLE OF ANESTHESIOLOGIST YOUR INITIAL PAIN CLINIC VISIT order, review, and interpret lab tests and diagnostic studies refer for consultations diagnose your pain problem determine and discuss with you the optimal approach to managing your pain Slide 39: GOALS OF THERAPY Decrease the frequency and / or severity of the pain General sense of feeling better Increased level of activity Return to work Decreased health care utilization Elimination or reduction in medication usage Comfortable exit Slide 40: TREATMENT OF PAIN Physical therapy Counseling ( kind words, gentle touch, just being present Medications Nonsteroidal anti-inflammatory medications (NSAID), ( COX-2) Steroid medications Narcotic medications ( nalbuphine,fentanyl) Antidepressant and anticonvulsant medications Co-analgesic medications Nerve blocks Implantable devices Surgery Slide 41: Pain assessment tools Slide 42: WHO Analgesic Ladder Simple analgesia Weak opioid Potent opioid Interventional Neural Blockade Slide 43: Adjuvants anticonvulsants: gabapentin, carbamazepine, valproic acid, clonazepam, phenitoin, lamotrigine, pregabalin(lyrica) local anesthetics Corticosteroids Clonidine topical agents Antidepressants: amitriptyline, duloxetin(cymbalta) Slide 44: Neuro-Ablation Percutaneous chemical radio-frequency Cryoanalgesia Neurosurgical Providing timely and effective pain management to the injured patient can help strengthen the patient’s lines of resistance : Providing timely and effective pain management to the injured patient can help strengthen the patient’s lines of resistance Slide 50: If pain is allowed to be prolonged, the body’s attempt to regain steady state may exhaust the patient’s lines of resistance, leading to disruption of the patient’s core structure—death may result. Why have people continued to suffer? : Why have people continued to suffer? The study of pain is relatively new Lack of knowledge concerning harmful effects of unrelieved pain Personal biases Populations at high risk: Cognitively impaired Very young, very old Trauma, hemodynamically unstable Hindrance to Pain Management : Hindrance to Pain Management Historically, undertreated or untreated Not considered a priority Minimal knowledge base effective interventions by healthcare providers Fear of addiction Fear of misdiagnosis Fear of weakness “he can’t even talk, he’s not in pain” “what if we bottom out the B/P?” “it’s not that important right now, wait until surgery” : “he can’t even talk, he’s not in pain” “what if we bottom out the B/P?” “it’s not that important right now, wait until surgery” You—the patient : You—the patient Be knowledgeable Ask your physician/surgeon BEFORE your surgery If not satisfied, get second opinion Take pain seriously Take analgesics when you need them, don’t save them for later Avoid peaks and valleys Slide 55: Pain Management We all must die. But if I can save them from days of torture, that is what I feel is my great and ever new privilege. Slide 56: “Pain is a more terrible lord of mankind than death itself.” Albert Schweitzer We have the science, but are we making any progress? : We have the science, but are we making any progress? Slide 58: When the music changes, so must the dance…. African Proverb Slide 59: B e patient in listening to patients pain problems A sses the psychological status of the patient S everity of the pain problem I ndicate previously taken medications L et them know the drug efficacy and complications L et them know the goal of their therapy U nderstand the financial status V oice out your concern regarding compliance S implify drug dosing if possible U nconditional LOVE to our patients Slide 60: Salamat po!!! Gising na Tapos na Tayo!!! You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
basil ppt pain basil05 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 136 Category: Science & Tech.. License: All Rights Reserved Like it (2) Dislike it (0) Added: August 31, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: basil05 (21 month(s) ago) send me your email and ill send you a copy, heres my email add dokbasilmd@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Slide 1: Aray................. Aray !!!!! Ang Sakit Sakit …….!!!!!!! Pain Management : Pain Management What is it? Emilio Rommel A. Basilio, MD Anesthesiologist and Pain Management Pain… : Pain… What is the real definition of pain? And what is pain management?? How can this information help me??? Pain : Pain Definitions: An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is whatever the experiencing person says it is. May not be directly proportional to amount of tissue injury. Highly subjective, leading to under treatment Pain… : Pain… Amplifies the body’s stress response