Doctor Doctor: M. D. Anderson Takes on Acute Pain
Network - Winter 2007
An associate professor in the Division of Anesthesiology and Critical Care, and director of the recently established Section of Acute Pain Medicine and Regional Anesthesia, Krishna Boddu, M.D., is helping lead efforts at M. D. Anderson to educate patients, families, heath care providers, insurers and others about acute pain management procedures, medications and devices.
What is acute pain and how does it differ from chronic pain?
Acute pain comes on quickly, can be severe and lasts a relatively short time, maximum three to six months. Examples are pain from surgery, bone fracture, a fall or burn. If acute pain is not well managed, it can cause a “permanent scar” in the mind and lead to fear of surgery, cause sleep disturbances, and eventually may bring about chronic pain, causing patients to suffer decreased functionality. In contrast to chronic pain, the intensity of acute pain is variable hour to hour, day to day and needs skillful adjustment of medication to match its intensity.
Why is good control of acute pain so important?
Good acute pain control after surgery or injury improves the patient’s mobility; prevents complications, such as deep vein thrombosis and breathing problems; shortens the patient’s hospital stays; and averts the chronic pain that can result from untreated acute pain. Severe pain also can increase heart rate and blood pressure and interfere with the body’s immune system.
What types of acute pain are there?
There are three types of acute pain depending on the part of the body involved. For example, if the pain is due to injury to skin, muscles and ligaments, it is referred to as somatic and often described as sharp. Neuropathic pain is due to nerve damage and manifests as a burning or shooting sensation. Visceral pain involves the organs and is usually described as a gnawing or cramping.
What are the principal ways of treating acute pain?
By taking a patient’s medical history and performing a physical exam, a physician is able to identify the type of pain and initiate specific therapy. Pain can be managed in two different ways: through non-invasive modalities or invasive modalities. The non-invasive modalities are getting a good deal of attention these days. They include drug therapies, as well as complementary and integrative therapies, such as hypnosis, meditation, biofeedback, acupuncture, massage and relaxation. Psychotherapists and chaplains also may provide help.
Invasive modalities include nerve blocks and epidural catheters. Often the solution is multimodal, combining several of these modalities. Good pain control facilitates effective occupational and physical therapies.
What is the role of medication in the control of acute pain?
It is not difficult to provide good pain relief with high doses of opioids, but if the patient is totally sedated and non-functional, that type of pain relief is not considered good quality. The latest concept of managing acute pain is to improve functionality. That’s why the multimodal approach is encouraged, attacking the pain with various drugs and procedures that could produce a synergistic effect in controlling pain and at the same time minimize the side effects of these medications by keeping their doses at minimal or optimal levels.
What medical devices are available to manage pain?
There are several devices available to manage acute pain. Some of them help in placing catheters; some help in monitoring patient safety; and some deliver medication into the system. For intravenous administration there are patient-controlled analgesia pumps and intravenous infusion pumps. There also are patient-controlled pumps for epidural administration. These allow for continuous infusion or can deliver doses on demand. For transdermal (through the skin) administration of medication there are skin patches and electronic patient-controlled transdermal pumps.
Peripheral nerve blocks/catheters block pain sensations even before they reach the spinal cord. They are especially excellent for limb surgeries and have no effect on the brain. The patient can even go home with the catheter in place and be monitored by telephone.