The multimodal approach - key recommendations for effective pain management
The term multimodal is often thrown around when discussing analgesia, but what does it actually mean? 🤔
Essentially, multimodal refers to the use of multiple classes of analgesic agents 💊 that target different receptors throughout pain pathways 🧠. The goal of this is to effectively manage pain 🩹 while limiting side effects from individual classes of drugs 🛑.
A classic, basic example that is common in the perioperative setting 🏥, is the use of opioid medications 💉 for pain management. Side effects of opioids include constipation 💩, nausea 🤢 and vomiting 🤮, respiratory depression 😤 and sedation 😴 - all of which we want to avoid for our patients! In an effort to do this, administration of agents such as paracetamol 💊, non-steroidal anti-inflammatory agents 💥 and local anaesthetic agents 💉 can help to reduce the overall amount of opioid required to adequately manage pain, reducing the occurrence or severity of opioid-related side effects 🛑.
A multimodal approach should be thought of as a recipe 🍳 for pain management, incorporating recommended drug classes 💊 with individual drug selections made (or omitted) based on the patient's history 🧑⚕️. The approach should aim to include the following elements (where possible):
💊 Simple analgesia (paracetamol and NSAIDS)
💉 Local anaesthetic
💀 Opioid analgesia
🚫 Opioid sparing adjuncts
Each patient presents with their own unique pain experience 😖 and history, meaning that multimodal analgesia will look different for each patient 🧑⚕️. Some factors that will influence analgesia options and decisions include:
⚠️ Drug allergies 🌾
💊 Drug interactions from regular medications 🧑⚕️
👶 Age 🧒
😴 Respiratory conditions (eg sleep apnoea 🛏️)
🧠Kidney/Liver function 🧬
⚖️ Chronic/persistent pain 💔
💉 Opioid tolerance and/or substance use disorder 🏚️
🧠 Cognition 🧩
Build Knowledge✅
Improve Safety✅
References:
ANZCA (2023) PS41 - Position statement on acute pain management. https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management
Schwenk, E. S., & Mariano, E. R. (2018). Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean journal of anesthesiology, 71(5), 345–352. https://doi.org/10.4097/kja.d.18.00217
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