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Acute Pain Management - Scientific Evidence - Third Edition PDF
Acute Pain Management - Scientific Evidence - Third Edition PDF
Scientific Evidence
Australian and New Zealand
College of Anaesthetists
and Faculty of Pain Medicine
Endorsed by:
FacultyofPainMedicine,RoyalCollegeof
Anaesthetists,UnitedKingdom
RoyalCollegeofAnaesthetists,
UnitedKingdom
AustralianPainSociety
AustralasianFacultyofRehabilitationMedicine
CollegeofAnaesthesiologists,
AcademyofMedicine,Malaysia
CollegeofAnaesthesiologists,
AcademyofMedicine,Singapore
CollegeofIntensiveCareMedicine
ofAustraliaandNewZealand
FacultyofPainMedicine,Collegeof
AnaesthetistsofIreland
HongKongCollegeofAnaesthesiologists
HongKongPainSociety
MalaysianAssociationfortheStudyofPain
NewZealandPainSociety
PainAssociationofSingapore
RoyalAustralianandNewZealandCollegeof
Psychiatrists
RoyalAustralasianCollegeofPhysicians
RoyalAustralasianCollegeofSurgeons
Recommended to members:
AmericanAcademyofPainMedicine
Disclaimer
have established it
Acute Pain:
iii
FOREWORD
iv
FOREWORD
Australasian College of Surgeons, the Royal Australian and New Zealand College of Psychiatrists
Levels of evidence
Key messages
vi
New
nchanged
Strengthened
Weakened
Reversed
New,
is
vii
Acute Pain
, an
Acute
Acute
of Pain Medicine
viii
References
Managing
Int J
:
34
BMJ
:
Contents
FOREWORD
iii
xix
6
7
8
36
43
47
47
73
77
89
97
98
and children
346
367
437
467
467
89
variables
Measurement
N
N
N
N
N
N
N
N
N
N
S
N
S
N
S
N
N
N
N
N
N
N
N
N
N
S
S
N
N
N
W
N
N
S
N
R
N
N
S
N
S
N
N
N
R
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
S
N
S
S
Intrathecal analgesia
S
N
N
S
N
R
S
N
N
N
Q
N
N
N
N
S
Acupuncture
N
S
S
S
N
N
N
N
N
N
N
N
S
N
N
N
S
N
R
N
N
N
N
N
N
N
R
S
N
N
N
N
N
N
N
N
N
S
N
Prehospital analgesia
N
N
N
N
N
Analgesic agents
R
N
N
N
Regional analgesia
nd
S
S
S
N
Q
N
S
N
N
N
Q
N
N
N
N
1.1
Applied
Peripheral nociceptors
physiology of pAin
TRP
TRPM8
cool
TRPA
acid sensing
H
P
serotonin
AMPA
kainate
IP
ATP
HA
serotonin
bradykinin
BI, B
cannabinoid
CB , CB
substance P, neurokinin A
tachykinin
PAR
Although
Sandkuhler,
Carlson et al,
1.2
psychologicAl
Attention
Nelson et al,
Brander
Patient-controlled analgesia
1.3
progression
Fassoulaki et
Inguinal hernia
Psychological vulnerability
1.4
pre-emptive
antagonists
at the
1.5
Adverse
of Acute pAin
II
Neural
and social factors
Metabolic
Source:
Insulin, testosterone
Source:
Hyperglycaemia
factors
neurons
endothelial cells
blood cells
Lipotoxicity
Protein catabolism
with
Basse
Andersen et al,
Cousins
1.6
phArmAcogenomics
Codeine
Tramadol
Methadone
NSAIDs
Rollason et al,
references
Pain
64
Pain
464
Acute Pain 4
46
Lancet
J Pain
77
Pain
Pain
46
63
Science
37
J Pain 6
Pain
Pain
6
76
Acute Pain 4
77
Pain
Pain
Pain
In:
Lancet
Lancet
367
Ann
J Pain 3
76
Ann
J Pain
Acta
Pain
77
Pain
Pain
Pain
3
66