to traumatic injury Causes endocrine and metabolic abnormalities Impedes a patient’s recovery from trauma and surgery Did you know… : Did you know… Pain is the most common reason individuals seek medical attention but only 1 in 4 receive proper treatment for their pain. Unrelieved pain has adverse physical and psychological effects (APS, 1999) Over 75 million Filipino suffer with pain each year Types of Pain : Types of Pain Acute: Relatively brief, pain that subsides as healing takes place. Characterized by: defined onset, self-limiting, tells you something is wrong, serves a purpose. Chronic: Can persist for months, serves no purpose, no change in vital signs Malignant (cancer) Non-malignant (non-cancer) Combination: Chronic with acute exacerbations Pain Language : Pain Language Subacute pain – from the end of the first month to the beginning of the seventh month of continued pain Recurrent acute pain – persists over an extended period of time but occurs mainly as isolated episodes Acute pain Chronic pain : Acute pain Chronic pain a protective purpose warns of danger injured/diseased body part signals the departure of pathology when the limiting condition resolves little protective significance persists despite normalization after injury/disease ultimately interferes with productive activity Major Categories of pain : Major Categories of pain 1. Nociceptive Pain: Results from ongoing activation of primary afferent neurons by noxious stimuli (intact nervous system) Somatic: Arises from bone, joint, muscle, skin or connective tissue: normally opioid sensitive Slide 20: Visceral: Arises from visceral organs, such as GI tract or pancreas. normally opioid sensitive Slide 21: 2. Neuropathic: Abnormal processing of sensory input by peripheral or central nervous system (lesion or dysfunction). - Abnormally process by the Nervous System Proposed mechanism: peripheral nervous system damaged in some way. Relatively opioid resistant. Treatment should include adjuvant analgesics. Slide 22: May be caused by injury (amputation and subsequent phantom limb pain), scar tissue from surgery (back surgery high risk), nerve entrapment (carpal tunnel), or damaged nerves (diabetic neuropathy) Unclear why depolarization and transmission of pain impulse are spontaneous and repetitive Slide 23: Herpes Zoster Infections -Shingles -Neuralgia Anatomy and Physiology of Nociceptive Pain : Anatomy and Physiology of Nociceptive Pain 4 Basic Processes Transduction—nociceptors free nerve endings with the capacity to distinguish between noxious and innocuous stimuli. When exposed to mechanical (incision or tumor growth), thermal (burn), or chemical (toxic substance) stimuli, tissue damage occurs. Substances are released by the damaged tissue which facilitates the movement of pain impulse to the spinal cord. Substances released… : Substances released… The substances released from the traumatized tissue are: prostaglandins bradykinin serotonin substance P histamine Major Nerve Distributions : Major Nerve Distributions Slide 27: Non-steroidal anti-inflammatories, such as ibuprofen, are effective in minimizing pain because they minimize the effects of these substances released, especially prostaglandins. Corticosteroids, such as dexamethasone used for cancer pain, also interferes with the production of prostaglandins. Process #2—Transmission : Process #2—Transmission Impulse spinal cord brain stem thalamus central structures of brain pain is processed. Neurotransmitters are needed to continue the pain impulse from the spinal cord to the brain—opioids (narcotics) are effective analgesics because they block the release of neurotransmitters Process #3—Perception of Pain : Process #3—Perception of Pain The end result of the neural activity of pain transmission It is believed pain perception occurs in the cortical structures—behavioral strategies and therapy can be applied to reduce pain. Brain can accommodate a limited number of signals—distraction, imagery, relaxation signals may get through the gate, leaving limited signals (such as pain) to be transmitted to the higher structures. Process #4—Modulation of Pain : Process #4—Modulation of Pain Changing or inhibiting pain impulses in the descending tract (brain spinal cord) Descending fibers also release substances such as norepinephrine and serotonin (referred to as endogenous opioids or endorphins) which have the capability of inhibiting the transmission of noxious stimuli. Helps explain wide variations of pain among people. Cancer pain responds to antidepressants which interfere with the reuptake of serotonin and norepinephrine . : Why treat pain? Tissue damage has the potential to elicit mechanisms that can create