International Conference on Pain Research & Management October 03-04, 2016 Vancouver, Canada

The World Health Organization recommends a pain ladder for managing analgesia. It was first described for use in cancer pain, but it can be used by medical professionals as a general principle when dealing with analgesia for any type of pain. Generally the drugs are classified for pain mainly include, Opioid medications can provide short, intermediate or long acting analgesia depending upon the specific properties of the medication and whether it is formulated as an extended release drug. Opioid medications may be administered orally, by injection, via nasal mucosa or oral mucosa, rectally transdermally, intravenously, epidurally and intrathecally. In chronic pain conditions that are opioid responsive a combination of a long-acting or extended release medication is often prescribed in conjunction with a shorter-acting medication  for breakthrough pain, or exacerbations. The other major group of analgesics are non-steroidal anti-inflammatory drugs Acetaminophen/paracetamol is not always included in this class of medications. However, acetaminophen may be administered as a single medication or in combination with other analgesics. The alternatively prescribed NSAIDs such as ketoprofen and piroxicam have limited benefit in chronic pain disorders and with long-term use are associated with significant adverse effects. Some antidepressant and antiepileptic drugs are used in chronic pain management and act primarily within the pain pathways of the central nervous system, though peripheral mechanisms have been attributed as well. These mechanisms vary and in general are more effective in neuropathic pain disorders as well as complex regional pain syndrome. Drugs such as gabapentin have been widely prescribed for the off-label use of pain control.Other drugs are often used to help analgesics combat various types of pain, and parts of the overall pain experience, and are hence called adjuvant medications. Gabapentin  an anti-epileptic  not only exerts effects alone on neuropathic pain, but can potentiate opiates. perhaps not prescribed as such, other drugs such as Tagamet and even simple grapefruit juice may also potentiate opiates, by inhibiting CYP450 enzymes in the liver, thereby slowing metabolism of the drug. In addition, orphenadrine, cyclobenzaprine, trazodone and other drugs with anticholinergic properties are useful in conjunction with opioids for neuropathic pain.

While NSAIDs are effective in relieving pain, fever and inflammation, they can cause unwanted side effects. Gastrointestinal side effects such as indigestion, stomach upset or stomach pain are commonly caused by NSAIDs. Use of NSAIDs can also cause ulcers and bleeding in the stomach and other parts of the gastrointestinal tract (gut). This is mainly because these medicines also attack the cyclooxygenase-1 enzyme that protects the stomach lining from normal stomach acid. common side effects of NSAIDs include Salt and fluid retention, Dizziness, Raised liver enzymes, High blood pressure, Less common side effects include: Ulcers of the oesophagus, Heart failure, Hyperkalaemia, Reduced kidney function, Bronchospasm, Skin infections.

To prepare for any chronic pain coping technique, it is important to learn how to use focus and deep breathing to relax the body. Pain control techniques mainly involved Altered focus This is a favorite technique for demonstrating how powerfully the mind can alter sensations in the body. Focus your attention on any specific non-painful part of the body and alter  pain sensation in that part of the body.   Dissociation As the name implies, this chronic pain technique involves mentally separating the painful body part from the rest of the body, or imagining the body and mind as separate, with the chronic pain distant from one’s mind. Sensory splitting This technique involves dividing the sensation into separate parts. Mental anesthesia This involves imagining an injection of numbing anesthetic (like Novocain) into the painful area, such as imagining a numbing solution being injected into your low back.   Mental analgesia Building on the mental anesthesia concept, this technique involves imagining an injection of a strong pain killer, such as morphine, into the painful area. Alternatively, you can imagine your brain producing massive amount of endorphins, the natural pain relieving substance of the body, and having them flow to the painful parts of your body.

Although pain can protect us by forcing us to rest an injury or to stop doing something, the experience of being in a state of uncontrolled pain is horrible, frightening, and can have a profound effect on our quality of life. Uncontrolled pain can leads to some altered physiological effects like Increased oxygen consumption, Impaired bowel moment , Cardiovascular effects, Sleep disturbances, Delays mobilization . It turns out that healing is actually delayed when pain caused by  cell tissue damage is not relieved. Research shows that uncontrolled pain has an adverse effect on our immune system. Continuous pain also appears to lower our body's ability to respond to stressful situations such as surgery, chemotherapy, and psychological stress. Far-reaching consequences can also result from pain due to damage to a nerve.This type of unrelieved pain seems to cause changes in the nervous system that contribute to the development chronic pain long after the damage to the nerve has healed.

These practice tools are available to help healthcare professionals diagnose and treat pain more appropriately in their patients. Pain is often regarded as the fifth vital sign in regard to healthcare because it is accepted now in healthcare that pain, like other vital signs, is an objective sensation rather than subjective. Most pain assessments are done in the form of a scale. The scale is explained to the patient, who then chooses a score. A rating is taken before administering any medication and after the specified time frame to rate the efficacy of treatment. Pain assessment tools mainly includes pain history or clinical history it includes general medical history and specific pain history intensity, location, pathophysiology etc. Uni-dimensional tool is simple easy and very useful mainly includes verbal descriptor scale, verbal numeric rating scale, visual analog scale wong-baker facial pain rating scale. multidimensional instruments Provides more complex information about  pain, For assessing chronic pain and   those are Time consuming.

