Page 33 - Learnwell EVS
P. 33
1. A few symptomes and syndromes
Treatment
T reatm ent d ep end1s o n the ty p e and intensity o f the p ain. It m ay be bo th
aetio lo gical
and sy m p to m atic if a treatable cause is id entified . T reatm ent is sy m p to m atic o nly in
o ther cases (no cause fo und , no n-curable d isease).
Nociceptive pain
T he W H O classifies analgesics used fo r this ty p e o f p ain o n a three-step lad d er:
– Step 1: no n- o p io id analg esics such as p aracetam o l and no nstero id al anti-
inflam m ato ry d rugs (NS A ID s).
– Step 2: weak o p io id analgesics such as co d eine and tram ad o l. T h eir co m binatio n
with o ne o r two S tep 1 analgesics is reco m m end ed .
– Step 3: stro ng o p io id analgesics, first and fo rem o st m o rp h ine. T h eir co m binatio n
with o ne o r two S tep 1 analgesics is reco m m end ed .
T he treatm ent o f p ain is based o n a few fund am ental co ncep ts:
– P ain can o nly be treated co rrectly if it is co rrectly evaluated . T he o nly p erso n who can
evaluate the intensity o f p ain is the p atient him self. T he use o f p ain assessm ent scales
is invaluable.
– T he p ain evaluatio n o bservatio ns sho uld be reco rd ed in the p atient chart in the sam e
fashio n as o ther vital signs.
– T reatm ent o f p ain sho uld be as p ro m p t as p o ssible.
– It is reco m m end ed to ad m inister analgesics in ad vance when ap p ro p riate (e.g. befo re
p ainful care p ro ced ures).
– A nalgesics sho uld be p rescribed and ad m inistered at fixed tim e intervals ( no t o n
d em and ).
– O ral fo rm s sho uld be used whenever p o ssible.
– T he co m binatio n o f d ifferent analgesic d rugs (m ultim o d al analgesia) is ad vantageo us.
– S tart with an analgesic fro m the level p resum ed m o st effective: e.g., in the event o f a
fractured fem ur, start with a S tep 3 analgesic.
– T he treatm ent and d o se cho sen are guid ed by the assessm ent o f p ain intensity , but
also by th e p atient‟s resp o nse wh ich m ay vary significantly fro m o ne p erso n to
ano ther.
Treatment of acute pain
M ild p ain P aracetam o l + / - NS A ID
M o d erate p ain P aracetam o l + / - NS A ID + tram ad o l o r co d eine
S evere p ain P aracetam o l + / - NS A ID + m o rp hine
31
Treatment
T reatm ent d ep end1s o n the ty p e and intensity o f the p ain. It m ay be bo th
aetio lo gical
and sy m p to m atic if a treatable cause is id entified . T reatm ent is sy m p to m atic o nly in
o ther cases (no cause fo und , no n-curable d isease).
Nociceptive pain
T he W H O classifies analgesics used fo r this ty p e o f p ain o n a three-step lad d er:
– Step 1: no n- o p io id analg esics such as p aracetam o l and no nstero id al anti-
inflam m ato ry d rugs (NS A ID s).
– Step 2: weak o p io id analgesics such as co d eine and tram ad o l. T h eir co m binatio n
with o ne o r two S tep 1 analgesics is reco m m end ed .
– Step 3: stro ng o p io id analgesics, first and fo rem o st m o rp h ine. T h eir co m binatio n
with o ne o r two S tep 1 analgesics is reco m m end ed .
T he treatm ent o f p ain is based o n a few fund am ental co ncep ts:
– P ain can o nly be treated co rrectly if it is co rrectly evaluated . T he o nly p erso n who can
evaluate the intensity o f p ain is the p atient him self. T he use o f p ain assessm ent scales
is invaluable.
– T he p ain evaluatio n o bservatio ns sho uld be reco rd ed in the p atient chart in the sam e
fashio n as o ther vital signs.
– T reatm ent o f p ain sho uld be as p ro m p t as p o ssible.
– It is reco m m end ed to ad m inister analgesics in ad vance when ap p ro p riate (e.g. befo re
p ainful care p ro ced ures).
– A nalgesics sho uld be p rescribed and ad m inistered at fixed tim e intervals ( no t o n
d em and ).
– O ral fo rm s sho uld be used whenever p o ssible.
– T he co m binatio n o f d ifferent analgesic d rugs (m ultim o d al analgesia) is ad vantageo us.
– S tart with an analgesic fro m the level p resum ed m o st effective: e.g., in the event o f a
fractured fem ur, start with a S tep 3 analgesic.
– T he treatm ent and d o se cho sen are guid ed by the assessm ent o f p ain intensity , but
also by th e p atient‟s resp o nse wh ich m ay vary significantly fro m o ne p erso n to
ano ther.
Treatment of acute pain
M ild p ain P aracetam o l + / - NS A ID
M o d erate p ain P aracetam o l + / - NS A ID + tram ad o l o r co d eine
S evere p ain P aracetam o l + / - NS A ID + m o rp hine
31
