Pain Management for Other Forms of Trauma

The Migraine And Headache Program

Migraines Treatment Diet

Get Instant Access

Providing analgesia to the trauma patient is a unique and challenging objective for healthcare professionals. The trauma victim often presents with multiple sites of injury resulting in respiratory, cardiovascular, and hemodynamic instability that require immediate attention (Table 19.3). These patients range from young healthy athletes to the debilitated elderly who may have a host of comorbid conditions. Whereas young males represent a disproportionate percentage of trauma victims, it is the elderly who are at highest risk for mortality. Lastly, the trauma itself may serve as a strong emotional stressor that may contribute to pain. These factors must be accounted for when developing an appropriate analgesic strategy.

Pain that arises from trauma often results in a vicious cycle. Increased pain stimuli result in increased firing in primary and secondary afferent neurons, which can lead to central

Table 19.3 Epidemiology, concerns, and analgesic strategies for various types of trauma.

Trauma

Frequency

Causes

Immediate concerns

Analgesic strategies

Long-term sequelae

Blunt chest

8% of trauma

MVC, falls

Pneumothorax,

Thoracic epidural,

High incidence of

trauma

admissions

hemothorax,

lumbar epidural,

postthoracotomy pain if

pulmonary/cardiac

interpleural catheter,

surgery required

contusion, cardiac

IV-PCA, intercostal

tamponade

nerve blocks, or

cryoanalgesia

Traumatic

1.5 million per

MVC, firearms,

Intracranial bleed,

Short term: analgesic

Chronic headaches,

brain injury

year in US

falls

spinal cord injury,

care plan that

neck pain, back pain,

cerebral edema,

minimizes effects on

cognitive impairment,

and hypoxia

cerebral

psychological disorders

hemodynamics; long

term: it may include

prophylactic and/or

abortive therapy for

headaches, nerve

blocks for neck pain,

and cervicogenic

headaches

Traumatic

Trauma accounts

MVC,power

Blood loss, limb

Mixed evidence for

Traumatic lower limb

amputation

for >16% of the

tools, lawn

preservation,

preemptive effect of

amputees have

>133,000

mowers, crush

which can

epidural analgesia to

increased morbidity

amputations per

injuries, knives,

significantly

prevent postamputation

and mortality from

year in US. The

and saws

improve long-term

pain in planned

cardiovascular disease.

last sentence

function

amputations. Treatment

High prevalence rates

should be Most

of stump pain should

of back pain (>50%),

involve digits in

focus on underlying

hip pain, bursitis, and

the upper

cause (e.g., neuroma,

other musculoskeletal

extremities

heterotopic

conditions in lower

ossification, adhesive

extremity amputees.

scar tissue, ill-fitting

Heterotopic ossification

prosthesis). Strongest

is much more common

evidence for short-term

(>50%) in major limb

benefit for phantom

traumatic amputations

pain is for opioids

Spinal cord

100,000 per year

MVC, falls,

Spinal stability,

Treatment should be

Psychological

injury

in the USA

sports injuries

aspiration,

aimed at the different

disorders, pressure

hypoventilation

types of pain: central

ulcers, impaired coping

(deafferentation),

skills

peripheral neuropathic

(radiculopathy, complex

regional pain

syndrome), spasticity,

visceral (e.g., organ

distension)

MVC = motor vehicle collision; IV = intravenous; PCA = patient-controlled analgesia.

MVC = motor vehicle collision; IV = intravenous; PCA = patient-controlled analgesia.

Table 19.4 Pharmacologic agents used in trauma.

Analgesic agents

Non-steroidal anti-inflammatory drugs (NSAIDs)/acetaminophen

Tramadol

Opioids

Adjuvant agents

Local anesthetics Ketamine

Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors

Anticonvulsants

Clonidine

Benzodiazepines

Antihistamines

Entonox (50:50% nitrous oxide:oxygen mixture) Corticosteroids sensitization. A successful analgesic strategy should aim to interrupt this cycle as soon as possible after the injury and provide maintenance relief thereafter. Early and aggressive use of analgesic interventions has been shown to reduce analgesic requirements and improve long-term outcomes for traumatic injuries (Hedderich and Ness 1999). In blunt chest trauma, inadequate analgesia may result in hypoventilation and the inability to clear secretions, leading to the development of atelectasis and pneumonia (Miller et al. 2009). In a study by Gaillard et al. (1990) published in 1990 in over 400 patients with multiple trauma including chest injuries, the authors reported mortality rates of 69, 56, 42, and 38% for flail chest, pulmonary contusion, hemothorax, and pneumothorax, respectively. A larger study by Ziegler and Agarwal reported a mortality rate of 12% in 711 patients with rib fractures secondary to trauma (Ziegler and Agarwal 1994). Table 19.4 summarizes analgesic and other adjuvant agents useful in the trauma setting.

Was this article helpful?

0 0
The Prevention and Treatment of Headaches

The Prevention and Treatment of Headaches

Are Constant Headaches Making Your Life Stressful? Discover Proven Methods For Eliminating Even The Most Powerful Of Headaches, It’s Easier Than You Think… Stop Chronic Migraine Pain and Tension Headaches From Destroying Your Life… Proven steps anyone can take to overcome even the worst chronic head pain…

Get My Free Audio Book


Post a comment