Pain management

Learning objectives

At the end of the workshop you will be able to:

Consider the important principles of pain and pain

management
Use validated tools to assist in assessing patients pain
Outline strategies to manage pain with your patients
Discuss pain medicines with your patients
 What is pain?
A message to the brain, pain is a
whole body experience and involves
both the mind and the body
Usually a protective mechanism to
warn us to be more careful of our
bodies

It hurts and may cause suffering or

distress
Different for different people: it is
whatever the person says hurts
 Types of pain

Acute pain can be important for the body to tell the brain that there is
something wrong and help to avoid harm.

Chronic pain is pain that goes on for a long time. It needs regular
assessment and a different approach to treatment.
 Chronic pain impacts on the whole person and
their community
Ask your patients about any
changes that have
happened in their lives since
their ongoing pain started.

For example:
How are you sleeping?
Are you feeling worried or sad?
Are you still visiting friends or
relatives?
Are you eating well?
 Things to talk about:
How pain is affecting their life
Where the pain is, how bad the pain is
How long they have had the pain
What medicines they are taking for the pain
(and any other conditions)
How the pain has affected them and their
family
If they have any other problems or worries
Make sure people understand that it may not
be possible to be pain-free at all times
Anticipation of pain
 How do we assess pain
Ask the patient:

To describe their pain

Rate their pain (use the faces scale based on

how they perform everyday activities)

What made the pain worse or better

Observe the persons body language (how freely
do they move).
Talk with the person about how they feel, and
how it affects their everyday life
Talk with their family when appropriate
REMINDER:
Use the same pain assessment
tool to keep a detailed record of
the patients pain changes in the
clinic notes.

Make sure people understand that it may not

be possible to be pain-free at all times
 Managing chronic pain
Treatment goals:

To improve the level of activity

To modify thoughts about pain
and suffering
To promote self-management
To relieve pain to a tolerable level
 Managing chronic pain
Tips on helping people to exercise

Educate patients that there is a

difference between hurt and harm
when you have chronic pain. Avoiding
physical activity can make their pain
seem worse over time.

Encourage patients to talk to their

family and friends and not isolate
themselves. Also get a family member
or friend involved as their exercise
buddy.

You may wish to suggest some

exercises to try e.g. walking,
swimming, gentle stretching
exercises. Remember to start slow
with exercise as they may feel some
discomfort initially, especially if they
have been inactive for a long time.
 Medicines

Key points:

Use a step-wise approach to

introduce pain medicines
(analgesics)

Prescribe regular doses of

analgesics

Plan a trial period with clear and

specific instructions

Review the effects on regular basis

eg may need more frequent review
for new medicines or when dose
changes
Analgesics Non-opioid analgesics

AMH 2010, CARPA 5th edition

Nonsteroidal anti-inflammatory drugs
(NSAID)
Generic
names
Diclofenac Indomethacin Ketoprofen
and how Ketorolac Mefenamic acid Naproxen
given Piroxicam Tiaprofenic acid

Cox-2 Inhibitors: Celecoxib Meloxicam

Other Parecoxib

NSAIDS

What it Mild to moderate pain and fever

Reduces swelling and inflammation in
is used arthritis , period pain, sprains and injuries or
attacks of gout
for Renal colic
Suppositories are used when the patient is
vomiting .They can still cause stomach pain
when used for long period s
Gels can be used as a rubbing medicine
Can be used with other medicines

Prostaglandins in the body cause redness,

How it swelling and pain at the site of injury. NSAIDs
works stop the body making prostaglandins

Adverse
effects
AMH 2010, CARPA 5th edition
 Short-acting and long-acting opioids
Short-acting opioids Long-acting opioids
codeine Modifies release
tramadol
Methadone
Tramadol
Modified-release
hydromorphone
hydromorphone
Immediate-release
Modified-release
morphine
morphine
Immediate-release
Modified-release
oxycodone
oxycodone
Immediate-release
Transdermal
tramadol
buprenorphine
 Opioid analgesics Combination analgesics
Generic PARACETAMOL +
names Codeine 30 mg
and (Panadeine Forte , Codalgin
Forte )
how
given
What it Moderate to strong pain relief
Can be used in combination with other pain
is used relief medicines

for
How it Two different medicines work
together (but in different ways)
works in the brain and nerve ending
to reduce pain
Drink lots of water to prevent
constipation
Adverse Laxatives may be needed
effects
Return to the clinic if need to
Use for more than a short time

If you take more than 8 tab lets a

day containing paracetamol you can
damage your liver (make sure there
is no paracetamol in your other
medicines)
Opioid analgesics - Morphine

AMH 2010, CARPA 5th edition

Opioid analgesics - Tramadol

Generic TRAMADOL
names
and how
given

What it is Moderate to severe

Drug interactions (do not take
used for pain
with) Warfarin SSRI Venlafaxine
Slow release
Carbamazepine St Johns Wort
formulations are
used for chronic pain
How it works

Adverse
effects

AMH 2010, CARPA 5th edition

 Take home messages
When you see a person who has pain:

Perform a thorough history and physical examination to

determine if referral is necessary

Discuss options for managing pain with the person

Recommend medicine only as part of an agreed pain

management plan
 Resources
Australian Pain Management Associations Pain Link Helpline (1300 340 357)

Australias National Phone Information and Support line

(1800 218 921) Provide support for patients, their carers and health professionals.

Chronic pain Australia www.chronicpainaustralia.org

Your name
Contact details