Array
(
[id] => 1680
[catid] => 291
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1680.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => If surgery is delayed, we suggest starting thromboprophylaxis preoperatively, preferably with LMWH, with a minimal interval of 12 hours between the last LMWH injection and surgery.(Evidence level:moderate/Low;Recommendation grade:Strong)
[laiyuan] => 如果手术推迟,我们建议在术前就开始进行血栓预防,最好使用低分子量肝素,且在上次注射低分子量肝素与手术之间至少间隔12小时。(证据分级:中或低;推荐强度:强推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
如果手术推迟,我们建议在术前就开始进行血栓预防,最好使用低分子量肝素,且在上次注射低分子量肝素与手术之间至少间隔12小时。(证据分级:中或低;推荐强度:强推荐)
If surgery is delayed, we suggest starting thromboprophylaxis preoperatively, preferably with LMWH, with a minimal interval of 12 hours between the last LMWH injection and surgery.(Evidence level:moderate/Low;Recommendation grade:Strong)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1681
[catid] => 302
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1681.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => We suggest continuing thromboprophylaxis until ambulation with full weight-bearing is achieved and for a minimum duration of 7 days. (Evidence level:moderate/Low;Recommendation grade:Strong)
[laiyuan] => 我们建议持续进行血栓预防,直至能够完全负重行走,且至少持续7天。(证据分级:中或低;推荐强度:强推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
我们建议持续进行血栓预防,直至能够完全负重行走,且至少持续7天。(证据分级:中或低;推荐强度:强推荐)
We suggest continuing thromboprophylaxis until ambulation with full weight-bearing is achieved and for a minimum duration of 7 days. (Evidence level:moderate/Low;Recommendation grade:Strong)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1682
[catid] => 302
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1682.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => We do not recommend aspirin for venous thromboprophylaxis. (Evidence level:High;Recommendation grade:weak)
[laiyuan] => 我们不推荐使用阿司匹林进行静脉血栓预防。(证据分级:高;推荐强度:弱推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
我们不推荐使用阿司匹林进行静脉血栓预防。(证据分级:高;推荐强度:弱推荐)
We do not recommend aspirin for venous thromboprophylaxis. (Evidence level:High;Recommendation grade:weak)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1683
[catid] => 302
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1683.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => We suggest against routine pharmacological thromboprophylaxis after knee ligament repair, simple arthroscopy, meniscectomy, forefoot surgery, or removal of osteosynthesis material.(Evidence level:moderate/Low;Recommendation grade:weak)
[laiyuan] => 我们建议在膝关节韧带修复、单纯关节镜检查、半月板切除术、前足手术或者内固定材料取出术后,不要常规进行药物性血栓预防。(证据分级:中或低;推荐强度:弱推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
我们建议在膝关节韧带修复、单纯关节镜检查、半月板切除术、前足手术或者内固定材料取出术后,不要常规进行药物性血栓预防。(证据分级:中或低;推荐强度:弱推荐)
We suggest against routine pharmacological thromboprophylaxis after knee ligament repair, simple arthroscopy, meniscectomy, forefoot surgery, or removal of osteosynthesis material.(Evidence level:moderate/Low;Recommendation grade:weak)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1684
[catid] => 291
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1684.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => If the patient has a major personal VTE risk factor** or several minor risk factors, we suggest thromboprophylaxis with an anticoagulant (anti-Xa DOAC or LMWH) .(Evidence level:moderate/Low;Recommendation grade:Strong)
[laiyuan] => 如果患者存在静脉血栓栓塞的主要个人危险因素或者若干次要危险因素,我们建议使用一种抗凝剂(抗 Xa 直接口服抗凝剂或低分子量肝素)进行血栓预防。(证据分级:中或低;推荐强度:强推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
如果患者存在静脉血栓栓塞的主要个人危险因素或者若干次要危险因素,我们建议使用一种抗凝剂(抗 Xa 直接口服抗凝剂或低分子量肝素)进行血栓预防。(证据分级:中或低;推荐强度:强推荐)
If the patient has a major personal VTE risk factor** or several minor risk factors, we suggest thromboprophylaxis with an anticoagulant (anti-Xa DOAC or LMWH) .(Evidence level:moderate/Low;Recommendation grade:Strong)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1685
[catid] => 291
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1685.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => We recommend thromboprophylaxis with LMWH for 4 weeks, including minimally invasive surgery or ERAS pathway.(Evidence level:High;Recommendation grade:Strong)
[laiyuan] => 我们推荐使用低分子量肝素进行为期4周的血栓预防,包括在微创手术或实施加速康复外科路径的情况。(证据分级:高;推荐强度:强推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
我们推荐使用低分子量肝素进行为期4周的血栓预防,包括在微创手术或实施加速康复外科路径的情况。(证据分级:高;推荐强度:强推荐)
