The challenges militating against effective pharmacological pain management.

1. We can
challenge
the
challenges
Dr Roshana Mallawaarachchi

2. Percentage of adults aged 18 and over with
chronic pain and high-impact chronic pain
in the past 3 months, by age group: United
States, 2019

5. What are the Barriers to Pain Management?
Patient
Institutional
Staff

6. What are the Barriers to Pain Management?
Patient
 Inevitability of pain
 Analgesia fears misconceptions
 Being a good patient
 Distracting from treatment
 Trade-offs analgesics side effect

7. What is nurses responsibility?
Explore patients’ concerns about
side effects or addiction through
focused questioning and
effective listening.

8. What are the Barriers to Pain Management?
Institutional
 Lack of institutional commitment
 Poor visibility of the problem
 Unclear lines of responsibility
 Lack of practical tools policies

9. Lack of institutional commitment

10. What Is a Pain Clinic?
Focus on the diagnosis and management of chronic pain.
 Cancer-related pain
 Back ache
 Neck pain
 Facial pain (Trigeminal neuralgia)
 Post herpetic neuralgia
 Phantom limb pain
 Neuropathic pain
 Pancreatitis

11. What Pain Clinic offers?
Drug therapy
Medical interventions such as injections
Physiotherapy and Occupational therapy
Psychological support

12. Who is
responsible?
 Doctors and Nurses
 Psychologists
 Physical therapists
 Occupational and vocational
therapists
 Nutritionists and dietitians

13. Nursing Roles

14. Lack of practical tools policies
 Pain Medication
 New Therapies/Interventions
 Pain managemnt devices
 New Technology
 Uptodate Guidelines

15. New Therapies Interventions

16. Entonox
 Nitrous oxide and Oxygen

17. Epidural in Labour

18. Fentanyl Patch

19. Capsaicin patch

20. IV Tramadol

21. Acupuncture

22. New Technology

23. Radiofrequency Ablation Device

24. HEAT Pain Pro TENS Device
 Combination
of Heat and
TENS
 Musculo and
acute joint
pain

25. ActiPatch

26. BurstDR Stimulation

27. Uptodate
Guidelines

29. What are the Barriers to Pain Management?
Staff
 Attitudes beliefs of staff
 No routine pain assessment
 Under-estimation of patients pain
 Analgesia misconceptions
 Prescribing administration inconsistencies
 Inadequate knowledge and education

30. Attitudes beliefs of staff

34. No routine pain assessment

35. Myths about children’s pain
 Infants do not feel pain (Develop in 26-week-old foetus)
 Children easily become addicted to narcotics (Only less
than 1%)
 Children tolerate pain better than adults (Tolerance
increases with age)
 Children are unable to tell you they hurt (Use scales, Eg:
faces pain scale)
 Children will tell you when they are experiencing pain
(Fear of injections)

36. Myths Regarding Opioid Use
 Tend to give lower doses
 Pain medications always lead to addiction (Less than 1%)
 Cause heavy sedation
 Some kinds of pain cannot be relieved (Need multimodal
Rx)
 Achieved on an “as needed” basis (Provide “around the
clock”)
 Narcotic analgesics in older patients should be avoided.
(No age limit)

37. Myths associated
with
Labour Epidurals

38. Myth: There’s a limited window of time
when you can get an epidural.
 Mother can get an epidural any time
during your labor:
 In the beginning, the middle or even
toward the end.

39. Myth: Epidurals can harm the baby.
 The amount of medication that reaches the baby
from the epidural is so small it doesn’t cause harm.

40. Do epidurals cause back pain?
 Epidural analgesia has not been
associated with an increase in the
prevalence or incidence of backache.

41. Myth: Epidurals can cause permanent back
pain or paralysis in the mother.
 Serious complications from an epidural, including
paralysis, are extremely rare.
 Some women have discomfort in the lower back (where
the catheter was inserted) for a few hours or days after
the epidural, but it doesn’t last.

42. Myth: Epidurals can slow down labor or
increase the risk of having a cesarean section
(C-section).
 There is no credible evidence that an epidural
slows down labor or increases your risk of
having a C-section.
 In fact, there is evidence that epidurals can
speed the first stage of labor for some women.

43. Myth: An epidural can interfere with the
birth experience.
 The epidural medications will not cause to
be weak or tired.
 Mother will be able to feel contractions –
they just won’t hurt – and they will be able
to push effectively.

44. Does epidural cause maternal fever?
 Minimal increase in body temperature
 little clinical significance
 Not associated with neonatal infection

45. Myth: Do epidurals interfere with
breastfeeding?
 Low-dose local anaesthetic ⁄ low-dose fentanyl
epidural labour analgesia regimens do not clinically
affect breastfeeding and should be still offered to
mothers wishing to breastfeed their babies.