1 / 10

Treatment Strategies for Chronic Nonmalignant Pain

Treatment Strategies for Chronic Nonmalignant Pain. Jennifer Crook Advisor: Dr. Hadley 04/10/08. What is Chronic Nonmalignant Pain?. Guideline definition: 1. Enduring or recurring nature 2. Persisting longer than usual for condition/ associated with chronic disease process

noe
Download Presentation

Treatment Strategies for Chronic Nonmalignant Pain

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Treatment Strategies for Chronic Nonmalignant Pain Jennifer Crook Advisor: Dr. Hadley 04/10/08

  2. What is Chronic Nonmalignant Pain? • Guideline definition: 1. Enduring or recurring nature 2. Persisting longer than usual for condition/ associated with chronic disease process 3. Refractory to treatment 4. Associated with functional impairment 5. Possibly comorbid with a psychological disorder (Sanders et al. 2005) • Examples: • Low back pain • Trigeminal neuralgia

  3. Chemical mediators and receptors implicated in CNMP mechanisms • IL-6  PGE2 • IL-1β  COX-2 • TNF-α  COX-2 • Nerve Growth Factor (NGF) • Down-regulation of GABAB receptors • Up-regulation of Substance P receptors • Up-regulation of P2X7

  4. Diagnosis and Assessment of CNMP • Believe the patient! • Assessment tools: • NIH • Institute for Clinical Systems Improvement • www.icsi.org • Current treatment guidelines • Pain assessment tools • Brief Pain Inventory Scale • Functional Ability Questionnaire • Video

  5. Treatment of CNMP • Challenging for the practitioner … • Deficit of resources • Clear guidelines • Algorithms • Time constraints • Treatment necessitates continual reassessment of the patient and frequent communication • Multifaceted nature of treatment • Pharmacologic • Non-pharmacologic • The opioid issue …

  6. Opioids in the Treatment of CNMP • “Current guidelines do not recommend the use of opioid medications with CPS [CNMP] patients.” (Sanders et al. 2005) • Disadvantages: • Opioid-induced Hyperalgesia (OIH) • Debilitation of immune response • Conclusion: • Appropriate for subset of CNMP population • DIRE screening tool • Opioid contracts • Video

  7. Multidisciplinary Pain Centers • Who? • Functionally impaired patients • CNMP is refractory to treatment • What? • Treatment goals • Improved physical function • Improvement of general functional status • Increase in self management • Improvement of vocational/ disability status • Reduction or D/C of opiates and sedative- hypnotic medications • Reduction in health care utilization (Sanders et al. 2005)

  8. Multidisciplinary Pain Centers • Where? • Outpatient treatment centers • 40 hours per week • < 20 days • When? • Onset of significant disability • Learn to recognize the development of: • Pain behaviors • Maladaptive coping mechanisms

  9. Multidisciplinary Pain Centers • How? • Pharmacologic treatment • Non-opioid, non-sedative • “Adjunctive” • Non-pharmacologic treatment • Fitness/ exercise • Pain coping • Relaxation • CAM • Internal locus of control

