Pain management basics
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“Pain Management Basics”. Maggie Buckley, MBA Patient Advocate. With Special thanks to: Micke A. Brown, BSN, RN, Director of Advocacy American Pain Foundation. Albert Schweitzer.

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Pain management basics

“Pain Management Basics”

Maggie Buckley, MBA

Patient Advocate

With Special thanks to:

Micke A. Brown, BSN, RN,

Director of Advocacy

American Pain Foundation


Albert schweitzer

Albert Schweitzer

“We must all die. But that I can save (someone) from days of torture, that is what I feel as my great & ever new privilege. Pain is a more terrible lord than even death itself”


What is pain

What is Pain?

  • Pain is:

    • Biological “red flag”

    • COMPLEX

    • SUBJECTIVE

    • UNIQUE to every individual

  • Pain is NOT:

    • just a symptom

    • meant to “build character”


The pain experience

The Pain Experience

  • Common to most people

  • Remains a medical research challenge

  • Most frequent problem reported during hospital admissions

  • Significant undertreatment in minorities, women, children, and elderly


Medical management of pain

Medical Management of Pain

  • Strongly influenced by professional ethics, attitudes, and philosophies

    • Neurological Construct:

      • sensation perception due to neuroanatomical or physiological disorder; the unexplained is “psychiatric in origin”

    • Psychological Concept:

      • sensation with complex set of modulatory influences from emotional, environmental & psychophysiological factors


Specialty definition

Specialty Definition

  • Pain is “an unpleasant sensory & emotional experience associated with actual or potential damage or described in terms of such damage”. (IASP, 1979)

  • Pain is “whatever the experiencing person says it is, existing whenever the person says it does”. (McCaffery, 1968)


Common misconceptions

COMMON MISCONCEPTIONS

  • Clinician

    • Educational deficits

    • Undermedication

    • Failure of adequate pain assessment

    • “Cookbook” therapies

    • Overestimation of risks

  • Patient

  • Regulatory agencies


Pain types

PAIN TYPES

  • ACUTE

    • Duration of less than 3-6 months (6 week average healing time)

    • ANS (stress) response; initial effect until adaptation

    • Acute injury cascade (flare, wheal, hyperalgesia); strong neurohormonal effects


Pain types1

PAIN TYPES

  • CHRONIC (Benign)

    • Duration of greater than expected healing time; greater than 6 months

    • ANS usually depleted; psychological impact from prolonged suffering


Pain types2

PAIN TYPES

  • Combination:

    • Malignant (Cancer)

    • HIV/AIDS

    • Sickle Cell Disease

    • RA/OA

    • Diabetes Mellitus

    • Fibromyalgia

    • Ehlers-Danlos Syndrome


Common types of chronic pain

Common Types of Chronic Pain

  • Arthritis

  • Cancer (tumor or treatment-related)

  • Chronic Low Back

  • Headache

  • Neurogenic (Nerve pain disorders)

  • Psychogenic (Centralized)


Pain transmission

Pain Transmission

  • Receptor cells:

    • Heat, cold, light touch, pressure

    • PAIN

    • Majority sense pain; minority sense cold

  • Injury stimulates chemical release: signals with use of “neurotransmitters”

    • Substance P, Prostaglandin's

    • Endorphins “morphine-like, Enkephalins “in the head”


Pain transmission1

Pain Transmission

  • Sensory pathways from nerve fibers -> spinal cord -> brain centers

  • All or nothing principal

  • Many opportunities to block pain before interpretation


Pain assessment

PAIN ASSESSMENT

  • Clinical Practice Guidelines

  • “The FIFTH vital sign”

  • Assessment Tools

    • Numeric Scale (0-10)

    • Faces Scale

    • Intensity Rating (mild, moderate, severe)

    • Activity/Function Rating


Keep a pain diary

Keep a Pain Diary

  • Keep a small notebook or tape recorder

  • Write what you need to write, do not worry about grammar or style

  • If too painful to write, have someone you trust help

  • Include: where it hurts, when it hurts, how it hurts

  • Plot relief measures & how the pain changes

  • Document effects of any medications good &/or bad

  • Add sleep, diet, work & pleasure interruptions


What to report

What to report

  • Location & movement of pain

  • When occurs, how long it lasts, predictability

  • How does it feel? Does it always feel the same?

  • Describe the sensations:

    • Sharp, dull, pressure, pulling, stabbing, burning


What to report1

What to report

  • Is sleep interrupted?

  • Is your mood changed by the pain?

  • Is your appetite affected?

  • What makes it better? Worse?

  • What DO YOU think is the cause?

  • Have you tried to relieve the pain? HOW?

  • WHAT IS YOUR GOAL FOR RELIEF?


Pain therapies

Drug

Acetaminophen

NSAID’s (Cox2)

Opioids

Steriods

Tricyclic Antidepressants

Muscle Relaxants

Steroids

Anticonvulsants

Non-Drug

Physical

Psychosocial

Sensory

Pain Therapies


Non drug physical

Non-Drug: Physical

  • Chiropractic maneuvers

  • Acupuncture/Acupressure

  • Reconditioning Program (PT/OT)

    • TENS

    • Pool therapy

  • Yoga; Tai Chi

  • Therapeutic Massage

  • Touch Therapy

  • Thermal Techniques

    • Counter-irritants


Non drug psychosocial

Non-Drug: Psychosocial

  • Relaxation & Breathing

  • Reframing (somatic re-education)

  • Biofeedback

  • Imagery: meditation, prayer, hypnosis

    • Walking meditation

  • Group ‘talk” therapies

  • Positive “self” talk


Non drug sensory

Non-Drug:Sensory

  • Aromatherapy

  • Nutrition: herbal, organic

  • Homeopathy

  • Art therapy

  • Music therapy

  • Humor therapy

  • Visualization


Where to go for help

Where to go for help

  • Primary healthcare professional

    • Address acute problem if new onset

    • Active listener

    • Holistic approach

  • Specialist

    • Neither dismissive nor indulgent

  • Pain Specialist

    • Multi-disciplinary approach


External resources

External Resources

  • American Pain Foundation www.painfoundation.org

  • American Society of Pain Management Nurses www.aspmn.org (800) 34-ASPMN

  • International Association for the Study of Pain www.iasp-pain.org


Consumer focused resources

Consumer-focused Resources

  • American Chronic Pain Association www.theacpa.org (916) 632-0922

  • American Pain Society www.ampainsoc.org (708) 966-5595

  • American Academy of Pain Management www.aapainmanage.org

  • UC Davis Division of Pain Medicine www.ucdmc.ucdavis.edu/pain/


Consumer focused resources1

Consumer-focused Resources

  • Dr. Andrew Weil www.pathfinder.com/drweil

  • NIH Complementary & Alternative Medicine Division www.nccam.nih.gov

  • National Headache Foundation www.headaches.org

  • National Fibromyalgia Association www.fmaware.org

  • CFIDS Association of America www.cfids.org

  • RSDS/CRPS Support Association www.rsdsa.org


The q factor

The Q Factor


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