Acute Care MedicineCoda ClinicalCritical CareTraumaUpdates in pain management

Updates in pain management by Gavin Pattullo

Opioids are often a mainstay of therapy in trauma pain, though they are in turn the cause of much trauma. For every 4000 Australians prescribed an opioid there will be one death in the community as a result. In-patients similarly have greater risk of harm when their analgesia is opioid based.

This presentation will focus on some of the valuable lessons learnt in pain management resulting from the opioid crisis. These include:

  1. Our need to differentiate clinically between pain and nociception. Pain is assessed by clinicians, using words such as coping, bothersomeness and troubling. Meanwhile, nociception is focussed on physical feelings and sensations.

Profound levels of nociception and the potential to lead to reports of significant pain, a major feature of trauma patients, requires firstly a focus on the two most effective anti-nociceptive strategies of neural blockade and NSAIDs/COX-2 inhibitors before introducing less effective strategies.

  1. Biological strategies of opioids and adjuvant agents have historically managed pain. An increasing focus in clinical practice on non-pharmacological strategies to manage pain, including placebo enhancing communication strategies and message framing.
  2. Avoidance of over-reliance on pain scores. An over-reliance on pain scores can mislead clinicians. Pain scores are useful when there is a clear understanding of the question and the difference between nociception and pain.
  3. Ensuring optimal effectiveness of the opioid avoiding strategy of neural blockade. Four clinical assessment endpoints indicate effectiveness of neural blockade: presence of Dynamic pain relief, Analgesia, Sensory anaesthesia and Opioid sparing/elimination (DASO).

In this podcast, Gavin discusses the practical approaches already in use. Tune in as Gavin provides updates in pain management.

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Gavin Pattullo

Dr Gavin Pattullo FANZCA FFPMANZCA. Consultant Anaesthetist, Specialist Pain Medicine Physician. Acute Pain Service, Royal North Shore Hospital, Sydney, NSW. Clinical Senior Lecturer, University of Sydney.