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Pain Management Case Study

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1.2 Pain management Under treated pain is one of the most common complains reported by patients, especially chronic pain which represents the main health problem for people seeking medical help(Heit, 2003). Regarding chronic pain management, treatment goals should include relieving pain or decreasing its severity, improving patients’ functionality thus restoring the ability of self-care and performing simple daily tasks and most importantly improving general health quality of life.
Due to the complex nature of chronic pain, management and treatment plan usually include multidisciplinary approaches.
1.2.1 Pharmacological approach:
The first approach used to control pain is the pharmacological approach represented by the use of analgesic drugs. …show more content…
Opioid receptors are located at important points in pain transmission, modulation and sensation pathways. Activation of presynaptic opioid receptors by opioids inhibits the release of neurotransmitters responsible of pain signal transmission from the afferent terminals of sensory fibers. Opioids hyperpolarize the postsynaptic membranes of dorsal horn neurons directly. In addition, opioids interfere with the action of prostaglandins at peripheral sites(Bovill, 1997). Opioids are usually considered broad spectrum analgesics, meaning they affect a wide number of body systems. Unfortunately, this also means they have a wide profile of side effects. The most common adverse effect of opioid – mainly with chronic use - is constipation which occurs in 40% to 95% of patients treated with opioids. Another common adverse effect of opioids is nausea with prevalence of 25 % in patients on opioids (Swegle and Logemann, 2006). These side effects may be severe enough to necessitate opioid discontinuation thus under-dosing and inadequate analgesia will take place. Other serious …show more content…
For instance, more than 17,000,000 Americans use various NSAIDs on a daily basis, which makes this class of drugs one of the most commonly used drugs in the world(Husni and Simon, 2002). NSAIDs are large group of compounds with analgesic, anti-inflammatory and antipyretic properties. For thousands of years, aspirin’s precursor and willow bark’s active ingredient, salicin, have been widely used in folk medicine. From Egyptians to Hippocrates, salicin applications varied between topical and oral routs for its antipyretic and analgesic properties. The big turning point from folk remedy #salicin$ to blockbuster drug #now known as Aspirin$ began in 1763 with early trials of extraction and modifications. It was not before the year 1828 until salicin was successfully extracted from and modified to produce what is known today as aspirin(Wick, 2012). Despite its efficacy, gastrointestinal toxicity #particularly dyspepsia$ associated with the use of acetylsalicylic acid #ASA$ led to the development of phenylbutazone in the early 1950s. It was the first non-salicylate NSAID developed for use in patients with inflammatory conditions. Again, toxic effects on bone marrow raised high concerns and finally led to Phenylbutazone’s withdrawal from markets(Lees and Toutain, 2013). As a substitute for

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