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PALLIATIVE TREATMENT OF CHRONIC PAIN

                      Palliative treatment of the Chronic pain


Persistent or chronic pain is quite a widespread phenomenon in the lives of the patients around the world, which most of the times is unable to be relieved by any common medication or other physical treatments. The solution for this condition is the pain management programs whose main emphasis is to improve the quality of life as much as possible, by improving the physical and psychological well-being of a person.
    The 1st step or you can say the cornerstone in the pain management(Palliative treatment of chronic pain) is to asses and reassess the patient's condition to know the root cause of the chronic pain. It can be done by taking a complete history and the physical examination of the patient by keeping in view of the parameters like intensity, location, timing, relieving or aggravating factors, timing, quality, radiation etc. The final treatment totally depends on the above mentioned factors.
So, to start with the medication, one has to follow the protocols as determined by WHO or by some other authentic organization dealing in health concerns. By keeping in view the increased need of the improved pain management worldwide, WHO has devised a Protocol which includes three steps. These three steps are:

Step 1: It involves the use of NSAID or acetaminophen with or without any combination therapy in mild pain.

Step 2: In mild to moderate pain weaker opioids can be added to the NSAIDS or    Acetaminophen
.
Step 3: In moderate to severe pain the therapy can be stronger opioids with NSAID or Acetaminophen.

A few examples of pain management or palliative treatment of chronic pain are as given below:

Cancer patients most of the times rely on opioids for their pain management. NSAIDS are of little or no use in the cancer patients. Usually the therapy is started with weal opioids (Codeine and hydrocodone) and then titrated to a stronger one (Morphine sulfate or hydromorphone). Transdermal Fantanyl patches is also used commonly in patients with cancer. The frequency of the dosage and the strength can be adjusted as per said by the Doctor or pharmacist.
Visceral pain is a nociceptive pain. Opioids are generally the principal line of therapy for this kind of pain. Therapy can be started after the careful assessment of the patient.
Somatic pain management most of the times involves the use of NSAIDS. As NSAIDS do not play any role in the activation of the opioid receptors, so they can easily be used with opioids if the pain gets severe. In certain circumstances, if the patient fails to respond to NSAIDS, then corticosteroid therapy can be helpful.
Patients with Neuropathic pain should be treated with tricyclic antidepressants or certain antiseizure medications.
Patients using opioids can develop tolerance and addictions, so they must be carefully monitored while the use of the opioids. So, these patients must be properly counseled about the effects of opioids. Moreover, patients who have been using opioids over an extended time period most of the times develop physiological dependence. One more thing to keep in mind is not to stop the opioid therapy abruptly as it can lead to severe withdrawal effects.

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