CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

PAIN MANAGEMENT AND PHARMACOTHERAPY IN ELBOW FRACTURES

Batu Malatyalı

Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye

Malatyalı B. Pain Management and Pharmacotherapy in Elbow Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.207-215.

ABSTRACT

The most common issue following bone damage is fractures and the pain associated with these fractures. Following the fracture, the nerve fibers innervating the bone are stimulated and transmitted to the brain within seconds. Hereby, the sharp bone pain pathway is initiated. Within minutes, neurotransmitters and cytokines are synthesized at the fracture site, causing increasingly severe pain, especially during movement of the injured extremity. Proper treatment of the fracture and pain management preserves the individual’s quality of life and function. Elbow fractures can occur through various mechanisms. Simple fall, direct trauma, traffic accidents, falling from height are some of them. Due to the intra-articular fracture, it is important to know the fixation, treatment, and pain management to restore the patient’s function. In the event of a complication during treatment (such as nonunion or chronic pain), it is almost certain that the range of motion in the joint will remain restricted. In a study conducted in our country, about 6.1% of orthopedic fracture patients presenting to the emergency department had adult elbow fractures. Therefore, both emergency medicine specialists and orthopedic specialists need to be aware of how to approach to patients with elbow fractures. The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. According to the World Health Organization, pain which heals within 3 to 6 months is acute. Acute pain is often associated with trauma. Chronic pain, on the other hand, is defined as pain that persists beyond the expected healing period following tissue damage. The main goal of pain management is to reduce the patient’s pain to a tolerable level and allow the individual to maintain functionality. Inadequate treatment of acute pain can lead to serious problems in the short and long term. Some of these problems are increased risk of infection, decreased comfort, and most importantly, chronic pain syndrome that causes partial disability in the person. There are several obstacles to treating acute pain. Some of these are the lack of a guideline for physicians to follow, inadequate measurement of pain, prejudice against opioid analgesics, and delay in analgesic administration.

