Pain Diagnosis - A Brief Guide

Pain Diagnosis Treatment Mild and Acute Chronic Healthhyme

Pain is the most common symptom of disease. It is an unpleasant sensation localized to a part of the body. It is often described in terms of a penetrating or tissue-destructive process (e.g., stabbing, burning, twisting, tearing, squeezing) and/or of a bodily or emotional reaction (e.g., terrifying, nauseating, sickening).

Any pain of moderate or higher intensity is accompanied by anxiety and the urge to escape or terminate the feeling.

Diagnosis

Self-report is the key to pain assessment. In non- or pre verbal children, facial expression is the most valid indicator of pain; therefore use faces pain scale to assess severity. Pain should be assessed by:

Duration
Severity, e.g. does the patient wake up because of the pain
Site
Character, e.g. stabbing, throbbing, crushing, cramp like
Persistent or intermittent
Relieving or aggravating factors
Accompanying symptoms
Distribution of pain
In children pain can be assessed by childs’ crying voice, posture, movement and colour.

Treatment for Acute and Mild pain

Aspirin, Paracetamol, and Non -steroidal Anti-Inflammatory Agents (NSAIDs); these drugs are considered together because they are used for similar problems and may have a similar mechanism of action.

Adult

A: Acetylsalicylic acid 600mg every 4 hours until pain subsides, OR,
A: Paracetamol 500- 100mg every 6-8 hours until pain subsides.

Children

A: Paracetamol 15 mg/kg/dose 4–6 hourly when required to a maximum of 4 doses per 24 hours;

Treatment for Severe Pain

Opioids are the most potent pain-relieving drugs currently available.They have the broadest range of efficacy, providing the most reliable and effective method for rapid pain relief.

Adults

C: Tramadol tablets or injection 50-100mg every 6 hours or until pain is controlled, OR,
C: Morphine 10mg IV every 6 hours on a “when necessary” basis;

Children

0.2mg/kg body weight IV every 6 hours.

For sugery and obstetric conditions

C: Pethidine 100mg IM/ IV every 6 hours when necessary.

Do not administer morphine in:

advanced liver disease
severe head injury
acute asthma
advanced chronic obstructive bronchitis, emphysema or other
respiratory disease with imminent respiratory failure
untreated hypothyroidism

Use morphine with extreme care if there is:

Recent or concurrent alcohol intake or other CNS depressants
Hypovolaemia or shock
In the elderly

Referral

Refer to Regional and Tertiary care for:

All children with moderate and acute severe pain
No response to oral pain control and unable to initiate opioids therapy
Uncertain diagnosis
Management of serious underlying conditions

Treatment for Chronic Non Cancer Pain

Chronic pain is a pain that persist for more than 4 weeks chronic pain can arise from:

Tissue damage (nociceptive pain), e.g. arthritis, fibromyalgia’s, lower back pain, pleurisy, cancer pain etc
Injury to nerves (neuropathic pain) e.g. post herpetic neuralgia (pain following shingles), trigeminal neuralgia, diabetic neuropathy, HIV related peripheral neuropathy, drug induced peripheral neuropathy or phantom limb
Abnormal nerve activity following disease

Psychological evaluation and behaviorally based treatment paradigms are frequently helpful, particularly in the setting of a multidisciplinary pain-management center.

Drug Treatment

Mild Pain

Adult: A: Paracetamol 1000 mg (O) 6 hourly until pain subsides

Moderate pain (Including neuropathy)

Adults: If still no relief to simple analgesics as above, add
- C: Tramadol 50 mg (O) 4–6 hourly as a starting dose (May be increased to a maximum of 400 mg daily)

Adjuvant therapy

Adults: In addition to analgesia as above add antidepressants;
- C: Amitriptyline 25 mg (O) at night; Maximum dose: 75mg.

Anticonvulsants and Antiarrhythmics may also be helpful in neuropathic pain. Give Phenytoin or carbamazepine.

Referral

Pain requiring strong opioids
Pain requiring definitive treatment for the underlying disease
All children

Chronic Cancer Pain

The long-term use of opioids is accepted for patients with pain due to malignant disease. Some degree of tolerance and physical dependence are likely with long-term use.

Therefore, before embarking on opioid therapy, other options should be explored, and the limitations and risks of opioids should be explained to the patient.

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