General Treatment Principles
Detailed assessment of the patient in the treatment of pain, pain onset, development and evaluation of current status, location, distribution, quality and intensity, knowledge of the correct evaluation of the mechanism of pain and evaluation of the patient's general condition is important. This is in line with the general principles of treatment for pain control methods used are as follows:
1 - Pain relief drugs
2 - Physical therapy methods
3 - Nerve blocks
4 - Radiofrequency thermocoagulation
5 - Radiotherapy
6 - intraspinal systems (morphine pump)
7 - Surgical procedures
8 - Psychological methods
9 - Alternative medicine methods
Pain Relief (Analgesics)
Analgesics at the beginning of pain control methods, the use of income. Is one of the most commonly used drugs in the community with antibiotics and analgesics. Therefore, accurate evaluation of the principles of analgesic use and patients must be taught the principles of analgesic use.
Analgesic use policies, as well as physicians, patients, pharmacists are also very important contribution to the process of teaching would be an important fact. Analgesics are used to provide acute and chronic pain syndromes of pain control drugs. The use of analgesics, perhaps as old as the history of mankind. Morphine - Opium and its derivatives like years since 5000, is considered the father of nonsteroidal antienflamatuarların acid (apirin) has been used in more than 100 years. The two groups in the last 50 years many new drugs have been developed and found uses.
Unfortunately, at the beginning of the wrong drugs are analgesics. The origin of the group of physicians and patients against improper use of this drug is based on lack of knowledge. The last 20-30 years, with the emergence of the science of pain used analgesics have become more accurate. Studies aimed at the use of analgesics to the World Health Organization (DST) began in the 1980s under. Brochure published in 1986, the principles of cancer pain and analgesic use.
These principles published by DST and cancer, as well as non-cancer pain by 80-85% may be possible to control pain. Prerequisite for the correct use of analgesics analgesics physician, the effectiveness of the mechanism of action, side effects and drug interactions and dosage is the recognition that in detail. With careful and thoughtful evaluation of pain origin, property, determining the location of the patient's age, general condition, other diseases, and used to determine the response to medication is essential.
Principles of analgesic use, Patient-Controlled Analgesia
Principles of analgesic use in this basic framework are as follows:
1. Primarily to the use of oral analgesics should be preferred.
Long-term oral analgesic use in chronic pain patients is the simplest way to use. In this way does not require any additional treatment should be tried as a priority. The use of oral as well as the cheapest, most effective drug use is a good idea to go to. Difficulty in swallowing, vomiting, nausea and lead to problems such as oral or necessarily to be preferred. The Mouth is not available, the appropriate format if there is selected as suppositories, subcutaneous, nasal as well as other roads should be contacted.
2. The frequency of injections of analgesics for the patient should be evaluated separately.
The person is a unique experience of pain is emphasized several times before. Similarly, even in patients with pain problems are huge differences between the analgesic requirements. For example, a putsch is a simple activity with the effectiveness of aspirin, cancer will be different from each other. With at least side-effect must be given the most appropriate dose, the ideal dose is given once in order to find a patient, the patient's needs must be compared with the duration of drug effect. To ensure this, the patient's assistance is essential.
Patients are asked to measure the duration of action until the pain a few times. Must go to a more careful dose adjustment in elderly patients.
3. Analgesics should be given pain before and at regular intervals. One of the biggest mistakes made in the treatment of pain analgesics analgesics after the start of each time is to give pain. This is considered to start from scratch each time the treatment of pain in a sense, an ideal analgesic treatment of pain control for 24 hours continuously. In this way, patients do not occur in a vicious circle, can be ensured the continuity of analgesia and it is possible to provide analgesia with a much lower dose of medication.
In other words, analgesics, the same blood pressure drugs, diabetes drugs, how, if given the blood pressure rise, if given sugar levels rise, the pain level should rise.
Traditionally, a wrong done, the application of food according to the order of 3x1. 4 hours between breakfast and lunch, lunch and dinner from 8 hours, or until the morning it will take 12 hours. This is highly irregular analgesics, intervals of 4-8-12 hours means the application. However, the half-times of analgesics in certain drugs. Therefore, individualized dose and duration of action after determining that the start time intervals, taking into account the effect of analgesics must be given at regular intervals.
4. Analgesics should be applied according to the principles of care. One of the important elements of the selection of analgesics in pain intensity. Which question which severe pain to start, but the other pains of DST performed for patients with cancer also may be used in response to the step system. DST has developed a three-step ladder system. In this system, the patient and physician misconceptions and analgesics minimized selection easier.
Step into groups according to the forces of analgesics according to the principle, according to the lowest effective influence of the highest order.