disabling, refractory, chronic situations that may prolong and even outlast the period of healing. Hedderich & Ness, 1999 Harmful Effects : Harmful Effects Cardiovascular and respiratory systems are significantly affected by the pathophysiology of pain adrenergic stimulation hypercoagulation, leading to DIC heart rate cardiac output myocardial oxygen consumption Harmful Effects : Harmful Effects pulmonary vital capacity alveolar ventilation functional residual capacity arterial hypoxemia suppression of immune functions, predisposing trauma patients to wound infections and sepsis Slide 35: Pain can kill you Slide 36: PRINCIPLES OF ACUTE & CHRONIC PAIN MANAGEMENT Slide 37: ROLE OF ANESTHESIOLOGIST YOUR INITIAL PAIN CLINIC VISIT obtain general medical history medical conditions and diseases medications (including supplements, herbals, OTCs, habits) Allergies obtain history specific to your pain onset, location, radiation, quality response to previous treatments review of medical records perform a physical examination Slide 38: ROLE OF ANESTHESIOLOGIST YOUR INITIAL PAIN CLINIC VISIT order, review, and interpret lab tests and diagnostic studies refer for consultations diagnose your pain problem determine and discuss with you the optimal approach to managing your pain Slide 39: GOALS OF THERAPY Decrease the frequency and / or severity of the pain General sense of feeling better Increased level of activity Return to work Decreased health care utilization Elimination or reduction in medication usage Comfortable exit Slide 40: TREATMENT OF PAIN Physical therapy Counseling ( kind words, gentle touch, just being present Medications Nonsteroidal anti-inflammatory medications (NSAID), ( COX-2) Steroid medications Narcotic medications ( nalbuphine,fentanyl) Antidepressant and anticonvulsant medications Co-analgesic medications Nerve blocks Implantable devices Surgery Slide 41: Pain assessment tools Slide 42: WHO Analgesic Ladder Simple analgesia Weak opioid Potent opioid Interventional Neural Blockade Slide 43: Adjuvants anticonvulsants: gabapentin, carbamazepine, valproic acid, clonazepam, phenitoin, lamotrigine, pregabalin(lyrica) local anesthetics Corticosteroids Clonidine topical agents Antidepressants: amitriptyline, duloxetin(cymbalta) Slide 44: Neuro-Ablation Percutaneous chemical radio-frequency Cryoanalgesia Neurosurgical Providing timely and effective pain management to the injured patient can help strengthen the patient’s lines of resistance : Providing timely and effective pain management to the injured patient can help strengthen the patient’s lines of resistance Slide 50: If pain is allowed to be prolonged, the body’s attempt to regain steady state may exhaust the patient’s lines of resistance, leading to disruption of the patient’s core structure—death may result. Why have people continued to suffer? : Why have people continued to suffer? The study of pain is relatively new Lack of knowledge concerning harmful effects of unrelieved pain Personal biases Populations at high risk: Cognitively impaired Very young, very old Trauma, hemodynamically unstable Hindrance to Pain Management : Hindrance to Pain Management Historically, undertreated or untreated Not considered a priority Minimal knowledge base effective interventions by healthcare providers Fear of addiction Fear of misdiagnosis Fear of weakness “he can’t even talk, he’s not in pain” “what if we bottom out the B/P?” “it’s not that important right now, wait until surgery” : “he can’t even talk, he’s not in pain” “what if we bottom out the B/P?” “it’s not that important right now, wait until surgery” You—the patient : You—the patient Be knowledgeable Ask your physician/surgeon BEFORE your surgery If not satisfied, get second opinion Take pain seriously Take analgesics when you need them, don’t save them for later Avoid peaks and valleys Slide 55: Pain Management We all must die. But if I can save them from days of torture, that is what I feel is my great and ever new privilege. Slide 56: “Pain is a more terrible lord of mankind than death itself.” Albert Schweitzer We have the science, but are we making any progress? : We have the science, but are we making any progress? Slide 58: When the music changes, so must the dance…. African Proverb Slide 59: B e patient in listening to patients pain problems A sses the psychological status of the patient S everity of the pain problem I ndicate previously taken medications L et them know the drug efficacy and complications L et them know the goal of their therapy U nderstand the financial status V oice out your concern regarding compliance S implify drug dosing if possible U nconditional LOVE to our patients Slide 60: Salamat po!!! Gising na Tapos na Tayo!!!