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Posted: March 14th, 2020

Improving Management of Acute and Chronic Pain

Improving Management of Acute and Chronic Pain

Acute pain is a common and unpleasant experience that can result from injury, surgery, or disease. Chronic pain is a persistent and debilitating condition that affects millions of people worldwide. Both types of pain can have significant impacts on physical, psychological, and social well-being. Therefore, effective management of acute and chronic pain is essential to improve quality of life and prevent complications.

The pathophysiology of pain involves complex interactions between the nervous system, the immune system, and the endocrine system. Pain can be classified into three main categories: nociceptive, neuropathic, and nociplastic. Nociceptive pain is caused by tissue damage or inflammation that activates nociceptors, which are sensory nerve endings that detect harmful stimuli. Neuropathic pain is caused by damage or dysfunction of the nervous system itself, such as in diabetic neuropathy or post-herpetic neuralgia. Nociplastic pain is caused by altered nociception without clear evidence of tissue damage or nerve injury, such as in fibromyalgia or irritable bowel syndrome.

The assessment of pain is challenging because it is a subjective and multidimensional experience that depends on various factors, such as the intensity, location, duration, frequency, quality, and meaning of pain. Moreover, pain can be influenced by emotional, psychological, social, cultural, and experiential factors that vary from person to person. Therefore, the assessment of pain should be individualized and comprehensive, using both self-report measures (such as numerical rating scales or visual analog scales) and observational measures (such as behavioral indicators or physiological changes). The assessment should also include the evaluation of the impact of pain on function, mood, sleep, and quality of life.

The management of acute and chronic pain should be based on a multimodal approach that combines pharmacological and non-pharmacological interventions tailored to the specific needs and preferences of each patient. The pharmacological interventions include the use of analgesics (such as opioids, nonsteroidal anti-inflammatory drugs, acetaminophen, or adjuvant drugs), local anesthetics (such as nerve blocks or epidural injections), or anticonvulsants (such as gabapentin or pregabalin). The non-pharmacological interventions include the use of physical therapies (such as exercise programs or acupuncture), psychological therapies (such as cognitive-behavioral therapy or acceptance and commitment therapy), or complementary therapies (such as massage or aromatherapy). The multimodal approach aims to enhance efficacy, reduce side effects, and minimize the need for opioids .

The goals of pain management are to relieve suffering, facilitate function, enhance recovery, and satisfy patients. To achieve these goals, pain management should be patient-centered, evidence-based, collaborative, and holistic. Pain management should also involve patient education, self-management strategies, regular reassessment, and adjustment of the treatment plan as needed. Pain management should also address the potential risks of opioid misuse, abuse, dependence, overdose, or diversion by implementing appropriate screening, monitoring, prescribing, and dispensing practices.

In conclusion, acute and chronic pain are complex phenomena that require comprehensive assessment and multimodal management. Pain management should be individualized and patient-centered to provide optimal pain relief and improve quality of life.

Works Cited

: Raja SN et al. The revised International Association for the Study of Pain definition of pain: concepts,
challenges,
and compromises. Pain 2020;161(9):1976-1982.
: Mears L et al. The pathophysiology,
assessment,
and management of acute pain. British Journal of Nursing 2023;32(2):88-94.
: Mariano ER et al. Approach to the management of acute pain in adults. UpToDate 2023.
: NICE recommends range of effective treatments for people with chronic primary pain and calls on healthcare professionals to recognise
and treat a person’s pain as valid
and unique to them. NICE 2020.
: Salsman JM et al. A promising approach to chronic pain management. Psychology Today 2023.
: Puntillo KA et al. Pain management challenges in acute
and critically ill patients. AACN Advanced Critical Care 2019;30(4):318-328.

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