Acute Pain in the Trauma Patient
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PAIN MANAGEMENT IN TRAUMA (MR HOFFMAN, SECTION EDITOR)
Acute Pain in the Trauma Patient Ruth Natalie Reed 1
&
Michael John Schurr 1,2
Accepted: 15 October 2020 / Published online: 20 November 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review This review will discuss the unique challenges associated with pain control in the trauma patient. Trauma is accompanied by painful conditions such as fractures, surgery, and nerve injury, but the trauma population also provides additional challenges compared to the general hospitalized population with respect to pain control because of the acute stress reaction and other psychological responses to trauma, often underlying chronic pain, and the increased risk of opiate use at baseline in this population. Recent Findings The importance of recognizing uncontrolled pain early is essential to prevent adverse acute and chronic outcomes including post-traumatic stress disorder, transition to chronic pain, delirium, and respiratory failure. Summary A true multimodal approach to pain control in trauma patients includes early evaluation and consideration of techniques such as epidural anesthesia as well as nerve and fascial blocks, the use of non-opiate medications in addition to opiate medication, and early evaluation for uncontrolled stress, anxiety, and risk factors for post-traumatic stress disorder. Keywords Acute pain . Trauma . Multimodal therapy . Post-traumatic stress disorder . Opioid use disorder
Introduction The trauma patient provides a unique challenge in managing acute pain. Pain in trauma stems from the chemical propagation of pain from injury, as well as the acute stress reaction from the traumatic event or injury that can create emotional distress that contributes to pain. In addition, because substances such as opiates increase the risk of traumatic injury, a higher percentage of the trauma population has narcotic tolerance or takes opiate pain medication at baseline than the general population. Traumatic injury is also an independent risk factor in developing persistent opiate use, which can transition to illicit use in up to 5% of chronic opiate users [1, 2••]. In spite of these challenges, managing acute pain effectively in the trauma patient is crucial. In these patients, background pain can be easier to treat than evoked pain; however, This article is part of the Topical Collection on Pain Management in Trauma * Michael John Schurr [email protected] 1
Department of Surgery, Mountain Area Health Education Center, Asheville, NC, USA
2
Asheville, USA
pain control of both is necessary. Poor control of acute pain is linked to a higher risk of developing chronic pain, longer and more delayed recovery, and worse quality of life [3•]. Inadequate pain control can lead to an altered release of hormones including insulin and catecholamines, metabolic disturbances, water retention, increased myocardial oxygen demand, agitation, delirium, delayed wound healing, hypoxia/ atelectasis, and neuropsychiatric complications such as isolation, anxie
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