Transcript Pain Management for AKU patients

Pain Management for AKU
patients
Dr Tom Kennedy FRCP
Consultant Physician in Acute Medicine and Rheumatology
Senior Lecturer and Director of Education Liverpool Health Partners
What is Pain
• An unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of such
damage. (International Association for the Study of Pain)
• Give me 3 examples where there is damage but no pain
• Give me 3 examples of pain with no injury
2 approaches to managing pain
• Non Drug management
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Pain tool kit (www.paintoolkit.org)
Planning your day
Distraction
Exercise and support for joints
• Drug therapy
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Simple analgesia
NSAID’s (non steroidal anti-inflammatory drugs)
Powerful analgesics
Neuropathic pain control
Non Drug management
• Planning your day
• Very important not to use your better days to do too much
• Bite size chunks of activity
• Enjoy the better days
• Distraction
• Concentrate on something else
• TV, books, radio, talking etc.
• Exercise
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Important to keep fit.
Very clear research for knee pain, thigh muscle strength very important
Also supporting joints with braces can be of help
Keep weight controlled
Drug management
• Simple analgesia
• NSAID’s (non steroidal anti-inflammatory drugs)
• Powerful analgesics
• Neuropathic pain control
How do people take their pain tablets?
Paracetamol or Cocodamol
• As on the packet –2 tablets 4 x daily
• When your pain is very bad
• Before activity
Pain Graph
X
Pain
10/10
Out of control
Controlled pain
No pain
Time
In summary
• Take simple pain tablets before activity
• You may take 2 more tablets, 2 hours after first set of tablets
• Maximum 2 tablets 4 x daily (if contain paracetamol)
Pain Graph
X
Pain
10/10
Out of control
Controlled pain
No pain
10.00
12.00
Time
Other examples
Examples of taking medicines to prevent symptoms
NSAID’s – non steroidal anti-inflammatory tablet
Ibuprofen – diclofenac- naproxen
• Drug regulators talk about lowest dose for shortest period of time
• Why are we so worried about them
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Stomach and Bowel ulcers
Kidney damage
Asthma
Heart attacks and strokes with long term use
• Think of these as if they were antibiotics for a chest infection
• i.e. take for 5-10 day courses
• Creams much safer and can work for hands especially
Powerful analgesics – morphine based
Tramadol, Dihydrocodiene, MST, Oromorph
• Can be very helpful but be sure they really do help
• Patches of Butrans / Fentanyl
• MST x 2 daily
• Often used to give background pain control – much more likely to be
addictive
• Constipation – Targinact may be used
Neuropathic pain
• 2 main groups
• Antidepressants e.g. amitriptyline, duloxetine nortriptyline
• Anticonvulsants e.g. gabapentin, Pregabalin
• Typically helpful after shingles or if nerve irritation
• Often helps sleep
• Titrate from very small doses to maximum tolerated
• Take at maximum tolerable dose for 6 weeks, then assess benefit
• Do not withdraw suddenly
Summary
• Keep as fit as you can – see a physio to develop your programme
• Keep weight under control
• Pace your selves – see OT to learn about this
• Be very careful lifting – please!!
• Use simple analgesics before activity
• NSAIDs for courses
• Try to avoid powerful analgesia unless very clear benefit
• Neuropathic pain is often missed and responds well to medicines
Thank you
Any questions