PAIN: A Prelude
Section snippets
A RETROSPECTIVE OF PAIN ASSESSMENT AND TREATMENT
Physicians' deficiency in pain assessment skills and apprehension of inducing overdose with the use of narcotics have been fairly well documented. In 1979 a survey of 100 patients admitted and treated in the intensive care unit revealed that 32 of these patients ranked pain as their greatest “worry.”9 Sixty-six of these patients stated that pain was a factor in both preventing and disturbing their sleep. In 1996, the study to understand prognoses and preferences for outcomes and risks of
Psychophysiology
Factors influencing pain in a particular patient tend to be multifactorial in origin. Elements that are most instrumental include a triad of psychology, physiology, and sociology.24 Two levels of pain threshold are generally described, low and high. The low pain threshold refers to the moment of a response to a painful stimulus. Upper pain thresholds are attained when absolute tolerance to the painful stimulus is achieved. These thresholds can be manipulated with the use of various
ANALGESIC INFLUENCES ON THE STRESS RESPONSE
Evidence has accrued demonstrating attenuation of the numerous physiologic alterations brought about by the stress response. As previously stated, while not problematic in some patients, a stress response may be of concern if exaggerated (e.g., a critical injury) or experienced by a patient with comorbid illness. Therefore, modifying the response may be appropriate. An abundance of literature supports the use of neural blockade of varied types to modify neuroendocrine responses, specifically in
OUTCOMES AND ANALGESIA
Attention to the administration of analgesics is a quintessential component of any comprehensive patient care plan. However, patients can be plagued by an abundance of undesired complications from the physiologic perturbations that occur during the stress of surgery. Therefore, a question of considerable relevance that must be examined is the effect of analgesia via neural blockade on clinical outcome (i.e., on pulmonary complications, duration of ICU stay, or mortality). The preponderance of
SUMMARY
Although pain is a common fear to most, our overall ability to recognize pain, and assess and intervene with appropriate therapies is mediocre at best. However, if made a priority, substantial gains can be made in improving patient satisfaction with pain control and in rectifying deficits in the knowledge of health-care professionals. This goal is not easily obtained and generally requires time, patience, and a multidisciplinary team approach.
Pain can induce numerous metabolic and
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2004, Veterinary Anaesthesia and AnalgesiaCitation Excerpt :The priming of pain pathways results in greater pain perception post-operatively, with a need for higher and more frequent doses of analgesics. In addition, neuronal events, producing pain in the post-operative period, result in delayed return to full recovery, activation of stress response, self-mutilation, delayed healing, and tissue inflammation (Lang 1999). Because the eye is so densely innervated with sensory fibers, it is likely that any surgical intervention that involves intraocular structures will result in significant post-operative pain with associated central sensitization, as has been described for other peripheral tissues of the body (Woolf 1993).
Acute pain management
2000, Veterinary Clinics of North America - Small Animal PracticeAssessment of depth of anaesthesia
2000, Bailliere's Best Practice and Research in Clinical AnaesthesiologyComparison of Self-Reported and Behavioral Pain Assessment Tools in Critically Ill Patients
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Address reprint requests to John D. Lang, Jr, MD, Department of Anesthesiology, The University of Alabama at Birmingham, 845M Jefferson Tower, 619 South 19th Street, Birmingham, AL 35233–6810
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Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, Alabama