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Pain management


Pain management, pain medicine, pain control or algiatry, is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain The typical pain management team includes medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician assistants, nurse practitioners, and clinical nurse specialists. The team may also include other mental health specialists and massage therapists. Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of chronic (long-term) pain, however, frequently requires the coordinated efforts of the management team.

Medicine treats injury and pathology to support and speed healing; and treats distressing symptoms such as pain to relieve suffering during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the task of medicine is to relieve suffering. Treatment approaches to chronic pain include pharmacological measures, such as analgesics, antidepressants and anticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy.


Common types of pain and typical drug management
Pain type typical initial drug treatment comments
headache paracetamol [1]/acetaminophen, NSAIDs doctor consultation is appropriate if headaches are severe, persistent, accompanied by fever, vomiting, or speech or balance problems; self-medication should be limited to two weeks
migraine paracetamol, NSAIDs triptans are used when the others do not work, or when migraines are frequent or severe
menstrual cramps NSAIDs some NSAIDs are marketed for cramps, but any NSAID would work
minor trauma, such as a bruise, abrasions, sprain paracetamol, NSAIDs opioids not recommended
severe trauma, such as a wound, burn, bone fracture, or severe sprain opioids more than two weeks of pain requiring opioid treatment is unusual
strain or pulled muscle NSAIDs, muscle relaxants if inflammation is involved, NSAIDs may work better; short-term use only
minor pain after surgery paracetamol, NSAIDs opioids rarely needed
severe pain after surgery opioids combinations of opioids may be prescribed if pain is severe
muscle ache paracetamol, NSAIDs if inflammation involved, NSAIDs may work better.
toothache or pain from dental procedures paracetamol, NSAIDs this should be short term use; opioids may be necessary for severe pain
kidney stone pain paracetamol, NSAIDs, opioids opioids usually needed if pain is severe.
pain due to heartburn or gastroesophageal reflux disease antacid, H2 antagonist, proton-pump inhibitor heartburn lasting more than a week requires medical attention; aspirin and NSAIDs should be avoided
chronic back pain paracetamol, NSAIDs opioids may be necessary if other drugs do not control pain and pain is persistent
osteoarthritis pain paracetamol, NSAIDs medical attention is recommended if pain persists.
fibromyalgia antidepressant, anticonvulsant evidence suggests that opioids are not effective in treating fibromyalgia

Assessment
Nonpharmacologic
Pharmacologic
  • How intense is the pain?
  • How does the pain feel?
  • Where is the pain?
  • What, if anything, makes the pain lessen?
  • When did the pain start?
  • OxyContin (oxycodone)
  • Hydromorph Contin (hydromorphone)
  • MS Contin (morphine)
  • M-Eslon (morphine)
  • Exalgo (hydromorphone)
  • Opana ER (oxymorphone)
  • Duragesic (fentanyl)
  • Nucynta ER (tapentadol)
  • Metadol/Methadose (methadone)*
  • Hysingla ER (hydrocodone bitartrate)
  • Zohydro ER (hydrocodone bicarbonate)
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Wikipedia

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