疼痛的藥物治療

Medication

for

Pain

Teng

Tong

De

Yao

Wu

Zhi

LiaoSpeaker:

XX

teacher1.KnowledgeAim:

Tomastertheprinciplesofdrugtherapyforpain,rationalselectionoftherapeuticdrugs,adversereactions,preventionandtreatmentofcommonlyuseddrugs.Familiarwiththetreatmentofchronicpaindrugaction,druginteraction2.AbilityAim:

Abletounderstandthepainpatientsfaceandguidetherationaluseofanalgesics.3.IdeologicalandPoliticalAimoftheCourse:

Transitionfrom“youwillneverunderstandthepainofothers”to“Understandpaincorrectly”LearningAimOverview

of

Pain

TreatmentChronic

PainWhat

pains

have

you

had

in

your

life?How

is

it

relieved?Overview

of

Pain

TreatmentChronic

PainPain

is

a

protective

response

of

the

body,reminding

the

body

to

avoid

or

deal

with

injuries

and

is

also

a

common

symptom

of

manyclinical

diseases;Severe

pain

not

only

brings

pain

and

anxiety

to

patients

but

also

causes

physiologicaldisorders

even

induces

shock

which

endangers

life.Overview

of

Pain

TreatmentChronic

PainA.

Overview

of

Disease

Definition:

Painful

feelings

and

emotional

experiences

resulting

from

actual

or

potential

tissue

damage

(InternationalAssociation

for

the

Study

of

Pain,

IASP)

Classification:

(where

pain

occurs)

Fast

pain

(sharp

pain)

—accurate

orientation,

rapid

occurrence,

short

Somatic

pain

Slow

pain

(dull

pain)

—imprecise

orientation,

slow

occurrence,

long

Visceralgia

Neuropathic

painOverview

of

Pain

TreatmentChronic

PainB.

Diagnosis

and

Treatment

of

PainPainisasubjectiveexperiencethatisdifficulttodefineaccurately,andtheevaluationofpainintensityshouldalwaysemphasizethepatient'sowndescriptionofpain,ratherthansubjectivejudgment.Numeric

rating

scale

(NRS)pain

questionnairePain

IntensityAssessment

Linear

visual

analog

scale

scoring

method

(VAS)

Verbal

rating

scale

(VRS)Overview

of

Pain

TreatmentChronic

PainPain

IntensityAssessmentPainlessPain

affects

sleepCan

not

fall

asleepSharp

painMildModerateSevereNumeric

Rating

Scale

(NRS)PainlessSlight

painMild

painModerate

painSevere

painSharp

painFacial

expression

assessment

methodOverview

of

Pain

TreatmentChronic

Pain

Pain

IntensityAssessmentCriteria

for

Pain

ControlThe

pain

intensity

of

NRS

is

less

than

3

or

is

0;Sudden

pain

within

24

hours

is

less

than

3

times;Analgesia

within

24

hours

is

less

than

3

times;Overview

of

Pain

TreatmentChronic

PainUnderstand

pain

correctlyYou

will

never

understand

the

pain

ofothersOverview

of

Pain

TreatmentChronic

PainOverview

of

PainTreatmentChronic

PainDefinition

Pain（IASP)

that

exceeds

the

normal

tissue

healing

time

(usually

3

months)；

Clinically,

chronic

pain

refers

to

pain

that

lasts

longer

than

6

months.Classification(Etiology)A.

Non-cancerous

Pain:

prosopalgia,

postherpetic

neuralgia,

pain

phantom

limb,

migraine,

lumbago

and

backache;B.

Cancerous

Pain:TreatmentMeansEtiology

removal,

drug

therapy,

nerve

block,

surgery,

psychotherapy

and

other

combined

treatment.Overview

of

PainTreatmentChronic

PainA.

