心肺功能不全的物理治療診斷與治療：Lect19 Physiotherapy management of acute post-operative pain

1、Lecture 19Physiotherapy management of acute post-operative pain1Lecture Series on Cardiopulmonary PhysiotherapyPhysiology of PainAn unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damageMerskey 19862Physiology of PainPain is

2、 subjective, individual and modified by degrees of attention, emotional state and the conditioning influences of past experience.Livingston 19433Types of painSomatogenicNeurogenic Psychogenic4Somatogenic Pain Acute pain pain is perceived as a warning transmitted by A fibres Chronic pain usually resu

3、lts from tissue damage transmitted by C fibres5Neurogenic Painautonomic disturbancesome form of neuronal damage, abnormal neural activitye.g. phantom limb pain（幻肢痛）, causalgia（灼性神經(jīng)痛）6Psychogenic painInfluenced by hormones and psychosocial factors7Mechanism of PainTissue damage NociceptionPerception

4、of painNoxious stimulusElectrophysiologic events8PainFunctionaldisability9Misconceptions（誤區(qū)） in pain managementMedical and nursing staff decide if the patient is in painPatient who requires a higher dose of analgesic drug is abnormalIncrease in dose in narcotics（鎮(zhèn)定劑） equates to increase in side effe

5、ct but not the effectiveness 10Different types of analgesia（止痛劑）Opioid類鴉片 analgesicsNSAIDS非類固醇抗炎藥Local anaesthetic blocksInhalational analgesia - EntonoxTENSPsychological modulationLaser激光 therapyAcupuncture針灸 / Acu-TENS11Narcotic analgesiaMorphine 嗎啡Pethidine杜冷丁Fentanyl芬太尼Patient controlled analges

6、ia(PCA)12Consider the rate of drug .absorptiondistributioneliminationas well as the potency of the drug1314Intermittent bolus administrationDrug concentrationTimeSide effectsPain freePainBolus15IV infusion靜脈注射 / epidural 硬膜外analgesiaDrug concentrationTimeSide effectsPain freePain16IV infusion / epid

7、ural analgesiaDrug concentrationTimeSide effectsPain freePainactivityBolus17The role of the physiotherapistaware of the adverse effects of painrespiratory depressionirritability of the patient due to anxiety, sleep deprivationaware of the patients level of pain psychological modulation (?)18The role of the physiotherapistunderstand the analgesia the patient is receivingroute of administration IV, IM, PCApotency of the drugcheck if a bolus is necessary befor