Articles: pain-management-methods.
-
Clin. Pharmacol. Ther. · Feb 2012
Rational opioid dosing in the elderly: dose and dosing interval when initiating opioid therapy.
Opioids are the mainstay of treatment for moderate to severe pain. However, opioid therapy in the elderly is often associated with significant morbidity because of excessive ventilatory depression. The large amount of interindividual variability in opioid dose-response relationships makes it difficult to individualize the dose and dosing interval to provide safe and effective analgesia. By examining how aging affects the pharmacokinetics (PK) and pharmacodynamics (PD) of opioids, it is possible to provide a rational basis for age adjustment in opioid dosing.
-
Paediatric anaesthesia · Feb 2012
Case ReportsIntrathecal infusion of bupivacaine and clonidine provides effective analgesia in a terminally ill child.
The intrathecal infusion of drugs to provide analgesia for terminally ill children with refractory pain is a rarely utilized but very effective technique. A number of pharmacological agents, most commonly opioids and local anesthetics, have been administered intrathecally for this purpose. ⋯ The alpha-2 agonist clonidine is commonly used to augment local anesthetic techniques for postsurgical pain in children and for the management of refractory cancer pain in adults, but there is only a single report of the use of clonidine intrathecally in a terminally ill child. We present the case of the youngest reported child to have received intrathecal analgesia for terminal care: a 3-year-old boy with advanced pelvic rhabdomyosarcoma, whose refractory pain was managed effectively with an intrathecal infusion of bupivacaine and preservative-free clonidine.
-
Despite the availability of effective pain treatments, there are numerous barriers to effective management resulting in a large proportion of patients not achieving optimal pain control. Chronic pain is inadequately treated because of a combination of cultural, societal, educational, political and religious constraints. The consequences of inadequately treated pain are physiological and psychological effects on the patient, as well as socioeconomic implications. ⋯ A better awareness and insight into the problems caused by unrelieved pain and greater knowledge about the efficacy and tolerability of available pain management options should enable physicians to seek out and adhere to treatment guidelines, and participate in interventional and educational programmes designed to improve pain management, and for institutions to implement the initiatives required. Although much work is underway to identify and resolve the issues in pain management, many patients still receive inadequate treatment. Continued effort is required to overcome the known barriers to effective pain management.
-
Review
Adverse effects associated with non-opioid and opioid treatment in patients with chronic pain.
Chronic pain is a debilitating condition that is associated with many common diseases; this places a major burden on the healthcare system. There are currently numerous analgesic agents available for the treatment of chronic pain. In general, the oral non-opioid analgesic, paracetamol, is recommended for the initial treatment of mild to moderate pain. ⋯ However, treatment with opioids is associated with a number of common adverse effects, including constipation, nausea or vomiting, pruritus, somnolence or cognitive impairment, dry mouth, tolerance or dependence and urinary retention. Although there are multiple strategies in place to manage adverse events that arise from both non-opioid and opioid analgesic therapy, a better understanding of the mechanisms involved in the development of specific drug-related adverse effects is required along with proper prescribing practices and adequate physician/patient education. Balanced against the adverse effects of pain management medications, there is a need to be mindful of the widespread, often serious, adverse consequences of poorly managed pain itself.
-
In the postoperative pain setting, the use of opioid analgesics remains essential in achieving effective analgesia and in avoiding the deleterious sequelae of uncontrolled pain that can worsen patient outcomes. However, postoperative pain remains undertreated in many patients. Choosing the most appropriate use of opioids in the postoperative setting, especially for patients undergoing ongoing opioid treatment for chronic pain, can pose daunting challenges for many clinicians. In this article, we examine the pitfalls that may be encountered when implementing postoperative pain management strategies with opioid analgesics, especially in patients receiving chronic opioid therapy prior to admission, and the critical steps for appropriate and effective analgesia in this setting.