Pain Management at Our Jersey City Clinic
- Anti-Inflammatory
- Pain - Treatment & Management
- Analgesic
- Anti-pasmodic
Pain and Disability Due to Pain Parse
Pain is dynamic. Without treatment, sensory input from injured tissue reaches spinal cord neurons and causes subsequent responses to be enhanced. Pain receptors in the periphery also become more sensitive after injury.
Aggressive pain prevention and control that occurs before, during, and after surgery can yield both short- and long-term benefits
Organization of Guidelines
To derive maximum benefit, clinicians should read the entire guideline. However, the guideline is organized so that users can go easily to those sections of immediate interest. Following a discussion of why clinicians should take an aggressive approach to prevention and control of postoperative pain, methods of pain assessment are described. Pharmacologic and nonpharmacologic methods of pain control are then presented for general control of postoperative pain, followed by discussion of pain control for specific operative sites and for specific types of patients. The final section discusses institutional responsibility for effective pain management. The appendixes contain a brief description of the methods used for scientific review and a table of scientific evidence for pain intervention, pain assessment tools, drug dosage tables for adults and children, and relaxation exercises.
Process of Pain Assessment & Reassessment
Pain is a complex, subjective response with several quantifiable features, including intensity, time course, quality, impact, and personal meaning. The reporting of pain is a social transaction between caregiver and patient.
- Pain management requires a successful assessment and control
- A positive relationship needs to be established between patients, health care providers and families.
- Post operative pain services and pre-operative history and work-up
- Patients' attitude towards drug is important in pain management as well.
- Family expectations
- Way the patient demonstrates pain
- Patient's coping mechanisms.
- Patient's knowledge and expectations and choices.
A single most reliable indicator of the existance and intensity of acute pain - and any resultant affective disconfort or distress - is the patient's self-report.
Samples of commonly used pain assessment tools are in appendix D. Three common self-report measurement tools useful for assessment of pain intensity and affective distress in adults and many children are: 1) a numerical rating scale (NRS); 2) a visual analog scale (VAS); and 3) an adjective rating scale (ARS). While many researchers prefer visual analog measures (Scott and Huskisson, 1976; Sriwatanakul, Kelvie, Lasagna, Calimlim, Weis, and Mehta, 1983), each of these tools can be a valid and reliable instrument as long as end points and adjective descriptors are carefully selected (Gracely and Wolskee, 1983; Houde, 1982; Sriwatanakul, Kelvie, and Lasagna, 1982).
In practical use, the visual analog scale is always presented graphically, usually with a 10-cm baseline and endpoint adjective descriptors. Patients place a mark on the line at a point that best represents their pain. The visual analog scale is scored by measuring the distance of a patient's mark from the zero. The numerical and adjective rating scales may be presented graphically (see appendix D) or in other formats.
In summary, health care providers should view good pain control as a source of pride and a major responsibility in quality care.
Process of Effective Pain Management
Postoperative pain management.
As illustrated in the flow chart (Figure 2), the process of postoperative pain management is ongoing. Following intraoperative anesthesia and analgesia, postoperative pain assessment and management begin. Based on the preoperative plan, postoperative drug and nondrug interventions are initiated. Patients should be reassessed at frequent intervals (not less than every 2-4 hours for the first 24 hours) to determine the efficacy of the intervention in reducing pain. If the intervention is ineffective, additional causes of pain should be considered, the plan should then be reevaluated, and appropriate modifications should be made. Pharmacologic interventions should be titrated to achieve optimal pain control with minimal adverse effects. Ongoing reassessment ensures satisfactory pain relief with the most appropriate balance of drug and nondrug strategies.
Discharge planning.
Inpatients, as well as ambulatory surgical patients, should be given a written pain management plan at discharge. Pertinent discharge instructions related to pain management include: specific drugs to be taken; frequency of drug administration; potential side effects of the medication; potential drug interactions; specific precautions to follow when taking the medication (e.g., physical activity limitations, dietary restrictions); and name of the person to notify about pain problems and other postoperative concerns.
Site-Specific Pain Control
Even for a single operation, there may be great variability in the approach to postoperative pain management based on patient factors such as age, weight, ability to understand and cooperate with plans for care, coexisting medical and psychological problems, and idiosyncratic sensitivity to analgesics; intraoperative course, such as size and location of incisions or drain placement or anesthetic management; and institutional resources available for specialized treatment and monitoring in the particular setting.
Despite these variable factors, the clinician can still outline certain pain management options to present to an adult patient whose management is otherwise uncomplicated. Many aspects of pain control are shared between operations on different parts of the body. For practical reference, pain management options for various surgical procedures are presented according to region of the body rather than by the pathophysiological mechanisms involved. In all cases, however, preoperative psychological preparation and medication should be considered, and ongoing postoperative assessment and reassessment of pain should be routine. In this way, pain can be controlled effectively. Vigilance for changes in postoperative pain will trigger prompt searches for diagnostically significant causes of new pain.