Pain
Acta
Lancet 343
47
Pain
Lancet
BMJ
437
Pain
Pain
J Pain
Pain
Acute Pain
74
Pain Management
J Pain 7
46
Pain
Pain 33
JAMA
BMJ
Science
Pain
Pain
Pain
2.1
v
v
v
v
and
v
Assessment
2.2
at rest
meAsurement
Categorical scales
Farrar et al,
Cook
Svensson et al,
2.3
outcome
Pain
v
relief
v
v
Moore
Physical functioning
v
v
Emotional functioning
references
Pain
343
Pain
Pain
Pain
Pain
Pain
J Pain
Pain
Pain
BMJ
3
In:
JAMA
Pain
J Pain 4
Pain
J Pain 6
Pain
64
Pain
33
Management
Lancet
3.1
educAtion
v
v
or
children
v
v
v
v
II
Ray et
3.2
orgAnisAtionAl
requirements
N
N
references
34
BMJ
74
BMJ
34
7
Pain
Acute Pain
46
BMJ
Pain 4
63
Pain
36
Pain
4.1
opioids
Buprenorphine
Codeine
Dextropropoxyphene
Diamorphine
Dihydrocodeine
Fentanyl
Hydromorphone
Methadone
Morphine
Sia,
Oxycodone
Staahl et al,
Pethidine
of biliary colic
Tramadol
Patient age
Gender
Genetics
Psychological factors
to the
Respiratory depression
Cardiac effects
Rusch
Habib
to the
et al,
Urinary retention
Pruritus
Bonnet
Chu et al,
Chang
N
N
N
N
N
N
N
N
S
N
4.2
pArAcetAmol,
Zacharias et
Hynes et al,
Adverse effects
Mahe
renal colic
Marret et al,
to the
clearly
Adverse effects
Bone healing
77
Adverse effects
Renal function
refer to the
to the
78
Moore
79
Targownik et al,
Bone healing
S
N
N
N
N
N
N
N
N
N
N
S
4.3
AdjuvAnt
Nitrous oxide
In adults, N
drugs
In children, N
to N
Henderson et al,
Zier
Toh et al,
Myles et al,
given N
N
N
v
v
v
v
v
v
v
Ketamine
Hayes et al,
Dextromethorphan
87
Magnesium
S
N
N
N
W
N
N
88
TCAs
SSRIs
Pooled diagnoses
SSRIs
Pooled diagnoses
SSRIs
8
to the
89
Cardenas
S
N
R
N
Phenytoin
Hurley et
Lamotrigine
Bell et
Chiou-Tan et
N
S
Bernard
Aho
Calcitonin
Bisphosphonates
N
S
N
N
II
97
CAMs include:
v
v
v
v
N
98
references
73
Lancet
Pain
Pain
99
Pain
Pain
Pain
37
Pain
44
44
BMJ
Pain
Am J
63
Lancet
43
J Pain 7
33
63
36
33
Pain
Pain
J Pain
Pain
34
Pain 74
J Pain
44
BMJ 337
BMJ 333
67
Pain
Int
34
47
BMJ
J Pain
BMJ
BMJ
Pain
BMJ
3
Acute Pain
33
Pain
Acta
J Pain
Pain 64
Pain
In:
BMJ
Pain
47
Acta
Acta
47
44
Pain
77
Acute Pain
Pain
BMJ
Pain
Pain
Lancet
Pain
64
JAMA
Pain
44
7
3
63
JAMA
47
63
Pain
46
Pain
64
43
46
33
Pain
46
Pain
JAMA
Lancet
67
Pain
37
34
Pain
Pain
JAMA
337
46
HSS J 4
Acute Pain 7
J Pain
333
BMJ
37
64
44
J Pain
Pain
Life Sci
JAMA
BJOG
37
5.1
locAl
AnAesthetics
II
Heid et
Ilfeld et
Direct toxicity
Systemic toxicity
II
II
Felice
Marwick
5.2
opioids
Intrathecal opioids
Hodgson
Epidural opioids
Ngan
Zeidan et al,
II
N
R
5.3
AdjuvAnt drugs
Neuraxial
Andrieu et al,
Plexus block
Intra-articular
Neuraxial
to the
Neuraxial
Peripheral sites
Clerc et al,
Topical
Tucker,
Ho
N
N
N
N
N
5.4
Anti-inflAmmAtory
Neuraxial
II
Peripheral sites
drugs
Bigat et al,
Topical
N
N
N
N
N
Peripheral sites
Colbert et
Topical
Zacher et al,
N
N
N
N
references
33
Acta
46
34
47
Pain
77
46
Ann
36
Acta
33
47
Acta
64
36
Acta
33
36
Pain
Pain
34
33
46
33
AANA J
