MindMap Gallery Surgery Pain Management
This is an article about surgery: pain treatment mind map, including the definition, classification, physiological impact and treatment of pain. If you need it, collect it quickly!
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pain treatment
Overview
Pain: An unpleasant subjective feeling produced by the brain in response to damage to body tissue or to stimuli that may cause tissue damage. Nociception: the response of an unconscious patient to tissue damage or noxious stimulation
clinical classification
pain level
slight
Moderate
severe
Rapid onset
Acute pain - trauma, surgery, acute inflammation, acute organ ischemia, acute organ obstruction and traction
Chronic pain - chronic low back and leg pain, cancer pain
Neuropathic pain: Pain caused by neuropathy and damage to any part of the peripheral or central nervous system - postherpetic neuralgia, diabetic neuropathy, stump pain, phantom limb pain
Pain area
Superficial pain - cornea, dental pulp; sharp pain, localized, well-localized; Aδ myelinated nerve fibers
Deep pain - internal organs, joints, ligaments, periosteum; dull pain, widespread, unclear localization; type C unmyelinated nerve fibers
pain level assessment
visual analog scale
0-10 scale: 0 represents no pain, 10 represents the most severe pain; ask the patient to mark according to the pain feeling
Numerical rating scale
0-10 numerical representation, let the patient choose a number to represent the pain level
physiological effects
Mental emotions
Acute pain - excitement, anxiety and restlessness
Long-term chronic pain - apathy, depression, despair
endocrine
Stress releases a variety of hormones—catecholamines, corticosteroids, angiotensin II, antidiuretic hormone, adrenocorticotropic hormone, aldosterone, growth hormone, and thyroxine
Catecholamines – inhibit insulin, promote glucagon – increase blood sugar, negative nitrogen balance (gluconeogenesis)
circulatory system
Catecholamines, angiotensin II—increased blood pressure, tachycardia, and even arrhythmia
Aldosterone, corticosteroids, antidiuretic hormone – sodium and water retention
Severe deep pain—sympathetic and parasympathetic disorders—lowering of blood pressure, slowing of heart rate, even collapse and shock
respiratory system
Thoracic and abdominal surgery - increased muscle tone, decreased thoracic compliance - shallow and rapid breathing, decreased vital capacity - hypoxemia; Affects deep breathing and forced coughing - obstacles to the removal of alveolar and bronchial secretions - pneumonia, atelectasis
digestive system
Chronic pain - anorexia, digestive dysfunction, nausea, vomiting
coagulation
The blood is in a hypercoagulable state
other
Decreased immune function - not conducive to preventing and treating infections and controlling the spread of tumors
Renal vasoconstriction, increased antidiuretic hormone - decreased urine output
Postoperative pain - difficulty urinating, prolonged urination - urinary tract infection
benefit
Induce the body to produce protective behaviors to avoid noxious stimuli
chronic pain treatment
Pain that lasts longer than the typical course of the disease/longer than the normal time required for the injury to heal (pain recurrence lasts for more than 1 month/pain that lasts for more than 3 months)
Diagnosis and treatment scope
Neck and shoulder pain, waist and leg pain
Chronic injury diseases of limbs
neuralgia
Peripheral vascular disease: Thromboangitis obliterans, Raynaud's syndrome
cancer pain
AIDS pain
psychogenic pain
treatment method
medical treatement
Chronic pain - regular and quantitative medication
Antipyretic, analgesic and anti-inflammatory drugs - headache, toothache, neuralgia, muscle pain, joint pain
Narcotic analgesics—trauma, surgery, late-stage cancer pain; beware of addiction
Anti-epileptic drugs: Carbamazepine - trigeminal neuralgia, glossopharyngeal neuralgia Gabapentin, pregabalin - neuropathic pain (diabetic peripheral neuralgia, postherpetic neuralgia, phantom limb pain, post-traumatic neuralgia)
Antidepressants—cancer pain, opioid resistance, poor opioid efficacy—concomitant use of antidepressants
Glucocorticoids - inflammation, cancer pain, complex regional pain syndrome
nerve block
stellate ganglion block
Anterolateral between the 7th cervical vertebra and the 1st thoracic vertebra
Suitable for migraine, caustic neuralgia, phantom limb pain, Raynaud's syndrome, thromboangiitis obliterans, herpes zoster
complication
local anesthetic toxic reactions
Accidentally injected into the spinal canal, blood pressure dropped, and breathing stopped.
pneumothorax
Phrenic nerve palsy
recurrent laryngeal nerve palsy
lumbar sympathetic nerve block
There are 4 to 5 pairs of ganglia on the left and right sides of the lumbar vertebrae on the anterolateral side.
Lower limb temperature increases and blood vessels dilate after block
complication
Accidental injection into subarachnoid space
local anesthetic toxic reactions
Injury causing local hematoma
Neuraxial drug therapy
Subarachnoid space injection
epidural space injection
Glucocorticoids - cervical spondylosis, lumbar disc herniation; reduce/eliminate inflammation
Opioids—cancer pain
local anesthetic
Pain point injection
Chronic pain disorders: tenosynovitis, frozen shoulder, lateral epicondylitis, tension headache, lumbar muscle strain
Acupuncture, massage, physiotherapy, transcutaneous electrical nerve stimulation, psychotherapy
Cancer pain treatment
The basic principle
Choose analgesics based on pain level
Mainly taken orally
Take medicine on time
personalized medicine
three step therapy
one: Mild pain – non-opioid: aspirin, ibuprofen, acetaminophen
two: Mild to moderate pain – add a weak opioid: codeine
three: Strong Opioids: Morphine
intraneural injection
Epidural injection of morphine
Inject nerve-damaging drugs into the subarachnoid space: phenol, absolute ethanol
Radiation therapy, chemotherapy, hormone therapy