Keywords: Pain management; Drug therapy; Elbow

Referanslar

  1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International. 2006;17(12). [Crossref]  [PubMed]
  2. Mitchell SAT, Majuta LA, Mantyh PW. New Insights in Understanding and Treating Bone Fracture Pain. Curr Osteoporos Rep. 2018;16(4):325-332. [Crossref]  [PubMed]  [PMC]
  3. Bilge O, Dundar ZD, Atılgan N, et al. The epidemiology of adult fractures according to the AO/OTA fracture classification. Ulusal Travma ve Acil Cerrahi Dergisi. 2022;28(2):209-216.
  4. Merskey H. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain. 1979;6:249-252.
  5. Fabbri A, Voza A, Riccardi A, Serra S, Iaco F De. The Pain Management of Trauma Patients in the Emergency Department. J Clin Med. 2023;12(9). [Crossref]  [PubMed]  [PMC]
  6. Stanger S, Dahill M, Hillary C, Whitham R, Tasker A. Improving analgesia prescription for trauma inpatients. BMJ Open Qual. 2018;7(4):e000397. [Crossref]  [PubMed]  [PMC]
  7. Hachimi-Idrissi S, Dobias V, Hautz WE, et al. Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines-part 2: management and recommendations. Intern Emerg Med. 2020;15(7):11411155. [Crossref]  [PubMed]
  8. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med. 2001;38(6):633-638. [Crossref]  [PubMed]
  9. Thomas SH. Management of pain in the emergency department. Int Sch Res Notices. 2013;2013(1):583132. [Crossref]
  10. Guidelines for the Management of Acute Pain in Emergency Situations. 2020.
  11. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65.19. [Crossref]  [PubMed]
  12. Prins JCM, Stubbe JH, van Meeteren NLU, Scheffers FA, van Dongen MCJM. Feasibility and preliminary effectiveness of ice therapy in patients with an acute tear in the gastrocnemius muscle: a pilot randomized controlled trial. Clin Rehabil. 2010;25(5):433-441. [Crossref]  [PubMed]
  13. Fusaro I, Orsini S, Sforza T, Rotini R, Benedetti MG. The use of braces in the rehabilitation treatment of the post-traumatic elbow. Joints. 2014;2(2):81-86. [Crossref]  [PubMed]  [PMC]
  14. Löw S, Papay M, Eingartner C. Pain Perception following Initial Closed Reduction in the Preoperative Care of Unstable, Dorsally Displaced Distal Radius Fractures. J Hand Microsurg. 2019;11(2):111-116. [Crossref]  [PubMed]  [PMC]
  15. Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J. Acute Pain Management: Scientific Evidence. Published online 2015.
  16. Oyler DR, Parli SE, Bernard AC, Chang PK, Procter LD, Harned ME. Nonopioid management of acute pain associated with trauma: focus on pharmacologic options. Journal Malatyalı Pain Management and Pharmacotherapy in Elbow Fractures of Trauma and Acute Care Surgery. 2015;79(3):475-483. [Crossref]  [PubMed]
  17. Ridderikhof ML, Lirk P, Goddijn H, et al. Acetaminophen or nonsteroidal anti-inflammatory drugs in acute musculoskeletal trauma: a multicenter, double-blind, randomized, clinical trial. Ann Emerg Med. 2018;71(3):357-368. [Crossref]  [PubMed]
  18. Bondarsky EE, Domingo AT, Matuza NM, Taylor MB, Thode Jr HC, Singer AJ. Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a randomized, controlled trial. Am J Emerg Med. 2013;31(9):1357-1360. [Crossref]  [PubMed]
  19. Lyrtzis C, Natsis K, Papadopoulos C, Noussios G, Papathanasiou E. Efficacy of paracetamol versus diclofenac for Grade II ankle sprains. Foot Ankle Int. 2011;32(6):571-575. [Crossref]  [PubMed]
  20. Dijkstra BM, Berben SAA, Van Dongen RTM, Schoonhoven L. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the N etherlands. European Journal of Pain. 2014;18(1):3-19. [Crossref]  [PubMed]
  21. Thomas SH. Management of pain in the emergency department. Int Sch Res Notices. 2013;2013(1):583132. [Crossref]
  22. Peura DA. Gastrointestinal safety and tolerability of nonselective nonsteroidal anti-inflammatory agents and cyclooxygenase-2-selective inhibitors. Cleve Clin J Med. 2002;69:SI31-9. [Crossref]  [PubMed]
  23. Williams K. Evidence on NSAID use in soft tissue injuries. Nurs Times. 2012;108(45):12-14.
  24. Ziltener JL, Leal S, Fournier PE. Non-steroidal anti-inflammatory drugs for athletes: an update. Ann Phys Rehabil Med. 2010;53(4):278-288. [Crossref]  [PubMed]
  25. Novartis Pharmaceuticals UK Ltd. Voltarol Ampoules summary of product characteristics. April 2017.
  26. Atnahs Pharma UK Ltd. Naproxen 500mg Tablets summary of product characteristics. October 2024.
  27. Solomon DH, Furst DE, Romain PL. Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics). Up To Date. 2024.
  28. Ortiz MI, Monroy-Maya R, Soto-Ríos M, et al. Effectiveness of diclofenac, ketorolac and etoricoxib in the treatment of acute pain from ankle fracture. In: Proc West Pharmacol Soc. 2010;53:46-48.
