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Acute pain management

Overview

Acute pain is a sudden onset of pain that serves as a warning signal to the body regarding injury, illness, or another problem requiring attention. It typically lasts less than six months and resolves once the underlying cause is treated. Acute pain management is crucial for promoting comfort, enhancing recovery, and preventing complications for patients suffering from acute pain. While it offers numerous benefits, it is essential to tailor techniques to the individual’s condition and carefully manage associated risks. Multimodal approaches, combining pharmacological and non-pharmacological strategies, are often the most effective and safest for managing acute pain. Multimodal approaches, combining pharmacological and non-pharmacological strategies, are often the most effective and safest for managing acute pain.

  • Improved patient comfort:
    • Reduces physical distress and enhances overall well-being.
    • Allows patients to engage more comfortably in daily activities or rehabilitation.
  • Enhanced healing and recovery:
    • Alleviates pain that might otherwise impair mobility or cause muscle tension.
    • Promotes faster recovery by reducing stress on the body.
  • Prevention of chronic pain: Properly managed acute pain reduces the risk of developing chronic pain syndromes, such as post-surgical pain or nerve sensitisation.
  • Reduced physiological stress: Mitigates the body’s stress response (e.g., high blood pressure, increased heart rate), minimising complications like cardiac strain or respiratory issues.
  • Improved mobility: Effective pain control supports early mobilisation, especially after surgeries or injuries, preventing complications like deep vein thrombosis or muscle atrophy.
  • Better outcomes in surgery and recovery: Patients with well-managed pain post-surgery are more likely to adhere to physiotherapy and achieve optimal recovery.

  • Pharmacological methods:
    • Analgesics (pain killers): Over-the-counter pain relief medications (e.g., paracetamol) and non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, aspirin) for general pain, and prescription drugs (stronger opioids; e.g., morphine, fentanyl) for severe pain.
    • Local anaesthetics: Lidocaine or bupivacaine, delivered as injections or as topical creams (to be applied on the skin) to block pain signals.
    • Adjunctive medications: Steroids, anticonvulsants, or antidepressants to enhance pain relief in specific cases.
    • Regional anaesthesia:
      1. Nerve blocks: Targeted injections near specific nerves (e.g., intercostal or sciatic blocks) to block pain sensation.
      2. Epidural/spinal anaesthesia: Used in surgeries or childbirth to block pain in larger regions of the body.
  • Non-pharmacological methods:
    • Physical therapy: Techniques like massage, stretching, or exercise to relieve pain and improve mobility.
    • Cold or heat therapy: For inflammation or muscle spasms.
    • Acupuncture: Stimulating pressure points to reduce pain perception.
    • Cognitive-behavioural therapy (CBT): Psychological techniques to manage pain perception.
  • Advanced interventions:
    • Patient-controlled analgesia (PCA): A pump allows patients to self-administer a controlled amount of pain medication.
    • Intravenous (IV) therapy: For immediate and sustained pain relief, often in a hospital setting.
    • Multimodal analgesia: Combines different drug classes and techniques to target multiple pain pathways, enhancing efficacy while minimising side effects.

  • Medication-related risks:
    • Opioids: Risks of dependency, respiratory depression, and constipation.
    • NSAIDs: Prolonged use can cause gastrointestinal irritation, ulcers, or kidney damage.
  • Allergic reactions: Hypersensitivity to medications, such as anaphylaxis.
  • Regional anaesthesia risks:
    • Nerve Injury: Rare but possible during nerve block procedures.
    • Infection(s) or hematoma: Complications associated with needle insertion in spinal or epidural anaesthesia.
    • Cardiovascular effects: Hypotension (low blood pressure) can be caused due to sympathetic blockade.
  • Psychological and behavioural risks:
    • Inadequate pain relief: Failure to address the pain adequately may lead to frustration or mistrust in medical providers.
    • Fear of dependence: Anxiety about becoming reliant on pain medications.
  • Procedural risks:
    • Misplacement of injection: Misguided injections can lead to nerve damage, paralysis (rare), or ineffective pain control.
    • Overmedication: Excessive doses may result in toxicity or systemic complications.
  • Non-pharmacological risks:
    • Cold or heat therapy: Improper application may cause skin burns or frostbite.
    • Physical therapy: Overzealous exercise can aggravate pain or delay healing.
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