BMJ
66
Ann
47
73
Pain
73
Pain
33
76
34
34
66
Pain
Science
Pain
Bandolier,
6.1
orAl
route
77
79
78
Placebo
Immediate-release formulations
v
v
v
v
Controlled-release formulations
6.2
intrAvenous
route
Continuous infusions
Moller,
6.3
intrAmusculAr
Stuart-Harris
Tveita et
II
6.4
rectAl
route
6.5
trAnsdermAl
route
Sandler
Hong et
II
Turan
Poyhia
6.6
trAnsmucosAl
routes
Opioids
and T
II
Coda
et al,
Abboud et al,
Rickard et al,
Opioids
Sharar et al,
Chong
Opioids
Miner
Fulda et
N
N
references
76
Acute Pain
Pain
Acute Pain
Acute Pain
47
4
BMJ
44
Acute Pain
BMJ
J
of
47
Acta
46
37
34
of
oral
Pain
Manag 4
63
64
47
to
Acute Pain
Pain
76
76
36
47
Acute Pain
J Pain
7.1
pAtient-controlled
AnAlgesiA
Macintyre,
Cost of PCA
Opioids
Sinatra et al,
Fentanyl
Howell et
Howell et
Other comparisons
Adjuvant drugs
Ketamine
Michelet et
Sartain et al,
et
Bolus dose
Lockout interval
Dose limits
Loading dose
Subcutaneous PCA
Oral PCA
Intranasal PCA
Striebel
Transdermal PCA
Skryabina
device, which
Equipment-related complications
Patri,
Patient factors
Tsui et al,
Ashburn
7.2
epidurAl
AnAlgesiA
levels and
Schunn et al,
Level of administration
Local anaesthetics
For
Opioids
Adjuvant drugs
II
II
Neurological injury
Epidural haematoma
Epidural abscess
Ho
An
and
and
Respiratory depression
Hypotension
was not
,
,
Treatment failure
Other
N
S
N
S
S
7.3
intrAthecAl
AnAlgesiA
Local anaesthetics
Opioids
Hodgson et al,
Bailey et al,
Adjuvant drugs
S
N
7.4
regionAl
AnticoAgulAnt medicAtions
is not
7.5
Upper limb
Interscalene
other
II
Lower limb
II
II
Morau
Chudinov
Thoracic
Anticoagulation
Nerve injury
Brull
Barrington et
Borgeat et al,
Toxicity
Auroy
Borgeat et
Infection
Neuburger
N
S
N
R
S
N
N
references
Acta
in
J
Acute Pain 4
Pain
Pain
46
74
37
37
Acta
47
34
47
46
63
64
64
Pain
9
33
44
rd
Pain
44
3
of
for
Pain 64
33
3
47
Acute Pain
44
44
JAMA
76
Acute Pain
Acute
Pain
literature
Pain
of
76
Acute Pain
for
63
76
76
43
47
73
46
J Pain
JAMA
Pain 64
Pain
43
8.1
psychologicAl
is
interventions
Relaxation
Hypnosis
Redd
N
Q
N
N
N
8.2
trAnscutAneous
N
S
8.3
Acupuncture
Madsen
Acupressure
8.4
other
physicAl therApies
references
J Pain
Pain
37
Pain 47
36
47
of
BMJ
Pain
a
Pain
Pain Management
63
9.1
postoperAtive
pAin
Rowlingson
Bates
v
v
v
Prevention
Therapy
v
v
v
v
v
v
S
S
S
Senturk
Bong et
Fassoulaki
I
Postherniotomy pain syndrome
Aasvang et
N
N
N
N
v
v
v
Fong et al,
II
Ilfeld,
Ilfeld et
Swenson
Swenson et
Cheng et al,
Non-pharmacological techniques
Sudheer
II
N
N
N
N
9.2
Acute
Siddall
Above level
At level
Below level
but
Ketamine
Chiou-Tan
9.3
Acute
Cuignet et al,
Borland
have
Tosun et al,
N
S
N
N
N
9.4
Acute
bAck pAin
v
v
v
v
9.5
Acute
musculoskeletAl pAin
Australian Acute
9.6
Acute
medicAl pAin
Renal colic
Rothrock
Primary dysmenorrhoea
Abdominal migraine
S
N
Shen et al,
Topical lignocaine
Aspirin
R
N
Cannon,
Treatment of pain
Morrissey et al,