  29. Davies NM, Jamali F. COX-2 selective inhibitors cardiac toxicity: getting to the heart of the matter. J Pharm Pharm Sci. 2004;7(3):332-336.
  30. Sibbald B. Rofecoxib (Vioxx) voluntarily withdrawn from market. Cmaj. 2004;171(9):1027-1028. [Crossref]  [PubMed]  [PMC]
  31. Hearn L, Derry S, Moore RA. Single dose dipyrone (metamizole) for acute postoperative pain in adults. Cochrane Database of Systematic Reviews. 2016;(4). [Crossref]  [PubMed]  [PMC]
  32. Shah RR. Metamizole (dipyrone)-induced agranulocytosis: Does the risk vary according to ethnicity? J Clin Pharm Ther. 2019;44(1):129-133. [Crossref]  [PubMed]
  33. Kang JH, Oh SY, Song SY, et al. The efficacy of lowdose transdermal fentanyl in opioid-naive cancer patients with moderate-to-severe pain. Korean J Intern Med. 2015;30(1):88. [Crossref]  [PubMed]  [PMC]
  34. Napp Pharmaceuticals. OxyContin 60 mg prolonged release tablets summary of product characteristics. June 2024.
  35. Buccelletti F, Marsiliani D, Zuccala G, et al. Paracetamol-codeine compared to ketorolac for pain control in the Emergency Department. Eur Rev Med Pharmacol Sci. 2014;18(20):3139-3143.
  36. Lehmann KA. Tramadol for the management of acute pain. Drugs. 1994;47(Suppl 1):19-32. [Crossref]  [PubMed]
  37. Farsi D, Movahedi M, Hafezimoghadam P, Abbasi S, Shahlaee A, Rahimi Movaghar V. Acute pain management with intravenous 0.10 mg/kg vs. 0.15 mg/kg morphine sulfate in limb traumatized patients: a randomized double-blinded placebo-controlled trial. Published online 2013. [Crossref]  [PubMed]
  38. Shear ML, Adler JN, Shewakramani S, et al. Transbuccal fentanyl for rapid relief of orthopedic pain in the ED. Am J Emerg Med. 2010;28(8):847-852. [Crossref]  [PubMed]
  39. Miller JP, Schauer SG, Ganem VJ, Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial. Am J Emerg Med. 2015;33(3):402-408. [Crossref]  [PubMed]
  40. Parvizrad R, Pakniyat A, Malekianzadeh B, Almasi-Hashiani A. Comparing the analgesic effect of intranasal with intravenous ketamine in isolated orthopedic trauma: A randomized clinical trial. Turk J Emerg Med. 2017;17(3):99-103. [Crossref]  [PubMed]  [PMC]
  41. Wu JJ, Lollo L, Grabinsky A. Regional anesthesia in trauma medicine. Anesthesiol Res Pract. 2011;2011(1):713281. [Crossref]  [PubMed]  [PMC]
  42. Morrison RS, Dickman E, Hwang U, et al. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial. J Am Geriatr Soc. 2016;64(12):2433-2439. [Crossref]  [PubMed]  [PMC]
  43. Riddell M, Ospina M, Holroyd-Leduc JM. Use of femoral nerve blocks to manage hip fracture pain among older adults Malatyalı Pain Management and Pharmacotherapy in Elbow Fractures in the emergency department: a systematic review. Canadian Journal of Emergency Medicine. 2016;18(4):245-252. [Crossref]  [PubMed]
  44. Grass JA. Patient-controlled analgesia. Anesth Analg. 2005;101(5S):S44-S61. [Crossref]  [PubMed]
  45. Birnbaum A, Schechter C, Tufaro V, Touger R, Gallagher EJ, Bijur P. Efficacy of patient-controlled analgesia for patients with acute abdominal pain in the Emergency Department: a randomized trial. Academic Emergency Medicine. 2012;19(4):370-377. [Crossref]  [PubMed]
  46. Ab Rahman NHN, DeSilva T. The effectiveness of patient control analgesia in the treatment of acute traumatic pain in the emergency department: a randomized controlled trial. European Journal of Emergency Medicine. 2012;19(4):241-245. [Crossref]  [PubMed]
  47. Hwang U, Platts-Mills TF. Acute pain management in older adults in the emergency department. Clin Geriatr Med. 2013;29(1):151-164. [Crossref]  [PubMed]
  48. Simpson PM, Bendall JC, Tiedemann A, Lord SR, Close JCT. Provision of Out-of-hospital Analgesia to Older Fallers With Suspected Fractures: Above Par, but Opportunities for Improvement Exist. Academic Emergency Medicine. 2013;20(8):761-768. [Crossref]  [PubMed]
  49. Bisson DL, Newell SD, Laxton C, Gynaecologists RC of O and. Antenatal and postnatal analgesia: scientific impact paper no. 59. BJOG. 2019;126(4):e114-e124. [Crossref]  [PubMed]
  50. Antonucci R, Zaffanello M, Puxeddu E, et al. Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. Curr Drug Metab. 2012;13(4):474-490. [Crossref]  [PubMed]
  51. Médecins Sans Frontières. Essential Drugs Practical guides intended for physcians, pharmacists, nurses and medical auxillaries: Médecins Sans Frontières April 2024.
  52. Wockhardt UK Ltd. Codeine Phosphate 30 mg. Summary of product characteristics. 2020.
  53. Hameln Pharmaceuticals Ltd. Fentanyl 50 microgram/mL injection. Summary of product characteristics. Hameln Pharmaceuticals Ltd. 2024.
  54. Pfizer Limited. Ketalar (ketamine) 50 mg/ml injection. Summary of product characteristics. 2024.
  55. Summary of product characteristics. Ketamine 10 mg/mL injection. 2024.