Commonly

used

therapeutic

drugs

Nonsteroidal

ant

i-inflammatory

d

rugs

(NSAIDs)Centralanalgesics

M

receptor

blockerAncillary

drugOverview

of

PainTreatmentChronic

PainMechanism

of

action:Classification:Feature:Application:

inhibit

COX

and

reduce

the

synthesis

of

PG;

non-selective

COX

inhibitors

and

selective

COX-2

inhibitors;there

is

a

capping

effect

and

most

drugs

are

OTC;

better

effect

for

moderate

dull

pain

and

mild

cancerouspain;

headache,

toothache,

neuralgia,

arthralgia,

muscle

pain,

dysmenorrhea

and

mild

cancerous

pain.(a)

Nonsteroidal

anti-inflammatory

drugs

(NSAIDs)ClassificationDrugsIndicationNon-selectiveCOXinhibitorsSalicylicacidclassAspirinAcoldfever,musclepain,arthralgia,dysmenorrhea,neuralgiaandthemildandmoderatepainofcancerpatient,etcAnilineAcetaminophenAcoldfever,musclepain,arthralgia,dysmenorrhea,neuralgiaandthemildandmoderatepainofcancerpatient,etcArylalkanatesIbuprofenUsualantipyreticanalgesicandthepaincausedbyrheumatismandrheumatoidarthritisNaproxenRheumatoidarthritis(RA),osteoarthritis,AnkylosingSpondylitis(AS),gout,mildandmoderatepaincausedbychronicdiseaseofmotorsystemPyrazoleketonesButazodineRheumatoidarthritis(RA),rheumatoidarthritis,mandatoryspondylitisandacutegoutIndoleaceticacidsIndometacinReliefofacuteandchronicrheumatoidarthritis,anti-inflammatoryanalgesicofgoutyarthritis,migraine,dysmenorrheaandcancerouspainSelectiveCOX-2inhibitorsCelecoxibAcuteandchronicosteoarthritis,rheumatoidarthritis(RA)Overview

of

PainTreatmentChronic

PainNSAIDs

Commonly

Used

and

their

Clinical

UseOverview

of

PainTreatmentChronic

Pain

(b)

CentralAnalgesicsMechanism

of

action:

stimulate

central

opioid

receptor;Classification:

strong,

weak

opioid

receptor

agonists

and

non-opioid;Feature:

strong

analgesia;Application:

Patients

with

moderate

and

severe

chronic

pain

for

which

otheranalgesic

methods

are

ineffective.ClassificationDrugsEffects,featuresandapplicationStrongopioidMorphineStronganalgesiceffect,willbeaddictiveifusedforlong,usuallyusedforacutesharppaininwhichotheranalgesicsareinvalidorlongusedforseverepaincausedbycancerMorphinecontrolledreleasetabletsMainlyapplicabletotheanalgesicofterminalcancerpatientsFentanylAnalgesiceffectis80timesofmorphine,quickonset,shortduration,littleaddiction,canbeusedforallkindsofseverepain,lhas"neurorelaxationanalgesia"effectcombinedwithdroperidolAdanonSimilaranalgesticeffectwithmorphine,slowonset,longduration,littleaddiction,usuallyusedforseveretraumaticandcancerouspain,post-traumaticsurgeryandchronicpainPethidineAnalgesiceffectis1/10~1/8ofmorphine,lessaddictivethanmorphine,usedforallkindsofseverepain,combinedwithatropinetotreatbiliarycolicandrenalcolicPentazocineAnalgesiceffectisstrong,isanon-addictiveanalgesic,usedforchronicseverepainWeakopioidCodeineAnalgesiceffectis1/12~1/7ofmorphine,notaddictive,itisoftencombinedwithacetaminophentotreatmoderatepain,likeheadache,backache,etcNon-opioidRotundineNon-addictiveanalgesic,usedforpepticulcerpain,dysmenorrhea,contractionsafterchildbirthandsoon,especiallyapplicabletoinsomniaccausedbypainduetoitshypnoticeffectTramadolNon-addictiveanalgesic,theintensityissimilarwithpentazocinewhichis1/10~1/8ofmorphine,usedformoderateandsevereacuteandchronicpain,likepostoperativepain,trauma,terminalcancerouspain,neuralgia,etcOverview

of

PainTreatmentChronic

PainThe

effects,

features

and

application

of

central

analgesics

commonly

usedOverview

of

PainTreatmentChronic

Pain(c)

