5^th International Conference and Exhibition on Pain Research and Management October 05-07, 2017 London, UK

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 medicationscan 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 inneuropathic 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.

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.

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.

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.

Inflammation is a process by which the body's white blood cells and substances they produce protect us from infection with foreign organisms, such as bacteria and viruses. However, in some diseases, like arthritis the body's defense system -- the immune system -- triggers an inflammatory response when there are no foreign invaders to fight off. In these diseases, called autoimmune diseases, the body's normally protective immune system causes damage to its own tissues. The body responds as if normal tissues are infected or somehow abnormal.

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.

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.

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.

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 pediatricpopulation 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. 

The management of pain in dentistry encompasses a number of procedural issues, including the delivery of anesthetic and the management of postprocedural pain, as well as pain diagnosis, management strategies for orofacial conditions that cause pain in the face and head, and the management of pain in special populations. Orofaical pain is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes. Orofacial pain has been defined as "pain localized to the region above the neck, in front of the ears and below the orbitomeatal line, as well as pain within the oral cavity, pain of dental origin and temporomandibular disorders".

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.

Pain is described by the patient mostly in terms such as stabbing, burning, tearing, squeezing, etc. Acute pain is accompanied by a stress response consisting of increase in blood pressure, tachycardia, pupillary dilatation, and high plasma cortisol levels. This may be accompanied by local muscle contraction. Four broad categories of pain are generally Nociception, Pain perception, Pain behaviours.

Chronic pain affects 20% of the European population and is commoner in women, older people, and with relative deprivation. Its management in the community remains generally unsatisfactory, partly because of lack of evidence for effective interventions. Good epidemiological research on chronic pain provides important information on prevalence and factors associated with its onset and persistence. Improving our understanding of associated factors will inform our clinical management, limiting severity, and minimizing disability

Chronic pain syndrome (CPS) is a Major problem that presents a major challenge to health-care providers because of its complex natural history, unclear etiology, and poor response to therapy. Chronic pain syndrome is a constellation of syndromes that usually do not respond to the medical model of care. This condition is managed best with a multidisciplinary approach, requiring good integration and knowledge of multiple organ systems.

Neuropathic pain is pain caused by damage or disease affecting the somatosensory nervous system. Neuropathic pain can be contrasted to nociceptive pain, which is the type of pain which occurs when someone experiences an acute injury. This type of pain is typically short-lived and usually quite responsive to common pain medications in contrast to neuropathic pain.

Neuro-orthopaedic service offers the latest advances in diagnosis and treatment to patients whose arms or legs are impaired by brain injury, stroke, anoxia, central nervous disorders, or orthopaedic conditions

The global pain management devices market is valued at an estimated USD 3.08 Billion in 2016 and is projected to grow at a CAGR of 8.5% during the forecast period of 2016 to 2021. A number of factors, such as the growing demand for long-term pain management among the geriatric population, large patient population base, adverse effects of pain medications, development of novel pain management device, established reimbursement scenario for spinal cord stimulation (SCS) devices in developed countries, and high proven efficacy of pain management device for the treatment of chronic pain are driving the growth of the global market.