We recommend thromboprophylaxis with LMWH for 4 weeks, including minimally invasive surgery or ERAS pathway.(Evidence level:High;Recommendation grade:Strong)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1686
[catid] => 291
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1686.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => We suggest that fondaparinux may be used as an alternative to LMWH.(Evidence level:moderate/Low;Recommendation grade:Strong)
[laiyuan] => 我们建议磺达肝癸钠可以作为低分子量肝素的一种替代药物来使用。(证据分级:中或低;推荐强度:强推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
我们建议磺达肝癸钠可以作为低分子量肝素的一种替代药物来使用。(证据分级:中或低;推荐强度:强推荐)
We suggest that fondaparinux may be used as an alternative to LMWH.(Evidence level:moderate/Low;Recommendation grade:Strong)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1687
[catid] => 302
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1687.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => We suggest that anti-Xa DOACs may be used as an alternative to LMWH after recovery of gastrointestinal function.(Evidence level:moderate/Low;Recommendation grade:Strong)
[laiyuan] => 我们建议在胃肠功能恢复后,抗Xa直接口服抗凝剂可以用作低分子量肝素的替代药物。(证据分级:中或低;推荐强度:强推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
我们建议在胃肠功能恢复后,抗Xa直接口服抗凝剂可以用作低分子量肝素的替代药物。(证据分级:中或低;推荐强度:强推荐)
We suggest that anti-Xa DOACs may be used as an alternative to LMWH after recovery of gastrointestinal function.(Evidence level:moderate/Low;Recommendation grade:Strong)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1688
[catid] => 291
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1688.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => After abdominal and pelvic surgery with an intermediate risk for VTE, we suggest thromboprophylaxis with LMWH for a minimum of 7 days. (Evidence level:moderate/Low;Recommendation grade:Strong)
[laiyuan] => 在腹部和盆腔手术且静脉血栓栓塞症发生风险为中等的情况下,我们建议使用低分子量肝素进行至少7天的血栓预防。(证据分级:中或低;推荐强度:强推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
在腹部和盆腔手术且静脉血栓栓塞症发生风险为中等的情况下,我们建议使用低分子量肝素进行至少7天的血栓预防。(证据分级:中或低;推荐强度:强推荐)
After abdominal and pelvic surgery with an intermediate risk for VTE, we suggest thromboprophylaxis with LMWH for a minimum of 7 days. (Evidence level:moderate/Low;Recommendation grade:Strong)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine
Array
(
[id] => 1689
[catid] => 302
[title] => Prevention of perioperative venous thromboembolism: 2024 guidelines from the French Working Group on Perioperative Haemostasis (GIHP) developed in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society of Thrombosis and Haemostasis (SFTH) and the French Society of Vascular Medicine (SFMV) and endorsed by the French Society of Digestive Surgery (SFCD), the French Society of Pharmacology and Therapeutics (SFPT) and INNOVTE (Investigation Network On Venous ThromboEmbolism) network
[thumb] =>
[keywords] =>
[description] =>
[hits] =>
[uid] => 3
[author] => 甘肃中医院
[status] => 9
[url] => https://www.anes-guide.com/show/1689.html
[link_id] => 0
[tableid] => 0
[inputip] => 39.144.210.1
[inputtime] => 2024-12-12 11:19:00
[updatetime] => 2024-12-12 11:19:00
[displayorder] => 0
[nrjc] => Array
(
)
[nrsh] => Array
(
)
[xzl] => 0
[dzl] => 0
[wailian] => https://pubmed.ncbi.nlm.nih.gov/39447869/
[demo_url] =>
[zjpjff] => GRADE
[zjfj] =>
[tjqd] =>
[nianfen] => 2024
[guojia] => Anaesthesia, critical care & pain medicine
[pdf] =>
[tjyjyw] =>
[lyyw] => After abdominal and pelvic surgery with a low risk for VTE, we suggest against routine pharmacological prophylaxis. Pharmacological prophylaxis is suggested if the patient has a major personal VTE risk factor** or several minor risk factors, or in the case of prolonged surgery or postoperative complications.(Evidence level:moderate/Low;Recommendation grade:weak)
[laiyuan] => 在腹部和盆腔手术且静脉血栓栓塞症发生风险较低的情况下,我们建议不要进行常规的药物性预防。但如果患者存在静脉血栓栓塞症的主要个人危险因素或者若干次要危险因素,又或者手术时间较长或出现术后并发症时,则建议进行药物性预防。(证据分级:中或低;推荐强度:弱推荐)
[znzldj] => B级
[_inputtime] => 1733973540
[_updatetime] => 1733973540
[_nrjc] =>
[_nrsh] =>
)
推荐意见
在腹部和盆腔手术且静脉血栓栓塞症发生风险较低的情况下,我们建议不要进行常规的药物性预防。但如果患者存在静脉血栓栓塞症的主要个人危险因素或者若干次要危险因素,又或者手术时间较长或出现术后并发症时,则建议进行药物性预防。(证据分级:中或低;推荐强度:弱推荐)
After abdominal and pelvic surgery with a low risk for VTE, we suggest against routine pharmacological prophylaxis. Pharmacological prophylaxis is suggested if the patient has a major personal VTE risk factor** or several minor risk factors, or in the case of prolonged surgery or postoperative complications.(Evidence level:moderate/Low;Recommendation grade:weak)
证据评价方法:GRADE
指南质量等级:B级
年份:2024
国家:Anaesthesia, critical care & pain medicine