Inhaled N
Haemophilia
The porphyrias
Anderson et al,
Steiner
Treatment
II
Migraine
Treatment
are either:
v
v
v
v
v
v
Silberstein
Triptans
SC
oral
oral
oral
oral
IN
oral
oral
oral
oral
oral
oral
oral
et al,
Brandes et al,
Bell et al,
Status migrainosis
Paediatric migraine
Menstruation-related migraine
Silberstein et
Triptans
Bahra et al,
Schurks et al,
Other treatments
Sudlow
Other treatments
Rucklidge
Other headaches
Silberstein,
N
N
N
N
N
Multiple sclerosis
II
Trigeminal neuralgia
Guillain-Barre syndrome
et
Chen et al,
al,
Hansen et al,
Moiniche
N
R
S
N
N
N
N
N
N
Breitbart et
with a substance abuse disorder, less educated individuals, and those with higher levels
Piscitelli et al,
McCance-
Breitbart et al,
N
N
N
9.7
Acute
cAncer pAin
Miaskowski et al,
Radiotherapy
Bisphosphonates
Pavlakis et al,
Percutaneous vertebroplasty
Mucositis
S
N
S
9.8
v
v
v
v
Acute
Manley
Carrer
N
S
N
9.9
Opioids
Acute
Fulda et
Tramadol
Mahadevan
Ketamine
Abdominal pain
Renal colic
Biliary colic and acute pancreatitis
Acute cardiac chest pain
Acute pain and sickle cell disease
Migraine
Shrestha et
II
II
II
II
II
II
I
Wounds
9.10
prehospitAl
AnAlgesiA
Rogovik
Rickard
Bruns et
Bounes et al,
Rickard
Inhalational agents
another series N
N
children receiving N
Ketamine
Barker et al,
Abdominal pain
N
N
N
N
N
N
N
references
Pain
44
63
3
Pain
34
37
34
BJOG
J Pain 7
Pain
JAMA
Acta
Pain
Pain
Pain
Pain 76
64
34
Pain
73
Pain
Acute Pain
34
47
3
Acute Pain
63
BMJ
a
BMJ 336
Pain
33
J
63
JAMA
47
Pain
33
Acute Pain 4
43
3
46
J Pain
Pain
Manage
37
46
34
33
J
Pain
Pain
Lancet
37
3
6
33
J Pain
Pain
37
34
46
33
Int
43
The
Pain
Pain
J Pain
3
Acute Pain 4
BMJ
Lancet
33
333
Pain
76
Lancet
Pain
J
Pain
Pain
37
Lancet
Pain 43
(
J Pain
Pain
Pain
74
Manage
67
Pain 36
63
33
JAMA
a
Pain
33
JAMA
66
37
6
Pain
JAMA
67
34
J Pain
63
Pain 67
Pain
Pain
Pain
Pain
33
Pain
44
Pain
Acta
47
Pain
Pain
77
JAMA
Pain
J Pain
a
44
33
44
63
Pain
44
J Pain
44
47
37
Pain
JAMA
Pain
44
67
44
47
7
Pain
36
3
BMJ
37
43
77
J Pain
Pain
Am J
34
a
Lancet 367
37
37
A
:
33
7
37
JAMA
36
Pain
BJOG
10.1
developmentAl
neurobiology of pAin
Mellon et
10.2
long-term
And injury
10.3
pAediAtric
pAin Assessment
Falanga et
Physiological measures
Howard et
Behavioural measures
v
v
v intensive care
v
v
v
v
Hicks et
v
v
v
Hunt et
not shown
to child
behavioural state
heart rate
brow bulge
nasolabial furrow
Neonatal Infant Pain
cry
legs
state of arousal
neonates
brow bulge
taut tongue
cries
cry
each scored as
total score
touch
face
each scored on
legs
total score
cry
consolability
alertness
heart rate
total score
and
Coloured Analogue
Scale
10.4
mAnAgement
above
of procedurAl pAin
Shah et al,
Lumbar puncture
Urine sampling
II
Henderson et al,
Hee et al,
Schechter et
Crock et al,
and
Urethral catheterisation and micturating cystourethrogram
II
N
Butler et
Burns dressings
II
Schechter
II