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).

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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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