Critical care clinics
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Pain is a common experience of the ICU patient, with a diverse clinical manifestation. To manage pain we must understand its anatomic pathways and physiology. This article reviews the development of our understanding of the theory of pain from Descartes to the gate theory of Melzack and Wall. We will review the anatomy of the pathways of pain and the interrelationship of "A" and "C" fibers and the unique nature of the opiate receptor.
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Effective pain management in trauma patients requires an understanding of both the physiologic responses to injury, and the potential modification of these responses produced by analgesic and anesthetic agents. Complex, multisystem injuries occur frequently and therapeutic intervention for the control of pain must be carefully incorporated within the overall management plan. Pain management strategies for specific injuries are discussed.
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Narcotics are explored in this section. Receptor theory is presented. ⋯ Pharmacokinetics of classic methods of narcotic delivery are discussed and compared to newer technologies of delivery. Finally, a strategy for decision making in pain control, tying together all the concepts previously discussed, is given.
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To manage pain in an ICU setting effectively, one must first understand the unique features associated with the disease process for which patients are admitted. Although there are certain common denominators, a postoperative patient is different from a patient with an acute myocardial infarction. This article reviews the aspects of pain associated with the individual syndromes of patients admitted to an ICU.