PAIN
PAIN MANAGEMENT IN ADULTS AND ADOLESCENTS
EVERY PHARMACIST SHOULD BE ABLE TO ASSESS AND MANAGE PAIN, WITH PARTICULAR UNDERSTANDING OF PHARMACOLOGICAL INTERVENTIONS FOR THE MANAGEMENT OF PAIN.
particular understanding of pharmacological interventions for the management of pain.
E
Pain is a major health problem, affecting approximately one in five Europeans at any one time. In the UK, an estimated 10 million people suffer from some form of pain on a daily basis2
. Prevalence and impact increase
in correlation to increasing age. As much as 20% of all GP consultations involve pain.
The cost of pain to the NHS per annum is unknown, however recent data reported an average cost of 4 billion pounds each year on treating pain in adolescents’ alone2
. An
astonishing 4.9 million working days are lost to employee absenteeism with work-associated back pain, and The National Rheumatoid Arthritis Society recently estimated that 9.4 million working days are lost through Rheumatoid Arthritis2
.
The quality of life of patients suffering with pain can be significantly reduced, which in turn can cause worry and anxiety for family and friends.
46 - SCOTTISH PHARMACIST
very pharmacist should be able to assess and manage pain, with
However, with the provision of both support and optimum treatment, pain can be managed successfully6
.
Services to manage pain are not currently standardised across Scotland and there are variations in referral rates to chronic pain services. wIn October 2012, Healthcare Improvement Scotland produced, “Update report on Scottish Pain Management Services”. This report aimed to highlight any gaps between pain management service provision at that time, 2010-2011, and the service provision required to implement the Scottish Service Model for Chronic Pain.
This service model sets out guidance for the level of input required at primary, secondary and tertiary care, as well as a treatment pathway for chronic pain. NHS boards can utilise resources more efficiently by bridging the gaps between the level of service provision met and that required to implement this model.
A number of recommendations were put forward based on the findings of the report; these recommendations are to be achieved by 2016. A key element for implementation by the NHS boards is the development of
children’s pain services. As many as 80,000 children and young people in Scotland suffer from significant pain which disrupts their quality of life and their education1
.
DEFINITION OF PAIN Pain is defined by the International Association for the Study of Pain (IASP) as;
“…an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”1
.
It is classified clinically as mild, moderate or severe. This classification is not always reliable as it is dependent on the person using it; different people have different pain thresholds. Acute pain diminishes over time and lasts under twelve weeks. Chronic pain lasts anything above twelve weeks. Pain can also be described in relation to the body’s physiological functions; this is termed neurophysiological classification and it is branched into nociceptive and non-nociceptive bodily functions1
.
Nociceptive pain is that which is transmitted following stimulation of some of the millions of the body’s
. Somatic nociceptive pain is that which is localised to one area; a patient can pinpoint the exact point on the body where the pain is occurring. Somatic pain usually has an external cause; an example would be a stab wound1
nociceptors. Some nociceptors respond to extremes of temperature, others to chemicals such as that produced from a wasp sting, or injury1
. Visceral nociceptive
pain is more diffuse in nature and has an internal cause. At times it can be referred pain such as that which is felt along the left arm following myocardial infarction1
.
Non-nociceptive pain, or neuropathic pain, is that which results from nerve damage7, 1
. Patients will describe this
type of pain as burning, stabbing, tingling, radiating, electric shock or paraesthesia. It is estimated that 7% of the UK suffer from chronic neuropathic pain. It results from surgery, trauma or medical conditions such as diabetic neuropathy.
Associated symptoms can include allodynia, where a stimulus that would not normally induce pain does so. Patients may also experience fatigue, depression, decreased concentration, anxiety and sleeping difficulties as a
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