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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
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