Medicated pain therapy
Very severe postoperative pain is treated with opiates. Opiates are centrally acting painkillers, as their action is based on the central nervous system. They can be administered both orally and intravenously.
The intravenous method is preferred in postoperative pain therapy. The disadvantage of opiates is sometimes very unpleasant and strong side effects such as nausea, tiredness, itching and sluggishness of the bowel. However, the side effects are accepted because of the good effectiveness.
In addition to the centrally acting analgesics, there are also the peripherally acting analgesics. These include, for example, diclofenac, metamizole and paracetamol, which many people also know from everyday use. These are also used in postoperative pain therapy.
WHO level scheme
The WHO recommends a graduated scheme for drug-based pain therapy. This step-by-step scheme is originally derived from a scheme for tumor therapy. The scheme contains three stages of drug treatment.
The fourth stage comprises invasive measures to alleviate pain. If the pain is insufficiently eliminated in one stage, the treatment is escalated to the next stage. In each stage, physiotherapeutic methods and co-analgesics in the sense of anticonvulsants, antiemetics, antidepressants, glucocorticoids and other groups of active substances are used as required.
Non-opioid analgesics include non-steroidal anti-inflammatory drugs (NSAIDs) such as ASS, ibuprofen andCOX2 inhibitors on the one hand and paracetamol, as well as metamizole and its group-related substances on the other. Weak opiates include tramadol, tilidine and dihydrocodeine, possibly in combination with naloxone.Highly potent opioids include morphine, oxycodone and fentanyl. A supportive decongestant therapy, e.g. with Wobenzym, can also have a positive effect on pain perception.
- Stage 1: In stage 1, only non-opioid analgesics are used initially (in combination with adjuvants (increases the effect of the drug) e.g. metamizole, paracetamol, NSAID
- Stage 2: Stage 2 involves the use of low-potency opioid analgesics in combination with non-opioid analgesics and/or adjuvants, e.g. tilidine, tramadol (+ Stage 1)
- Stage 3: Finally, in stage 3, highly potent opioids are combined with non-opioids and/or adjuvant e.g. morphine, oxycodone, fentanyl, methadone, hydromorphone (+ stage 1)
- Stage 4: Treatment using invasive techniques ? peridural and spinal injection, spinal cord stimulation, ganglion block and peripheral local anesthesia
