Pain Management: Acute Pain




Abstract


Acute pain is the physiologic response and experience to noxious stimuli that is normally sudden in onset and influences behaviors to avoid actual or potential injury to tissue. The diagnosis of acute pain is usually made with a thorough history and physical, while measuring and monitoring pain is a greater diagnostic dilemma requiring the use of regular multidimensional assessments. Ideal management of acute pain consists of timely administration of multimodal analgesia with unique mechanisms of actions. Ultimately, pain is a continuum, so prompt recognition and resolution of acute pain is essential to avoid chronification of pain and the complications that chronic pain can carry. This chapter outlines principles for the evaluation of acute pain and provides evidence-based management strategies.




Keywords

acute pain, physiologic pain, pathologic pain, multidimensional assessment, multimodal analgesia, chronification

 







ICD-10-CM Codes

















Codes vary by location of the pain
G89.1 Acute pain, not elsewhere classified
G89.11 Acute pain due to trauma
G89.18 Other acute postprocedural pain




General Information





  • Acute pain is the physiologic response and experience to noxious stimuli that can become pathologic, is normally sudden in onset, time limited, and motivates behaviors to avoid actual or potential tissue injuries (Acute Pain Medicine Shared Interest Group).





Etiology and Pathogenesis





  • Pain is multifactorial and dependent on both physiologic and psychologic components.



  • Traditional attempts to delineate acute and chronic pain, while clinically helpful, may neglect potential pathophysiologic links between the two.



  • Commonly used systems include:




    • Time course, where an upper limit of 3 to 6 months is ascribed to acute pain



    • Qualitative descriptors, where perioperative, traumatic, obstetric, etc., usually refer to acute pain processes and cancer, noncancer, neuropathic, etc., typically apply to chronic pain




  • Categorizing pain as physiologic or pathologic may be more appropriate




    • Physiologic (adaptive pain)




      • Most common type of acute pain (e.g., surgery, trauma)



      • Relies on peripheral nociceptor activation by noxious stimuli (e.g., extreme temperatures, pressure, inflammatory cytokines and chemokines)



      • Afferent pathways transmit peripheral impulses to the central nervous system



      • Efferent pathways modulate the response to noxious stimuli to locate and interpret the intensity of pain, avoid or minimize additional tissue damage, and support behavioral modifications to promote recovery and function.




    • Pathologic (maladaptive pain)




      • Less common cause of acute pain; usually associated with chronic pain (e.g., migraines, stroke, spinal cord injury)



      • Described as neuropathic pain or dysfunction of the somatosensory system





  • The pain experience is significantly impacted by anxiety, depression, pain catastrophizing, fear avoidance, previous experience with pain, culture, and beliefs.





History and Physical





  • A thorough history is essential, given the subjective and individualized nature of pain.



  • The simple mnemonic, OLD CARTS, covers most components of a pain history (Onset, Location/radiation, Duration, Character, Aggravating factors, Relieving factors, Temporal association, Severity).



  • It is additionally helpful to ascertain associated symptoms (e.g., nausea and vomiting), effect on activities and sleep, relevant medical history, previous and current treatments, and factors influencing the patient’s response to treatment (e.g., beliefs, knowledge, and expectations of pain and its management).



  • Physical examination becomes more important when history is limited by critical illness, age, communication barriers, or cognitive impairment.



  • Provocative maneuvers such as Spurling test, Tinel sign, Phalen test, straight leg raise, and slump test may reveal less apparent neurogenic involvement.



  • Findings suggestive of pain include increased respiratory rate, heart rate, blood pressure, palmar sweating, intracranial pressure, and agitation.


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Sep 17, 2019 | Posted by in ORTHOPEDIC | Comments Off on Pain Management: Acute Pain
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