By Michael Serpell
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Additional info for Handbook of Pain Management
Concerning opioids in particular, the use of intravenous boluses and patient-controlled analgesia pumps is increasing and has led to an overall improvement in postoperative pain relief (see Chapter 5). /POQIBSNBDPMPHJDBMJOUFSWFOUJPOT This includes other modalities such as interventional regional analgesia, physical therapy rehabilitation, psychological therapies and very occasionally neurosurgery. With the exception of regional analgesia for postoperative pain and psychology-based pain management programmes for chronic pain, the evidence for implementing one specific therapy over another is weak.
Its oral bioavailability is almost 90%, but rectal absorption is variable and unreliable. Oral and intravenous doses of 15 mg/kg, up to a maximum of 4 g/day, can be safely administered in adults, although the total dose should be reduced appropriately in children and low-weight adults as excessive doses can cause hepatotoxicity. While the majority of paracetamol is metabolized in the liver safely through glucuronidation, a small proportion is metabolized via a separate cytochrome P450 system that can lead to the generation of oxygen free radicals when glutathione stores are exhausted.
This breadth of understanding means that a clinician may often need to use assessment skills developed from other specialities such as orthopaedics and psychology in the same pain patient. Due to its complexity it took medicine almost 2000 years to produce a universally agreed definition of pain . Patients may suffer completely different experiences which can all be described as painful. Patients may undergo the same pain experiences (such as hernia surgery or suffering osteoarthritis of the hip) and yet report wildly differing pain intensity.
Handbook of Pain Management by Michael Serpell