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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Identify characteristics of the types of pain: nociceptive, inflammatory, neuropathic, and functional.

  2. Explain the mechanisms involved in pain transmission.

  3. Select an appropriate method of pain assessment.

  4. Recommend an appropriate choice of analgesic, dose, and monitoring plan for a patient based on type and severity of pain and other patient-specific parameters.

  5. Perform calculations involving equianalgesic doses, conversion of one opioid to another, rescue doses, and conversion to a continuous infusion.

  6. Educate patients and caregivers about effective pain management, dealing with chronic pain, and the use of nonpharmacologic measures.

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KEY CONCEPTS

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  • Image not available. Pain is an unpleasant, subjective experience that is the net effect of a complex interaction of the ascending and descending neurons involving biochemical, physiologic, psychological, and neocortical processes.

  • Image not available. Following initial assessment of pain, reassessment should be done as needed based on medication choice and the clinical situation.

  • Image not available. Effective treatment involves an evaluation of the cause, duration, and intensity of the pain and selection of an appropriate treatment modality for the pain situation.

  • Image not available. Whenever possible, the least potent oral analgesic should be selected.

  • Image not available. Equianalgesic doses should be used when converting from one opioid to another.

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Pain is defined by the International Association for the Study of Pain (IASP) as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."1 Image not available. Pain is an unpleasant subjective experience that is the net effect of a complex interaction of the ascending and descending neurons involving biochemical, physiologic, psychological, and neocortical processes. Pain can affect all areas of a person's life including sleep, thought, emotion, and activities of daily living. Because there are no reliable objective markers for pain, the patient is the only person who can describe the intensity and quality of their pain.

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Pain is the most common symptom prompting patients to seek medical attention and is reported by more than 80% of individuals who visit their primary care provider.2 Despite the frequency of pain symptoms, individuals often do not obtain satisfactory relief of pain. This has led to initiatives in healthcare to make pain the fifth vital sign, thus making pain assessment equal in importance to obtaining a patient's temperature, pulse, blood pressure, and respiratory rate.

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EPIDEMIOLOGY AND ETIOLOGY

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Prevalence of Pain

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Most people experience pain at some time in their lives, and pain is a symptom of a variety of diseases. For some, pain might be mild to moderate, intermittent, easily managed, and have minimal effect on daily activities. For others, pain might be chronic, severe, or disabling, all consuming, and treatment resistant. Thus identifying the exact prevalence of pain is a difficult task. According to the American Pain Foundation, more than 76 million people in the United States suffer from chronic pain, ...

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