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Acute Pain Management


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Table of Contents

Effectiveness of Acute Pain Management
Adverse Effects of Undertreated Severe Acute Pain
Acute Pain Management and Patient Outcomes

Delivery of Effective Acute Pain Management
Guidelines and Protocols
Acute Pain Services

Assessment and Monitoring
Types of Pain
Assessment of Pain and Pain Relief
Assessment of Adverse Effects

Pharmacology of Opioids
Mechanism of Action
Effects of Opioids
Predictors of Opioid Dose
Titration of Opioid Dose
Commonly Used Opioid Agonists
Opioid Antagonists

Pharmacology of Local Anesthetics
Mechanism of Action
Efficacy of Local Anesthetics
Adverse Effects of Local Anesthetics and Their Management
Commonly Used Local Anesthetic Drugs

Nonopioid and Adjuvant Analgesic Agents
Nonselective Nonsteroidal Antiinflammatory Drugs
COX-2 Selective Inhibitors (coxibs)
Alpha-2-adrenergic Agonist Drugs
Antidepressant Drugs
Anticonvulsant Drugs
Membrane Stabilizing Drugs
Inhalational Agents

Systemic Routes of Opioid Administration
Subcutaneous and Intramuscular

Patient-Controlled Analgesia
Analgesic Drugs Used with PCA
The PCA "Prescription"
Requirements for the Safe Management of PCA
Management of Inadequate Analgesia
Complications of PCA
"Step-down" Analgesia
Alternative Systemic Routes of PCA Administration

Epidural and Intrathecal Analgesia
Drugs Used with Epidural Analgesia
Requirements for the Safe Management of Epidural Analgesia
Patient-Controlled Epidural Analgesia
Management of Inadequate Analgesia
"Step-down" Analgesia
Complications and side Effects of Epidural Analgesia
Concurrent Antithrombotic or Antiplatelet Therapy
Intrathecal Analgesia

Other Regional and Local Analgesia
Continuous Peripheral Nerve Blockade
Intraarticular Analgesia
Wound Infiltration
Topical Analgesia

Nonpharmacological Therapies
Psychological Interventions
Transcutaneous Electrical Nerve Stimulation
Physical Interventions

Acute Neuropathic and Persistent Postacute Pain
Pathophysiology of Neuropathic Pain
Clinical Features and Diagnosis of Neuropathic Pain
Acute Neuropathic Pain Syndromes
Treatment of Acute Neuropathic Pain
Progression of Acute to Persistent Pain
Preventive Analgesia

Nonsurgical Acute Pain
Burns Injury
Spinal Cord Injury
Other Specific Conditions

More Complex Patients
Older Patients
Opioid-Tolerant Patients
Patients with an Addiction Disorder
Patients with Obstructive Sleep Apnea
Pregnant or Lactating Patients
Patients with Renal or Hepatic Impairment

Opioid Analgesia after Discharge from Hospital
Potential Risks
Choice of Discharge Opioid Regimen
Information for Patients and Treating Doctors

Self-Assessment Questions

About the Author

Pamela E. Macintyre, BMedSc, MBBS, MHA, FANZCA, FFPMANZCA, Director Acute Pain Service, Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital and clinical associate professor, Discipline of Acute Care Medicine, School of Medicine, University of Adelaide, Australia. Stephan A. Schug, MD, FANZCA, FFPMANZCA, Professor and Chair of Anaesthesiology, Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia and Director of Pain Medicine, Royal Perth Hospital, Australia.


"This is the fourth edition of a practical guide to acute pain management, and the first edition that includes access to an ebook version. ... This is a handy resource for anyone who takes care of patients in pain, regardless of the setting. The authors are experienced clinicians who have been writing about this subject for a long time. ... There are others books on acute pain management, but they tend to focus more on theory than on practice. This one provides the nitty-gritty details of pain management that are expected to be taught at the bedside but often are not."
-Tariq M. Malik, MD, University of Chicago Pritzker School of Medicine in Doody's Book Reviews

"This exceptional book incorporates a conglomerate of evidence about acute pain. Outstanding is the concise format which makes it very usable for clinicians."
-Prof. Esther Pogatzki-Zahn, MD, Department of Anesthesiology, University Hospital Muenster, Germany

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