Non-pharmacological approaches may contribute to effective analgesia and are often well accepted by patients. Some simple measures which are sometimes recommended eg, hot or cold packs have not been well studied. Complementary therapies for pain are often sought out by patients, and require evaluation for their potential role in the palliative care setting. Patient education about managing cancer pain has been studied. A systematic review shows that educational interventions can have a modest but clinically significant impact on pain, and that this is an underutilised strategy.  Non pharmacological methods used in pain management can be classified in different ways In general; they are stated as physical, cognitive, behavioral and other complementary methods or as invasive or non-invasive mehods. Meditation, progressive relaxation, dreaming, rhythmic respiration, biofeedback, therapeutic touching, transcutaneous electricalnerve stimulation, hypnosis, musical therapy, acupressure and cold-hot treatments are non-invasive methods. The most famous and common method among the invasive methods is acupuncture .It is considered that these methods control the gates that are vehicles for pain to be transmitted to the brain and affect pain transmission or the release of natural opioids of the body such as endorphin. 

Pain-relieving drugs, otherwise called analgesics, include nonsteroidal anti-inflammatory drugs, acetaminophen, narcotics, antidepressants, anticonvulsants, and others. NSAIDs and acetaminophen are available as over-the-counter and prescription medications, and are frequently the initial pharmacological treatment for pain. These drugs can also be used as adjuvantes to the other drug therapies, which might require a doctor's prescription. NSAIDs include aspirin, ibuprofen Motrin, Advil, Nuprin, naproxen sodium, and ketoprofen, Orudis KT. These drugs are used to treat pain from inflammation and work by blocking production of pain-enhancing neurotransmitters, such as prostaglandins. Acetaminophen is also effective against pain, but its ability to reduce inflammation is limited. Narcotics handle intense pain effectively, and are used for cancer pain and acute pain that does not respond to NSAIDs and acetaminophen. Narcotics are classified as either opiates or opioids, and are available only with a doctor's prescription. Opiates include morphine and codeine, which are derived from opium, a substance naturally found in some poppy species. Opioids are synthetic drugs based on the structure of opium. This drug class includes drugs such as oxycodon, methadone, and meperidine. Although antidepressant drugs were developed to treat depression, it has been discovered that they are also effective in combating some chronic headaches, cancer pain, and pain associated with nerve damage. Antidepressants that have been shown to have analgesic (pain reducing) properties include amitriptyline Elavil, trazodone and imipramine. Anticonvulsant drugs share a similar background with antidepressants. Developed to treat epilepsy, certain anticonvulsants were found to relieve pain as well. Drugs such as phenytoin and carbamazepine are prescribed to treat the pain associated with nerve damage. Neuroleptic agents in the treatment of pain is limited. However these durgs may be considered for the patients with neuropathic pain . pimozide is durg used to relive from trigeminal neuralgia. Antiepileptic drugs are widely used in pain clinics to treat neuropathic pain. phenytoin is used in the treatment of trigeminal neuralgia. Subsequently, carbamazepine was studied and found to be successful in this alleviating this condition . Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress.

Preventive measures for Pain mainly includes the following procedures  Most entry-site infections can be managed by oral antibiotics, dressing changes, and local incision and drainage. Superficial infections associated with percutaneous catheters often can be managed without having to remove the device. Deep infections, however, can extend to the intrathecal space and generally require removing the indwelling catheter or subcutaneous injection port, followed by appropriate wound management and antibiotic therapy. The National Surgical Infection Prevention Project has guidelines for preoperative antibiotic prophylaxis for surgical patients. Because of the possibility of catastrophic infection, routine antimicrobial prophylaxis is recommended for all patients receiving a spinal cord stimulator or implanted intrathecal drug-delivery system. Cefazolin, clindamycin, and vancomycin are the drugs of choice. A bacterial infection typically caused by S. aureus, epidural abscess is a severe infection of the epidural space that usually requires emergency neurosurgical intervention. Epidural abscess is treated with laminectomy, abscess drainage, and antibiotics, and most patients recover completely. Early diagnosis can help reduce or avoid permanent neurologic deficits.

