Chapter 11 - Pain control

Summary

This chapter discusses the importance of pain relief, source of pain, types and severity of pain and modalities of pain relief. Paracetamol is very useful for soft tissue pain and as an opioid sparing drug in more severe pain states. Non-steroidal anti-inflammatory drugs (NSAIDs) are powerful analgesics, particularly useful for bony pain. Tramadol is an atypical analgesic with antagonist actions at morphine receptors and inhibitory effects on the reuptake of serotonin and norepinephrine from the synaptic cleft. Potentiation of serotinergic neurons may be important in activating the descending pain control neuronal pathways. Opioids are the most potent analgesics widely available and form the basis of most critical care pain management treatments. The different opioids discussed in the chapter are: morphine, diamorphine, fentanyl, alfentanil, remifentanil, codeine, ketamine and nitrous oxide. Regional anaesthesia is commonly provided in conditions where the pain intensity is expected to resolve over time.