Pain Management: Basic Principles...Page 1...( easier to read )

From: Helen Dynda (olddad66@runestone.net)
Sun Jul 23 14:54:24 2000


Pain Management: Basic Principles

INTRODUCTION

As specialists in the area of pain control, anesthesiologists are frequently consulted to lend assistance with pain management. Pain specialists often get involved in continuing care of extremely complicated situations that require multiple specialists to work together to effectively treat a patient's pain. Other times, pain specialists are needed to treat patients that require some type of invasive treatment such as a nerve block, etc.

There are, however, many cases in which the patient may not need ongoing care by a pain specialist and can be treated by following some simple guidelines. How do we recognize the differences? How do we start to evaluate and treat pain?

Here is an overview of some of the issues involved with pain management - how to define, assess, and diagnose pain... as well as some simple principles involved in treatment. These more basic modalities are appropriately utilized first - before sending the patient on to additional specialty care.

BASIC DEFINITION OF PAIN

Pain can be defined in basic terms as:

a.) an unpleasant sensory event

b.) and an unpleasant emotional or psychological experience

c.) associated with or indicating actual or potential damage to tissue

It is important to realize that this definition clearly states that pain is more than just a physiological event - it is an emotional and psychological one as well. In addition, the practitioner should recognize that tissue injury may have already occurred and may not be ongoing - but pain may still exist. Also note that the definition leaves room for a psychological cause or component to the pain.

NORMAL PAIN SIGNALS AND PATHWAY

Normally pain is caused by a stimulus that activates free nerve endings. (This stimulus is known as "noxious" and the nerve endings are termed "nociceptors".)

These signals are then transmitted from the nerve endings in the body to the spinal cord (via what are known as A-delta and C fibers) and then to the brain (via the spinothalamic tract and the spinohypothalamic tract).

In the brain, the signals reach parts of the brain called the thalamus and the cortex.

The brain, in turn, sends signals downwards to the spinal cord to modulate or control the way these pain signals are transmitted upwards (this is done in an area called the dorsal horn). In a way, the brain controls how and how much signal it ultimately receives.

This is only a simplistic explanation. For those of you that want more details, take a look at these offsite links to a picture of the pathway and this excellent article on the anatomy of pain.

NEUROPATHIC PAIN

In neuropathic pain, the pain signals do not follow this normal course. Instead, the signals originate at different areas of the pathway (instead of at the free nerve endings mentioned above) and cause the sensation of pain. Sometimes what begins as a "normal" pain pathway can become an abnormal one - and different types of medications are often utilized in an attempt to stop this abnormal transmission of pain.

Among the types of medications that have actions on the nerves and pathways involved in neuropathic pain are:

a.) Topical local anesthetics

b.) Other topical agents such as Capsaicin

c.) Opioid medications

d.) Anticonvulsant agents

e.) Antidepressants

... and these medications are often used in different combinations for treating these pain syndromes.

Often it is neuropathic pain that lasts a period of time where psychological and emotional factors begin to play an important role. Patients that have moved beyond simple pain to a neuropathic pain state may require more intense treatment by multiple specialists that includes psychological and emotional considerations.

The above article is found at the following Url. You will have to enter this Url on the address-line of your computer monitor...if the entire Url is not highlighted.

http://anesthesiology.about.com/health/anesthesiology/library/weekly/aa071100a.htm


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