M

Receptor

Blocker

Mechanism

of

action:

block

M

receptor

to

relax

Gastrointestinal

smooth

muscle;

Drugs

commonly

used:

atropine,

anisodamine,

propantheline

bromide,

atropa

belladonna,

etc;

Application:

pain,

renal

colic,

biliary

colic

caused

by

the

stomach

and

intestines

cramps,

pain

of

Gastric

and

duodenal

ulcers.ClassificationDrugsEffect,featureandapplicationCorticosteroidsDrugsPrednison,prednisolone,betamethasone,etcStronganti-inflammatoryeffect,reducecongestionandedemaofthearea,preventinflammatorymediumtostimulatetissuesoastorelievepainTricyclicantidepressantAmitriptyline,fluoxetine,etcUsedforanalgesia,sedation,changethemoodandisthecommonlyusedancillarydrugsAnti-seizuremedicationCarbamazepine,phenytoinInhibitionofspontaneousneurondischarge,canbeeffectivelyusedinneuralgiaSedativehypnoticsDiazepam,estazolam,etcRelievepatient'sanxiousstateandirritablemood,improvethequalityofsleep,etc,assistanalgesiaLocalanestheticsLlidocaine,procaineChronicpainwithelectricshock-likepain,painblocktherapyOverview

of

PainTreatmentChronic

Pain(d)

Ancillary

DrugsEffect,featureandapplicationofancillarydrugscommonlyusedOverview

of

PainTreatmentChronic

PainC.

Principles

of

Drug

Therapy

Follow

WHO

three-step

analgesia

principle

for

cancer

pain

treatment

5.

Oral

drug

administration:

try

best

to

use

oral

drug

administration,

avoid

traumatic

drug

administration;

4.

Proceed

drug

administration

on

time:

proceed

with

drug

administration

at

regular

intervals

to

ensure

continuity

of

pain

relief;

3.

Proceed

drug

administration

by

step:

drug

selection

should

be

graded

up

according

to

the

intensity

of

pain

from

weak

to

strong;

2.

Proceed

drug

administration

by

individualization:

the

use

of

analgesic

drugs

should

be

graded

up

from

weak

to

strong,

pay

attention

to

the

actual

curative

effect

of

specific

patients;

1.

Pay

attention

to

specific

details:

deal

with

adverse

reactions

of

various

drugs

timely,

adjust

drug

dosage

timely.Pain

is

controlledOverview

of

PainTreatmentChronic

Pain

Grade

1

pain

NonsteroidalAnti-inflammatory

drugs

(NSAIDs)

+

ancillary

drugThree-StepAnalgesia

Treatment

of

Cancerous

Pain

Treatment

Pain

is

not

controlledGrade

2

moderate

pain

Weak

opioid

drug

+

NSAIDs

+ancillary

drugPain

is

not

controlledGrade

3

severe

continuous

pain

Strong

opioid

+

NSAIDs

+ancillary

drugOverview

of

PainTreatmentChronic

PainMisunderstanding:

Cancer

patients

taking

morphine

are

dying

Drugs

have

both

side

effects

and

treatment

effects,

like

a

double-edged

swordOverview

of

PainTreatmentChronic

PainD.

Adverse

Reaction,

Prophylaxis

and

Treatment

of

Drugs1.

Nonsteroidal

anti-inflammatory

drugs

(NSAIDs)Gastrointestinal

reaction

Blood

andhematopoietic

system

effect

Liver

andkidney

function

damageNaphylaxisOther

adverse

rea