Lecture on Pain Management

Personal Anecdote

• Speaker fell while skiing at 13 and tore knee ligaments
• Experienced severe pain until opioid injection at hospital
• Highlighted importance of physicians in relieving pain and suffering

Categories of Pain Medications

1. Opioids

• Act on the central nervous system
• Bind to opioid receptors
• Useful for nociceptive pain, inflammatory pain, and sometimes neuropathic pain
• Effective for moderate to severe pain

2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Examples: aspirin, ibuprofen, naproxen
• Mechanism: Block cyclooxygenase enzyme that produces prostaglandins
• Prostaglandins are involved in pain and inflammation
• Useful for nociceptive and inflammatory pain
• Less useful for neuropathic or dysfunctional pain

3. Acetaminophen

• Unique category due to unknown exact mechanism
• Lacks anti-inflammatory effects
• Mostly useful for nociceptive pain

4. Adjuvants

• Include anti-seizure medications and antidepressants
• Block neural transmission
• Most useful for neuropathic pain

Addressing Pathological/Dysfunctional Pain

• No specific category of medication directly targets dysfunctional pathological pain
• Effective pain management can be achieved through Woodruff's model of total suffering
• Impact on physical symptoms and hidden suffering (cultural, spiritual, social, psychological) can significantly affect the overall experience of pain