Nociceptive Pain

Nociceptive pain is triggered when receptors detect injury or irritation. Acetaminophen, local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and/or steroids are indicated for somatic pain (i.e., sharp localized pain caused by activation of Adelta fibers located in peripheral nerves), such as lacerations, burns, needle procedures, abrasions, and ear or skin infections. Cold packs and tactile stimulation can also be helpful. For neonates, breast milk and/or oral sucrose can be helpful for one-time injection pain (Shah et al. 2007). Intraspinal local anesthetics, NSAIDs, opioids, and/or steroids are indicated for visceral pain (i.e., generalized pain that can be dull or sharp, caused by activation of C fibers with deeper innervation), such as joint pain, muscle pain, kidney stones, appendicitis, or sickle cell pain. Surgical pain is typically related to activation of both A-delta and C fibers and is responsive to NSAIDs and opioids.

Antispasmodics, NSAIDs, and baclofen are used for colic or muscle spasms. Dorsal penile nerve blocks are recommended for newborn circumcision (Brady-Fryer et al. 2004).

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