3. PAIN - DEFINITION ‘ AN UNPLEASANT SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE OR DESCRIBED IN TERMS OF SUCH DAMAGE’ ‘ AN UNPLEASANT SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL OR POTENTIAL TISSUE DAMAGE OR DESCRIBED IN TERMS OF SUCH DAMAGE’ Ref: International Association for Study of Pain

6. CLASSIFICATION OF PAIN ACUTE ACUTE CHRONIC CHRONIC NOCICEPTIVE NOCICEPTIVE NEUROPATHIC NEUROPATHIC PSYCHOGENIC PSYCHOGENIC

7. MEASUREMENT OF PAIN VISUAL ANALOGUE SCALE (VAS) VISUAL ANALOGUE SCALE (VAS) VERBAL RATING SCALE VERBAL RATING SCALE McGILL PAIN QUESTIONNAIRE McGILL PAIN QUESTIONNAIRE PAKISTAN COIN SCALE (PCS) PAKISTAN COIN SCALE (PCS)

8. Pain Assessment Scales NoMildModerateSevereVeryWorst painpainpainpainseverepossible painpain Verbal Pain Intensity Scale 0–10 Numeric Pain Intensity Scale No Moderate Worst pain pain possible pain 0123456789 10 Visual Analog Scale No Pain “Faces” Scale Worst possible pain

11. BONICA(1990) HAS ESTIMATED THAT; 15-20% OF POPULATION HAVE ACUTE PAIN 15-20% OF POPULATION HAVE ACUTE PAIN 25-30% OF POPULATION HAS SOME FORM OF CHRONIC PAIN 25-30% OF POPULATION HAS SOME FORM OF CHRONIC PAIN

12. GENERAL PRINCIPLES / OPTIONS OF PAIN RELIEF  PREVENT INITIAL EXCITATION OF NOCICEPTIVE NERVES:NSAIDS  INTERRUPT PERIPHERAL NOCICEPTIVE TRANSMISSION: LOCAL ANAESTHETICS  ALTER SPINAL MODULATION:  SPINAL/EPIDURAL NARCOTICS  EPIDURAL LOCAL ANAESTHETICS  EPIDURAL LA+NARCOTICS

13. GENERAL PRINCIPLES / OPTIONS OF PAIN RELIEF (CONTD)  INTERRUPT SPINAL CORD NOCICEPTIVE TRANSMISSION  ALTER CENTRAL PROCESSING OF NOCICEPTION INFORMATION: OPIODS, NITROUS OXIDE  ALTER EMOTIONAL RESPONSE TO PAIN, ANXIETY OF ACUTE PAINS, DEPRESSION OF CHRONIC PAIN  ALTER BEHAVIOURAL RESPONSE TO PAIN

14. ACUTE PAIN SOME EXAMPLES POSTOPERATIVEOBSTETRICTRAUMATICMEDICALSURGICALORTHOPAEDICCANCER

15. METHODS OF ACUTE PAIN MANAGEMENT MEDICATIONOPIOIDS PROSTAGLANDIN SYNTHETASE INHIBITORS OTHER DRUGS e.g KETAMINE INHALATIONAL AGENTS ANXIOLYTICS

16. CHRONIC PAIN MEDICAL MEDICAL SURGICAL SURGICAL MUSCULO-SKELETAL MUSCULO-SKELETAL NEUROLOGICAL NEUROLOGICAL PSYCHOLOGICAL PSYCHOLOGICAL

17. METHODS OF CHRONIC PAIN MANAGEMENT THE PAIN RELIEF CLINIC MEDICATION THE PAIN RELIEF CLINIC MEDICATION ANALGESIC ANALGESIC PSYCHOTROPIC DRUGS PSYCHOTROPIC DRUGS ANTICONVULSANTS ANTICONVULSANTS OTHER DRUGS OTHER DRUGS

18. NEURAL BLOCKADE TRIGGER POINT INJECTION TRIGGER POINT INJECTION CRANIAL NERVE BLOCKS CRANIAL NERVE BLOCKS EPIDURAL INJECTIONS EPIDURAL INJECTIONS SYMPATHETIC BLOCKADE SYMPATHETIC BLOCKADE

19. SYMPATHETIC BLOCKADE STELLATE GANGLION BLOCK STELLATE GANGLION BLOCK COELIAC PLEXUS BLOCK COELIAC PLEXUS BLOCK LUMBAR SYMPATHETIC BLOCK LUMBAR SYMPATHETIC BLOCK INTRAVENOUS REGIONAL GUANETHIDINE BLOCK INTRAVENOUS REGIONAL GUANETHIDINE BLOCK

20. ROUTES OF OPIOID ADMINISTRATION INTRAMUSCULARINTRAVENOUSSUBCUTANEOUSORALSUBLINGUAL OTHER ROUTES: BUCCAL, NASAL, TRANSDERMAL EPIDURAL / INTRATHECAL

21. SELECTION OF TECHNIQUE DEPENDS UPON: INTENSITY OF PAIN SITE OF SURGERY ANTICIPATED DURATION OF SEVERE PAIN PHYSICAL STATUS OF THE PATIENT NURSING STAFF

22. CHOICE OF ANALGESIA ACCORDING TO SURGERY OPERATIONS ABOVE C4 OPERATIONS ABOVE C4 SYSTEMIC DRUGS OPERATIONS FROM T1 TO S4 OPERATIONS FROM T1 TO S4EPIDURALS NERVE BLOCKS NERVE BLOCKS

23. IN SHORT TWO TYPES OF DRUGS OPIODS AND LOCAL ANAESTHETICS WITH DIFFERENT METHODS OF ADMINISTRATION

24. PAIN RELIEF IN CHILDREN SMALL CHILDREN DO FEEL PAIN SMALL CHILDREN DO FEEL PAIN DO USE LA BLOCKS AND OTHER METHODS OF PAIN RELIEF DO USE LA BLOCKS AND OTHER METHODS OF PAIN RELIEF

25. WHO ANALGESIC LADDER

26. PHANTOM LIMB PAIN

28. CANCER PATIENTS EVERY YEAR 6 MILLION NEW PATIENTS ARE DIAGNOSED IN THE WORLD MORE THAN 4 MILLION DIE 10% OF ALL DEATHS 70% OF PATIENTS HAVE PAIN

34. OTHER METHODS

38. FACET JOINT BLOCK FOR BACHACHE

39. FOR SHOULDER PAIN

40. CRPS (COMPLEX REGIONAL PAIN SYNDROME)

41. CATHETER IN EPIDURAL SPACE

42. IMPLANT WITH CATHTER

43. IMPLANT FOR BACHACHE

44. Thank You