Description
La plupart des brûlures légères peuvent être traitées efficacement en ambulatoire et guérissent sans intervention. Une classification précise des brûlures est essentielle pour garantir des soins appropriés. Les brûlures thermiques sont des lésions cutanées provoquées par une chaleur extrême, généralement due au contact avec des objets chauds, des liquides, de la vapeur ou des flammes. La plupart des brûlures sont bénignes et les patients peuvent être pris en charge dans les hôpitaux proches ou en ambulatoire. Les centres spécialisés pour brûlés traitent environ 6,5 % des cas de brûlures. La surface corporelle brûlée, la gravité des brûlures et les caractéristiques uniques de chaque patient, telles que l'âge, les antécédents de blessures ou d'autres problèmes médicaux, sont prises en compte lors de la décision de transférer et de traiter un patient dans un centre pour brûlés.
Résumé
- Chronic pain, defined as pain lasting over three months, is an under-recognized problem affecting a significant portion of the population, with incidences ranging from one in five adults in the US to 30% in India. Pain is a subjective experience influenced by biological, psychological, and social factors, and a patient's report of pain should always be respected and addressed. While acute pain serves an adaptive role in preventing further injury, chronic pain no longer serves a productive purpose and significantly interferes with quality of life.
- Chronic pain often leads to a pain cycle involving muscle guarding, spasm, inflammation, restricted movement, weakness, and psychological issues like anger and frustration. Breaking this cycle requires a multimodal approach, including medication, injections, and multidisciplinary treatment to improve functionality and enhance the patient's quality of life. Assessment involves history taking, clinical examination, investigations, and diagnostic interventions like nerve blocks.
- History taking is critical, emphasizing the need to rule out "red flags" indicative of serious underlying conditions. Key elements include the site, quantity, quality, onset, duration, aggravating and relieving factors, special characteristics, timing, relation to posture, and associated complaints. Pain is often considered the fifth vital sign, measured using tools like the numerical rating scale (NRS), faces pain rating scale, and visual analogue scale (VAS).
- Common chronic pain conditions include tension headaches, migraines, cluster headaches, and trigeminal neuralgia, a facial pain condition often treated with carbamazepine and nerve blocks. Chronic neck pain can arise from various sources, including muscles, facet joints, intervertebral discs, and nerves. "Text neck," caused by prolonged phone use, can contribute to neck pain and other health problems. Low back pain can stem from herniated lumbar discs, facetogenic pain, and sacroiliac joint dysfunction, often requiring MRI imaging and nerve root blocks or radiofrequency ablation.
- Neuropathic pain presents with symptoms like burning, tingling, electric shocks, and crawling sensations. Post-herpetic neuralgia, a common neuropathic condition following herpes zoster, can be managed with anti-neuropathic medications and nerve blocks. Musculoskeletal pain and joint pains, like osteoarthritis of the knee, can be addressed with regenerative pain medicine techniques like platelet-rich plasma (PRP) therapy or genicular nerve blocks. Myofascial pain, caused by trigger points in muscles, is often underdiagnosed and can be treated with local anesthetic injections.
- Fibromyalgia is a diagnosis of exclusion, characterized by widespread musculoskeletal pain, fatigue, and cognitive/psychiatric disturbances, requiring lifestyle changes and anti-neuropathic medication. Chronic cancer pain can be managed using the WHO pain ladder, involving non-opioid analgesics, weak opioids, and strong opioids like morphine and fentanyl, alongside nerve blocks like celiac plexus block for upper abdominal malignancies. The management of chronic pain generally requires a multidisciplinary approach that integrates medications, procedures, physical therapy, lifestyle adjustments, psychological support, and specialist coordination.
Exemple de certificat
À propos des intervenants
Dr. Saipriya Tewari
Consultant Pain Medicine and Palliative Care, Manipal Hospital, New Delhi
Divulgation financière
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