  10. References • Angst MS, Clark JDC (2006) Opioid-induced hyperalgesia. Anesthesiology 104: 570-587 • Carver A (2007) “Pain,” ACP Medicine Vol. 2 3rd. Ed. WebMD Inc.: 2169-2179 • Castro AR, Pinto M, Lima D, Tavares I (2006) Secondary hyperalgesia in the monoarthritic rat is mediated by GABAB and NK1 receptors of spinal dorsal horn neurons: a behavior and c-fosstudy. Neuroscience 141: 2087-2095 • Célèrier E, Laulin J-P, Corcuff J-B, Le Moal M, Simonnet G (2001) Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: a sensitization process. Neuroscience 21(11): 4074-4080 • Ciccone DS, Just N, Bandilla EB, Reimer E, Ilbeigi MS, Wu W-H (2000) Psychological correlates of opioid use in patients with chronic nonmalignant pain: a preliminary test of the downhill spiral hypothesis. J Pain Symptom Manage 20(3): 180-192 • Clark LG, Upshur CC (2007) Family medicine physician’s views of how to improve chronic pain management. J Am Board Fam Med 20(5): 479-482 • Chou R, Huffman LH (2007) Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/ American College of Physicians clinical practice guideline. Ann Intern Med 147: 492-504 • Coughlin AM, Badura AS, Fleischer TD, Guck TP (2000) Multidisciplinary treatment of chronic pain patients: its efficacy in changing patient locus of control. Arch Phys Med Rehabil 81: 739-740 • Dina OA, Green PG, Levine JD (2007) Role of interleukin-6 in chronic muscle hyperalgesic priming. Neuroscience, doi 10.1016/j.neroscience.2008.01.006 • Gureje O, Von Korff M, Simon GE, Gater R (1998) Persistent pain and well-being. J Am Med Assoc 280(2): 147-152 • Hoheisel U, Unger T, Mense S (2007) Sensitization of rat dorsal horn neurons by NGF-induced subthreshold potentials and low-frequency activation. A study employing intracellular recordings in vivo. Brain Res 1169: 34-43 • Hooten WM, Townsend CO, Sletten CD, Bruce BK, Rome, JD (2007) Treatment outcomes after multidisciplinary pain rehabilitation with analgesic medication withdrawal for patients with fibromyalgia. Pain Med 8(1): 8-16 • Høsted J, Sjøgren P (2007) An update on the role of opioids in the management of chronic pain of nonmalignant origin. CurrOpinAnesthesiol 20(5): 451-455 • Huge V, Schloderer U, Steinberger M, Wuenschmann B, Schöps, Beyer A, Azad SC (2006) Impact of a functional restoration program on pain and health-related quality of life in patients with chronic low back pain. Pain Med 7(6): 501-518 • Institute for Clinical Systems Improvement (2007) Assessment and management of chronic pain. National Guideline Clearinghouse: http://www.guideline.gov/summary/ • summary.aspx?doc_id=10724&nbr=005586&string=chronic+AND+pain • Accessed 02/29/08 • McGaraughty S, Chu KL, Namovic MT, Donnelly-Roberts DL, Harris RR, Zhang XF, Shieh CC, Wismer CT, Zhu CZ, Gauvin DM, Fabiyi AC, Honore P, Gregg RJ, Kort ME, Nelson DW, Carroll WA, Marsh K, Faltynek CR, Jarvis MF (2007) P2X7- related modulation of pathological nociception in rats. Neuroscience 146: 1817-1828 • Morone NE, Greco CM (2007) Mind-body interventions for chronic pain in older adults: a structured review. Pain Med 8(4): 359-375 • Narita M, Shimamura M, Imai S, Kubota C, Yajima Y, Takagi T, Shokawa M, Inoue T, Suzuki M, Suzuki T (2007) Role of interleukin- 1β and tumor necrosis factor-α-dependent expression of cyclooxygenase-2 mRNA in • thermal hyperalgesia induced by chronic inflammation in mice. Neuroscience doi: 10.1016/j.neuroscience.2007.10.039 • Sanders SH, Harden RN, Vicente PJ (2005) Evidence-based clinical practice guidelines for interdisciplinary rehabilitation of chronic nonmalignant pain syndrome patients. Pain Practice 5(4): 303-315 • Schofferman J (2000) Long-term opioid analgesic therapy for severe refractory lumbar spine pain. Clin J Pain 16(1): 86 • Strasser F, Driver LC, Burton AW (2003) Update on adjuvant medications for chronic nonmalignant pain. Pain Pract 3(4): 282-297 • Tsao JCI (2007) Effectiveness of massage therapy for chronic, nonmalignant pain: a review. eCAM 4(2): 162-179 • Zeng Q, Wang S, Lim G, Yang L, Mao J, Sung B, Chang Y, Lim J-A, Guo G, Mao J (2007) Exacerbated mechanical allodynia in rats with depression-like behavior. Brain Res doi: 10.1016/j.brainres.2008.01.038 • Zhang W, Lui LY, Xu TL (2007) Reduced potassium chloride cotransporter expression in spinal cord dorsal horn neurons contributes to inflammatory pain hypersensitivity in rats. Neuroscience doi: 10.1016/j.neuroscience.2007.12.037

More Related