**7. The pain management strategies**

Pain is *"*a*n unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage [21]."*

The components of pain assessment include history and physical assessment, functional assessment, psychosocial assessment, and multidimensional assessment. All kinds of pain are associated with stress, which is an essential factor in pain management. Thus, the psychological component of pain is crucial in determining the patient's treatment protocols and promoting active involvement in self pain control. In addition, the pain perceptions may vary among individuals depending upon types of injuries/pathology, duration of pain, and associated psychosocial backgrounds. Therefore, the ABCDE of pain management (**Figure 3**) is essential to deal with any pain [22].

The pain management strategies have been evolving and ever-changing. With the introduction of a new effective protocol every decade, the approach to handle pain has become more comprehensive and target-specific. This evolution in the management strategies resulted in more effective and focused results with reduced complications.

#### **Figure 3.**

*Perceptions of pain and ABCDE of pain management.*

### **7.1 Evolution of pain management**

• **1980**: Pain was underrated and usually treated with intravenous/intramuscular narcotics. Due to fear of the side effects of narcotics (opioid phobia), the pain remained undertreated (oligoanalgesia) in this decade.


#### **Figure 4.**

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Evolution of pain.
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*(IV/IM: Intravenous/intramuscular, PCA: Patient-controlled analgesia, RA: Regional analgesia/anesthesia, MMA: Multimodal analgesia, OFA: Opioid-free anesthesia, PNB: Peripheral nerve block, LIA: Local infiltration analgesia).*
