Acute and Chronic Pain Management

Training Objectives

Acute Pain

• Organization of acute pain service and role of acute pain nurse
• Pain assessment in various groups of patients
• Physiological changes secondary to pain
• Different modalities of pain control
• Pharmacology and side effects of opioid analgesia and non-opioid analgesia
• Principle of patient-controlled analgesia and assessment of its efficacy
• Pharmacology and side effects of epidural/intra-thecal opioid
• Neurological assessment of epidural blockade and management of failed block
• Management of regional blockade – brachial plexus, para-vertebral and intra-pleural block
• Management of epidural abscess
• Substance abuse and acute pain control
• Pain control in concurrent medical diseases – COAD, IHD, bleeding tendency, geriatric
• Pain control in burns patients
• Pain control in trauma patients included multiple rib fracture
  

Chronic Pain

• Differentiation of nociceptive pain and neuropathic pain
• Mechanism of chronic pain and role of NMDA receptor
• Different modalities of chronic pain management – physical therapy, psychotherapy, neuro-ablation, neuro-augmentation, spinal opioid, interventional neuro-blockade, non-opioid analgesia
• Anatomy, indication, technique and complication of chemical sympathectomy (lumbar sympathectomy, stellate ganglion block, celiac plexus block)
• Principle of management of cancer pain
• Principle of management of non-cancer neuropathic pain – phantom limb pain, post-herpetic neuralgia, complex regional pain syndrome, trigeminal neuralgia
• Principle of management of non-cancer nociceptive pain – myofascial pain, lower back pain, intractable angina, burns, chronic pancreatitis, PVD
• When to refer to pain medicine specialist and role of pain medicine specialist