The first step in the treatment of aspirin-like analgesics and nonsteroidal anti-inflammatory drugs, ie drugs begins. This is what we call drugs, in addition to pain relief secondary to antidepressants, muscle relaxants and other drugs can be added. This step becomes insufficient strong opioids morphine derivatives, leads to extended-release oral opioid derivatives. Weak opioids are effective at this stage is left. DST has developed this three-step system, 80-in 85% of patients can be effective. This is not effective if it should be in the interventional procedures.
Certainly not used analgesics in patients with no need to launch the first order. A step down for the correct evaluation of a 24-hour period should pass. Step system, bypassing the implementation of a number of patients may lead to the emergence of side effects. For this reason, patients and relatives, and physicians are extremely careful to make an assessment of this evaluation is necessary to educate and warn patients and their relatives. Most of the patients to assess their work by reading the prospectuses. Analgesics about the physicians, patients and their relatives have unnecessary fears of some. These fears of morphine and similar drugs, especially against the development.
Painkillers - analgesics classification
Centrally acting analgesics are classified in two groups, and regional influence. Regional effective pain relievers
Willow leaves to find Hoffman in 1853 in conjunction with aspirin is an important breakthrough was opened in regional effective pain relievers. Antienfla-inflammatory agents known as nonsteroidal in the first instance of the aspirin group. However, after hundreds of people similar to the drug has been developed.
Nonsteroidal anti-inflammatory agents, mild to moderate pain, fever, rheumatic fever, rheumatoid arthritis, osteoarthritis, inflammatory conditions, such as enfla-chronic pain and cancer pain (especially with bone metastases) is used to treat. Use the principles 1 Gastritis, peptic ulcer should be used cautiously in such cases.
2. Used with caution in patients with clotting disorders.
3. Should not be used during pregnancy unless forced to. I have to use if, the risks should be considered. Birth should not be used for pain.
4. Previously developed allergies to medication and should not be used in patients with advanced or shortness of breath.
5. Nonsteroidal anti-inflammatory drugs in patients, the answer is variable. Not benefit from a calendar or can not tolerate it, another agent can be treated successfully.
6. Aspirin and other nonsteroidal anti-inflammatory agents used in combination. Because there is both a lot of therapeutic benefits as well as about the side effects, especially gastro-intestinal system increases.
7. These drugs should not be used on the dose. Because the effect we called ceiling effect when used with more features do not show more painkillers. In other words, a drug must be taken twice a day are being received six times only increases the effect of gastric, does not increase the effect of pain relief.
The main side effects
There are many side effects of these drugs. For this reason, are not used indiscriminately
Nonsteroidal adverse effects:
1. Gastrointestinal system
3. Cardiovascular system
6. Allergies and skin rashes
1. Gastro-intestinal system: effect of different intensity on the intestinal system, including the stomach makes. Nausea, vomiting, stomach, heartburn, diarrhea, constipation, abdominal pain, ulcers, perforations and bleeding of the stomach may cause side effects, and leads to. Age, smoking, coffee, alcohol use, gender, steroid use can increase the side effects of these drugs on the gastrointestinal system. To prevent this, apply to gastric protective drugs.
2. On renal function in acute renal failure, chronic renal failure may occur. Especially elderly patients using these drugs should be very careful.
3. Cardiovascular system: High blood pressure, heart failure may occur.
4. Effects on the liver: Liver failure may occur. Especially in the first 8 weeks of treatment in chronic liver tests should be performed.
5. Blood: Blood clots that decrease in platelet count and anemia, can be seen. Does not matter as much clinical antiplatelet effect of nonsteroidal, antithrombotic therapy is used.
6. Hypersensitivity reactions: Aspirin and similar drugs, allergies, respiratory distress and shock may cause similar reactions. Allergic skin rash may occur. Itching may occur.
7. Effect on the respiratory system: Rarely, respiratory distress may develop. If there is no difference may develop respiratory failure.
Regional analgesics, head, teeth, cancer, metastasis, postoperative pain, trauma, back pain, migraine pain and dysmenorrhea, except as rheumatoid arthritis, gout, ankylosing spondylitis, tendinitis, epicondylitis, and osteoarthritis can be used in such cases.
Center to develop a dependency on effective analgesics in different, develop a tolerance, respiratory depression and drowsiness, although the advantages of non-steroidal analgesics, such as not to open the way there is a ceiling effect. Analgesic effect of a dose effect seen on the ceiling, whereas the increase of side effects. For example, the analgesic effect of aspirin on the ceiling of 650 ml / mg dose increases the analgesic effect and did not increase from a place such as the severity of adverse effects increases. Therefore, the ceiling effect of nonsteroidal use should be considered. All of them are in different half-periods may be possible for a drug to another drug.
