Pain, relief

MANAGING ANXIETY. Fhtients may exhibit varying degrees of anxiety related to tiieir illness and infection and die necessary drug therapy. When these drug are given by die parenteral route, patients may experience anxiety because of the discomfort or pain that accompanies an IM injection or IV administration. The nurse reassures die patient that every effort will be made to reduce pain and discomfort altiiough complete pain relief may not always be possible. 

Intrathecally or epidurally for pain relief for extended periods without apparent loss of motor, sensory, or sympathetic function... 

In some situations, narcotic analgesics may be ordered tor pain relief using patient-controlled analgesia (PGA). If the patient will be receiving PGA at home, the nurse makes sure to review the following steps with the patient and the caregiver ... 

Pain relief should occur shortly after pushing die button ... 

Call die nurse if pain relief does not occur after two successive doses. 

Like aspirin, ibuprofen is a nonsteroidal anti-inflammatory drug. It is a cyclooxygenase inhibitor that interferes with COX-1 and COX-2 forms of that enzyme. Its effects on COX-2 give it fever-reducing (antipyretic), analgesic (pain relief), and anti-inflammatory functions. 

Koppel RA, Coleman KM, Coleman WP (2000) The efficacy of ELMA versus ELA-Max for pain relief in... 

Koppel RA, Coleman KM, Coleman WP (2000) The efficacy of EMLA versus ELA-Max for pain relief in medium-depth chemical peeling a clinical and histopathologic evaluation. Dermatol Surg 26 61-64 Brody HJ (2001) Complications of chemical resurfacing. Dermatol Clin 3 427-437... 

Cross A, Asher L, Seguin M, Yuan L, Kelly N, Hammack C (1995) The importance of a hpopoly-sacchaiide-initiated, cytokine-mediated host defense mechanism in mice against extraintesti-nally invasive escheiichia coh. J Clin Invest 96(2) 676-686 Dahan A, van Dorp E, Smith T, Yassen A (2008) Morphine-6-glucuronide (M6G) for postoperative pain relief. Eur J Pain 12(4) 403-411... 

Complete C-fibre inhibitions can be produced under normal conditions but opiates do not always produce a complete analgesia in some clinical situations, especially when the pain arises from nerve damage. Reasons for this are suspected to be excessive NMDA-mediated activity which is hard to inhibit and the mobilisation of cholecysto-kinin in the spinal cord which can act as a physiological antagonist of opiate actions. The idea that pre-emptive analgesia aids post-operative pain relief by preventing the pain-induced activation of these systems is becoming popular. 

Drugs with no therapeutic use (cannabis, LSD) and so are not prescribed Drugs with medical use — heroin and morphine for pain relief, amphetamine for narcolepsy and cocaine... 

General treatment measures for all STE ACS and high- and intermediate-risk NSTE patients include admission to hospital, oxygen administration (if oxygen saturation is low, less than 90%), continuous multi-lead ST-segment monitoring for arrhythmias and ischemia, frequent measurement of vital signs, bed rest for 12 hours in hemodynamically stable patients, avoidance of Valsalva maneuver (prescribe stool softeners routinely), and pain relief (Fig. 5-3). 

If pain relief is achieved by avoiding ethanol or fatty meals, encourage continuation of these practices. 

Use the least potent oral analgesic that provides adequate pain relief and causes the fewest side effects. 

The short-term goal of headache therapy is pain relief and a return to normal activities. 

Monitor patients for adverse effects of abortive therapies used for headache pain relief ... 

At equipotent doses, the analgesic and anti-inflammatory activity of all NSAIDs and aspirin are similar. The selection of a specific NSAID should be based on tolerability, previous response, and cost. Some patients respond to one NSAID better than to another. If an insufficient response is achieved with one NSAID, another agent from the same or a different chemical class should be tried. Pain relief occurs rapidly (within hours), but antiinflammatory benefits are not realized until after 2 to 3 weeks of continuous therapy. This period is the minimal duration that should be considered an adequate NSAID trial. 

Elucidation of the activities of individual COX isoforms led to the development of drugs that selectively inhibit the inducible form of the enzyme, COX-2. Thus COX-2 inhibitors were expected to minimize NSAID gastrointestinal toxicity and antiplatelet effects (see Fig. 55-3).19 A common misconception is that COX-2 inhibitors are more effective than nonselective NSAIDs in relieving pain and inflammation. In clinical trials, patients experienced similar levels of pain relief with COX-2 inhibitors and nonselective NSAIDs. 

Pain and joint function have been evaluated frequently in clinical trials administering hyaluronan to patients with OA. Results are conflicting, with some suggesting dramatic improvements and others indicating no effect. In one controlled trial, hyaluronan injections relieved pain to a similar extent as oral NSAIDs.29 Hyaluronan provides greater pain relief for a longer time than intraarticular corticosteroids, but corticosteroids work more rapidly.29... 

Tramadol is a reasonable option for patients with contraindications to NSAIDs or failure to respond to other oral therapies. For the treatment of hip or knee OA, tramadol is as effective as NSAIDs. The addition of tramadol to NSAIDs or acetaminophen may augment the analgesic effects of a failing regimen, thereby securing sufficient pain relief in some patients. Moreover, concomitant tramadol may permit the use of lower NSAID doses. 

Capsaicin achieves pain relief by depleting substance P from sensory neurons in the spine, thereby decreasing pain transmission. Capsaicin is not effective for acute pain up to 2 weeks may be necessary before pain relief is appreciated. Most patients experience a local burning sensation at the site of application. The discomfort usually does not result in... 

Monitor the patient for pain relief and decreased swelling of the affected joints. Both parameters should be improved significantly within 48 hours of starting acute gout therapy. 

There are two main approaches to pharmacologic intervention for pain relief oral (systemic) and topical agents. 

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