Pain assessment is critical to optimal pain management interventions. While pain is a highly subjective experience, its management necessitates objective standards of care. The WILDA approach to pain assessment focusing on words to describe pain, intensity, location, duration, and aggravating factors offers a concise template for assessment in patients with acute and chronic pain. Assessment of the patient experiencing pain is the cornerstone to optimal pain management. However, the quality and utility of any assessment tool is only as good as the clinician's ability to thoroughly focus on the patient. This means listening empathically, believing and legitimizing the patient's pain, and understanding, to the best of his or her capability, what the patient may be experiencing. A health care professional's empathic understanding of the patient's pain experience and accompanying symptoms confirms that there is genuine interest in the patient as a person. This can influence a positive pain management outcome. After the assessment, quality pain management depends on clinicians' earnest efforts to ensure that patients have access to the best level of pain relief that can be safely provided. Clinicians most successful at this task are those who are knowledgeable, experienced, empathic, and available to respond to patient needs quickly.

Documentation of pain management is essential for tracking  patient care and for supporting therapeutic treatment. Pain management requires documentation of assessment, interventions, response, and reassessment of pain. Document the patient’s response to pain management, both therapeutic and adverse, as well as the following information specific to pain management. Intensity ,quality, location, onset, frequency, diurnal variation, alleviating factors, radiation are the important factors in Documenting pain.

Individual differences in sensory experiences are of profound importance in the treatment of pain. Subjective ratings are essential for the diagnosis and treatment of pain, but profound individual differences in sensitivity complicate treatment. The study of individual differences in pain has only recently been a topic of focused examination. Historically, reliance on subjective reports dampened enthusiasm for such lines of investigation, but the increasing confidence in psychophysical assessment of pain, in combination with increasing capability to explore genetic contributions to pain, has led to a growth in the output of this aspect of  pain research.The contributions of functional imaging studies to the determination of the neural mechanisms supporting cognitive and psychological modulation of pain has opened new realms for the investigation of individual differences. However, the development of a full understanding of individual differences in pain remains challenging, due to the myriad of genetic, environmental, psychological, and cognitive variables that can shape such differences. 

There are several causes of cancer pain, however usually cancer pain happens once a tumor presses on nerves or body organs or once cancer cells invade bones or body organs. Cancer treatments like therapy radiation, or surgery conjointly might cause pain. Cancer pain is acute or chronic. Acute pain is owing to injury caused by AN injury and tends to solely last a brief time. For instance, having an operation will cause acute pain. The pain goes once the wound heals. Within the in the meantime, painkillers can typically keep it in check. Chronic pain is pain caused by changes to nerves. Nerve changes might occur owing to cancer pressing on nerves or owing to chemical produced by a tumor. It may also be caused by nerve changes owing to cancer treatment. The pain continues long once the injury or treatment is over and may vary from delicate to severe. It is there all the time and is additionally referred to as persistent pain. Chronic pain is tough to treat, however painkillers or alternative pain management strategies will usually with success management it.

Chronic pain  may be a growing downside among pediatric and adolescents, with some epidemiologic studies indicating that roughly half-hour of youngsters and adolescents expertise pain that lasts for three months or longer. The foremost common pediatric chronic pain complaints mainly migraine repeated abdominal pain, and general contractile organ pain, together with limb pain and back pain. Chronic pain is usually related to practical incapacity. Within the pediatric population this incapacity most often manifests as college impairment, problem maintaining social contacts, slashed participation in recreational activities, impairments in health connected quality of life, and a rise in health care utilization. As a result, these patients actual high prices on the health care system. 

Orofacial pain may be outlined as pain localized to the region on top of the neck, before of the ears and below the orbitomeatal line, yet as pain at intervals the rima oris.Orofacial pain disorders square measure extremely rife and enervating conditions involving the top, face, and neck. These conditions represent a challenge to the practician since the orofacial region is advanced and so, pain will arise from several sources. The orofacial pain classification is split into physical and psychological conditions. Physical conditions comprise emporomandibular disorders (TMD), that embrace disorders of the articulatio temporomandibularis (TMJ) and disorders of the contractor structures (eg, masticatory muscles and cervical  neuropathic pains, that embrace episodic and continuous (eg, peripheral/centralized mediated) pains and neurovascular disorders (eg, migraine).Psychological conditions embrace mood and anxiety isorders. This review focuses on the present views in orofacial pain management. The scope of orofacial pain includes common disorders like dental pain and TMDs, yet as variety of rare pain syndromes. Pain within the orofacial region springs fromseveral distinctive tissues like teeth, meninges, and cornea. This ends up in many distinctivephysiological mechanisms that are well reviewed Because of those distinctive mechanisms and also the demand for specialist data of the advanced anatomy and physiology of the orofacial region designation could also be tough. several patients have consulted multiple clinicians for his or her condition nonetheless stay unknown or with Associate in Nursing incorrect designation.

The nurse’s primary commitment is to the health, welfare, comfort and safety of the patient. Self-awareness, knowledge of pain and pain assessment, and knowledge of the standard of care for pain management enhances the nurse’s ability to advocate for and assure effective pain management for each patient. When advocating for the patient, it is crucial that the nurse utilize and reference current evidence-based pain management standards and guidelines.The Role of nurse  is responsible and accountable to ensure that a patient receives appropriate evidence-based nursing assessment and intervention which effectively treats the patient’s pain and meets the recognized standard of care.