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Opioid analgesia such as morphine provides a powerful, widely available means of managing acute pain.

However, drug addiction and adverse events have been reported, including breathing and gastrointestinal problems, nausea, vomiting, sedation and psychological disturbances.3, 4, 5

In addition, prescribing an accurate dose may be confounded by pharmacological differences in the individual response to opioids, and by the attitudes of patients and health professionals towards pain management.6

During intense pain, opioid analgesia may not provide adequate relief,2 and other pain management techniques may be needed, such as sedatives, analgesics, anaesthetics and nonpharmacologic strategies.7

Economic Consequence of Inadequate Pain Management
In clinical and trauma environments, many patients experience or anticipate noxious stimuli from a variety of sources.

For example, burns patients exposed to short painful procedures associated with daily wound care or dressing changes.

The pain sensation may cause or aggravate muscle spasm, constrict blood vessels, and induce endogenous chemicals that cause or augment existing pain.

According to Kestsumpun 4, the social and economic consequences of inadequate pain management are considerable, since uncontrolled pain may interfere with a patient's ability, or willingness, to resume daily activity.

Pain Exacerbates Disease Symptoms
Noxious sensations, or a feeling of imminent pain, will invariably cause anxiety, so the patient develops an apprehensive uneasiness of mind that exacerbates the pain sensation.

The way people cope with real or perceived pain has profound effects on immunity, wound healing, neuroendocrine and autonomic activitym,8 and personality factors, particularly coping mechanisms, may exacerbate disease symptoms, perpetuate disability, and play a crucial role in the progression and outcome of disease.

Cognitive factors are significant predictors of acute asthma mortalities, and progression of viral and bacterial infections (e.g. AIDS), cancer, heart disease and wound healing.9, 10, 11

In tubercular patients, many clinicians believe the prognosis is more accurately predicted by psychological profiles (i.e. emotional, mental and nervous states) than results of chest X-rays.12

Pharmacological Strategies for Pain Management

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