Center effective pain relievers
Opioid analgesics, naming
Morphine and similar drugs are often "narcotic analgesics" is called. This left behind them, similar to a wrong naming easily. "Narcotic" the Greek word, drowsiness, numbness means. For almost all drugs used in a somnolent period. In this sense, cocaine is also included in this group. However, cocaine central nervous system stimulant properties. The word is also used for narcotic drugs are also addictive.
"Opiate" The word from the natural and semi-synthetic drugs used for morphine, while the synthesis of fully synthetic drugs with morphine-like "opioid" that the word being used is similar to morphine. Today, the word of opioids like morphine, natural, semi-artificial and artificial cover all drugs. However, opiate and opioid words used interchangeably in many places.
Today, there are many drugs with effects similar to morphine. These are natural, semi-synthetic or artificial properties. Although all of these drugs remains as painkiller morphine. 1803'were isolated by morphine. Opium, also known as the opium poppy, unripe seed capsules of plants complete the demarcation of the white liquid with the consistency of chewing gum with the arrival of decision and as a result of contact with air is achieved. There are more than 20 substances in the opium gum. Codeine in the analgesic properties of these in 1832 which was isolated by Robiquet.
Mechanisms of action
Binding to specific receptors on their sensors shows the effects of-opioids. Morphine-like drugs and gastrointestinal system, lungs, nose, subcutaneous, intramuscular act as easily from anywhere. Directly to the spinal cord area in recent years, giving a much more powerful way is to get a domain. Therapeutic doses of morphine given to a person without pain, nausea, vomiting, dysphoria, apathy and reduced physical activity are seen. In their response to pain is different. Opioid analgesics alter pain perception and reaction against it. Patients often have pain but it is no longer an unpleasant feeling that is expressed as a algılamadıklarını. Opioids, moved to the central nervous system, preventing painful stimulus.
Euphoria / dysphoria: individuals or dependents of opioid pain medications anxiety, frustration by removing, creating a pleasant feeling, unlike in normal individuals can cause discomfort and fatigue is dominated by dysphoria. Drowsiness: Drowsiness and blurring of consciousness are common, but less common to almost no loss of memory. Opioids in the elderly might provide more frequent drowsiness, sleep, wake-up is easy. Synthetic opioids less frequently, and causes mild drowsiness.
Respiratory deterioration: Opioids have a dose-dependent stops the brain stem respiratory centers.
Suppression of cough reflex: Opioid analgesics suppress the cough reflex Codeine is the most powerful way.
Nausea and vomiting: nausea and vomiting by stimulating the center of the brain stem can cause nausea.
Gastrointestinal system: opioid analgesics often causes constipation. Urinary system.: Morphine and similar drugs cause temporary difficulties in making urine.
Opiophobia fear of morphine addiction and
Morphine dependence needs to be done to understand the correct definition of some concepts. Generally, tolerance, dependence, which is used as a synonym for concepts such as incorrect.
Tolerance: a drug for a while after you use the old show no effect. This is very normal.
Physical and psychic dependence: Repeated doses of opioids to be used at different levels of physical dependence can develop, if the cessation of runny nose, yawning, chills, often breathing, fever, muscle aches, vomiting, diarrhea and so on. deficiency symptoms, such as occurs. The emergence of the symptoms depends on the severity of physical dependence. Deficiency symptoms 6-10 hours after the last dose of morphine occurs, reaches a peak within 36-48 hours and usually disappear after 5 days. To avoid symptoms of deficiency are more than one quarter of the dose used in patients with end to end should not be more than one use.
Psychic dependence is the increase in the desire to use drugs. Usually this is the feared event. Both physicians and patients because of this fear, try not to use enough medication. Facilitates the development of psychic dependence on drugs or not enough pain patients. World Health Organization for his studies on 40,000 patients, but four patients were found to develop in patients with psychic dependence.
Morphine and similar drugs to be effective in all kinds of belief that pain is wrong. Opioids, while useful in severe and constant pain, sharp pain that comes once in a while is not so effective. Well-chosen type of pain. Cancer and other serious diseases can be used in patients with chronic pain.
Shortness of breath: Morphine, shortness of breath due to heart failure and pulmonary edema are useful.
Cough: cough reflex is suppressed to less than the dose required for analgesia. However, more effective today, do not make the addiction and analgesia, used artificial drugs in relieving cough, diarrhea: infection associated diarrhea should be applied. Opioids effectively prevent all types of diarrhea.