Wilderness and Rescue Medicine 8th Edition

Chapter 12: Pain Management

Pain has a purpose: to keep us from damaging ourselves. Once the damage is done, however, pain becomes a management problem. It is a natural and appropriate reaction for you to want to relieve someone’s suffering, especially if you are the caregiver. The most effective form of pain relief is to cor- rect the cause. Reduce the dislocation , loosen the splint, drain the abscess , or rehydrate the dried-out hiker with the headache. Secondary swelling can be reduced with elevation and cool- ing. Unstable injuries are less painful when effec- tively stabilized. Acute partial-thickness burns are less painful when occlusive dressings are applied. Ask the patient what feels better and help them achieve it. Sometimes, however, definitive field treatment is not possible or does not completely fix the prob- lem. The pain remains, and you are left to treat the pain as a symptom, being fully aware that the original problemmay remain. Nevertheless, pain by itself is not a true emergency. Pain Medication Medications for pain come in two basic forms: analgesics and anesthetics. Analgesics work systemically to reduce the production of pain impulses, or the perception of pain by the brain.

Anesthetics work by inactivating nerve cells, caus- ing temporary numbness. The two forms are often used concurrently, and both have a place in pain management in the backcountry setting. Analgesics can be divided into three classes: nonsteroidal anti-inflammatory drugs (NSAIDs), other non-opioid analgesics, and opioids. NSAIDs include such medications as aspirin, ibuprofen, and naproxen sodium. These medications work by inhibiting the action of some of the chemical mediators of inflammation and pain at the site of injury. The result is fewer pain impulses being transmitted from the injury to the brain. The vari- ous NSAIDs work in slightly different ways, but all work to reduce pain, fever, and inflammation. Ibuprofen is a good example, and very effective in therapeutic doses of 400–600 mg every 8 hours for an adult.

Pain Medication Non-steroidal anti-inflammatory drugs: ibuprofen, naproxen sodium, aspirin, ketorolac… Non-opioid analgesics: acetaminophen, paracetamol Opioids: morphine, hydrocodone, oxycodone, fentanyl… Combinations: Vicodin, Percocet, Vicoprofen , Lortabs…

General Principles

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