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Published on April 26, 2014

Author: AnooshRoozrokh

Source: slideshare.net

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Pain management

The Principles of Pain Management (Part 1): Pain and its subtypes, definitions and concepts By: Babak Roozrokh, MD Palliative Care Doctors Group, Inc.

Pain

Pain Physical

Pain Physical Emotional

Physical Pain

Physical Pain

Physical Pain Nocioceptive

Physical Pain Nocioceptive Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis

Physical Pain Nocioceptive Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction

Physical Pain Nocioceptive Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart:Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart:Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Central Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart:Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Peripheral Central Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart:Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Peripheral Central Sympathetic Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart:Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Peripheral Central Sympathetic •Tingling •Burning •Numbness •Itching •Stabbing Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart:Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Peripheral Central Sympathetic •Tingling •Burning •Numbness •Itching •Stabbing Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart: Post Herpetic Neuralgia Diabetic Neuropathy Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Peripheral Central Sympathetic Mixed ( Nocioceptive & Neuropathic ) : Cancer •Tingling •Burning •Numbness •Itching •Stabbing Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart: Post Herpetic Neuralgia Diabetic Neuropathy Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Peripheral Central Sympathetic Mixed ( Nocioceptive & Neuropathic ) : Cancer •Tingling •Burning •Numbness •Itching •Stabbing Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis EXAMPLE 89 year old male with metastatic pancreatic cancer (metastasized to femur and spine) describes his pain as “dull and achy” and sometimes “stabbing and sharp” in his back and feels “numbness and burning” in his legs. Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart: Post Herpetic Neuralgia Diabetic Neuropathy Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Neuropathic Peripheral Central Sympathetic •Tingling •Burning •Numbness •Itching •Stabbing Mixed ( Nocioceptive & Neuropathic ) : Cancer Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart: Post Herpetic Neuralgia Diabetic Neuropathy Skin Burn, Pulmonary Embolism, Myocardial infarction Functional (Pain for secondary gain)

Physical Pain Nocioceptive Neuropathic Peripheral Central Sympathetic •Tingling •Burning •Numbness •Itching •Stabbing Mixed ( Nocioceptive & Neuropathic ) : Cancer Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis EXAMPLE 24 year old army soldier wants to hang out with his buddies for upcoming high school reunion complains of severe abdominal pain. Physical exam, labs and all imagings are normal. Pain is “gone” when he is allowed to go home “to rest”. Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart: Post Herpetic Neuralgia Diabetic Neuropathy Skin Burn, Pulmonary Embolism, Myocardial infarction Functional (Pain for secondary gain)

Physical Pain Nocioceptive Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart: Neuropathic Peripheral Central Sympathetic Functional (Pain for secondary gain) Psychogenic (Somatization) •Tingling •Burning •Numbness •Itching •Stabbing Post Herpetic Neuralgia Diabetic Neuropathy Mixed ( Nocioceptive & Neuropathic ) : Cancer Skin Burn, Pulmonary Embolism, Myocardial infarction

Physical Pain Nocioceptive Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis Neuropathic Peripheral Central Sympathetic Functional (Pain for secondary gain) Psychogenic (Somatization) •Tingling •Burning •Numbness •Itching •Stabbing Mixed ( Nocioceptive & Neuropathic ) : Cancer EXAMPLE 30 year old registered nurse just heard that her grandmother whom she was very closed to passed away suddenly. She now has severe pain in her right foot and can not walk. Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction Somatic (Sharp) i.e. Skin, Lungs, Heart: Post Herpetic Neuralgia Diabetic Neuropathy Skin Burn, Pulmonary Embolism, Myocardial infarction

Emotional (Suffering)

Emotional (Suffering) Psychological / Spiritual

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger What have I done to deserve this? Why did God do this to me?

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social What have I done to deserve this? Why did God do this to me?

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation Hair loss secondary to cancer

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation Hair loss secondary to cancer Wheelchair bound and isolated

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation Hair loss secondary to cancer Wheelchair bound and isolated EXAMPLE 56 year old former beauty queen was just diagnosed with breast cancer. She is refusing chemotherapy because she does not want to become “bald”.

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation Short / Tall – Obese/ Thin Hair loss secondary to cancer Wheelchair bound and isolated

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation Short / Tall – Obese/ Thin Cultural differences: Accent Hair loss secondary to cancer Wheelchair bound and isolated

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social Financial What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation Short / Tall – Obese/ Thin Cultural differences: Accent Hair loss secondary to cancer Wheelchair bound and isolated

Emotional (Suffering) Psychological / Spiritual Anxiety: Fear of death Anger Social Financial Other… What have I done to deserve this? Why did God do this to me? Physical Disability / Isolation Short / Tall – Obese/ Thin Cultural differences: Accent Hair loss secondary to cancer Wheelchair bound and isolated

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