Journal of Community Medicine & Health Education
Open Access

Abstract

Pain Management is an integral part of therapeutics and clinical medicine. The physiology and pathology of pain whether peripheral or central involves nociception and transmission from the injured tissue-skin, muscle or viscera. Afferent fibers, spinal cord sensory cells and chemical mediators play a pivotal role. Pain management is associated with a Step Up approach relating to the type of pain and underlying pathophysiology. Traditionally Non-Steroidal Anti-inflammatory drugs have been the mainstay of treatment. However failure of NSAID�s to treat pain or more chronic conditions require a Step 1 Up approach which would then introduce the opioids. Opioid analgesics address central mechanisms and are also used to treat severe pain particularly those associated with terminal illness and myocardial infarcts. The mechanisms of action, of opioids are similar however they differ in pharmacokinetic parameters. Conditions such as trigeminal neuralgia, neuropathic pain, Multiple sclerosis, cerebral palsy, Fibromyalgia and Diabetic neuropathy are addressed differently. These conditions involve the use of carbamazepine, gabapentin, TCA and SSRI; s to name a few. This presentation addresses the use of opioids and general approach to the treatment of these conditions.

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