Pain management
Pain management typically follows a structured approach known as the WHO Analgesic Ladder, designed to provide a stepwise method to treating pain. It was originally developed for cancer pain but is now widely applied to various types of pain. There are three main steps in this ladder, though modern pain management sometimes includes a “fourth step” for more complex cases. Here's a summary of each step:
1. Step 1: Non-Opioids (Mild Pain) Drugs Used: Non-opioid analgesics like acetaminophen (paracetamol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin.
Purpose: Used for mild pain, these medications work by reducing inflammation and blocking pain signals at the source.
Adjuvant Therapies: May include muscle relaxants, antidepressants, anticonvulsants, or topical treatments to enhance pain relief.
2. Step 2: Weak Opioids (Moderate Pain) Drugs Used: Weak opioids such as codeine, tramadol, or low doses of stronger opioids like hydrocodone. Purpose: This step is for moderate pain that cannot be adequately controlled with non-opioids alone. Combination: Often, weak opioids are combined with non-opioid analgesics for enhanced effectiveness.
3. Step 3: Strong Opioids (Severe Pain)
Drugs Used: Strong opioids such as morphine, oxycodone, fentanyl, or hydromorphone.
Purpose: This step is used for severe or persistent pain that doesn't respond to weak opioids. Titration: Doses are carefully titrated based on pain relief and side effect management. Opioids are often used alongside adjuvants to reduce side effects and enhance pain control.
Step 4: Interventional and Advanced Therapies (Complex or Refractory Pain)
Interventions: Nerve blocks (e.g., epidural injections or regional anesthetic blocks) Spinal cord stimulation (neurostimulation techniques) Intrathecal drug delivery (direct administration of medications into the cerebrospinal fluid) Surgical interventions (e.g., nerve ablation, neurolysis) Palliative radiotherapy (for pain relief in cases of bone metastases or tumor-related pain) Purpose: Used when the standard pharmacological steps fail to manage pain adequately. This step is reserved for complex cases such as chronic pain, neuropathic pain, or cancer pain where more invasive approaches are necessary.
Each step in this ladder is intended to be flexible, allowing for movement up or down the ladder based on the patient’s pain intensity and response to treatment. The goal is to provide effective pain relief while minimizing side effects.
Pain treatment
see Pain treatment.
PAIN MANAGEMENT MEETINGS
7th London Pain Forum “Advances in Pain Medicine” Winter Symposium 20-25 January 2019 Hotel Village Montana, Tignes Le Lac, France Web: www.winterpainsymposium.com
12th RA-UK/ESRA/LPF Ultrasound in Chronic Pain Medicine Course 22-23 March 2019 Dept of Anatomy, St George's Hospital, London, U Web: www.uspmlondon.com
Headache and Facial Pain Treatment Symposium 5 April 2019 Park Plaza Victoria, Amsterdam Centraal, The Netherlands Web: www.painways.com
British Pain Society Annual Scientific Meeting 1-3 May 2019 Hilton Tower Bridge Hotel, London, UK Web: www.britishpainsociety.org
12th Annual Leeds Hands-on Interventional Workshop 9-10 May 2019 University of Leeds, Leeds, UK Web: www.painandneuromodulationlondon.com
6th SUA Ultrasound Guided Chronic Pain Interventions Workshop 3 September 2019 Royal College of Physicians, London, UK Web: www.painandneuromodulationlondon.com
Neuromodulation Society of the UK & Ireland Annual Scientific Meeting and Hands-on Cadaver Workshop 15-17 November 2019 Aspire Conference Centre & Dept of Anatomy, Univ. of Leeds, Leeds, UK Web: www.painandneuromodulationlondon.com