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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 SchweitzerAlbert 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 ExperienceThe Pain Experience
Common to most peopleRemains a medical research challengeMost frequent problem reported during
hospital admissionsSignificant undertreatment in minorities,
women, children, and elderly
Medical Management of PainMedical 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 DefinitionSpecialty 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 COMMON MISCONCEPTIONSMISCONCEPTIONS
Clinician– Educational deficits– Undermedication– Failure of adequate pain assessment– “Cookbook” therapies– Overestimation of risks
PatientRegulatory agencies
PAIN TYPESPAIN 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 TYPESPAIN TYPES
CHRONIC (Benign)– Duration of greater than expected healing time;
greater than 6 months– ANS usually depleted; psychological impact
from prolonged suffering
PAIN TYPESPAIN TYPES
Combination:– Malignant (Cancer)– HIV/AIDS– Sickle Cell Disease– RA/OA– Diabetes Mellitus– Fibromyalgia– Ehlers-Danlos Syndrome
Common Types of Chronic Common Types of Chronic PainPain
ArthritisCancer (tumor or treatment-related)Chronic Low BackHeadacheNeurogenic (Nerve pain disorders)Psychogenic (Centralized)
Pain TransmissionPain 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 TransmissionPain Transmission
Sensory pathways from nerve fibers -> spinal cord -> brain centers
All or nothing principalMany opportunities to block pain before
interpretation
PAIN ASSESSMENTPAIN 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 DiaryKeep 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 reportWhat to report
Location & movement of painWhen occurs, how long it lasts,
predictabilityHow does it feel? Does it always feel the
same?Describe the sensations:
– Sharp, dull, pressure, pulling, stabbing, burning
What to reportWhat 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 TherapiesPain Therapies
Drug– Acetaminophen– NSAID’s (Cox2)– Opioids– Steriods– Tricyclic
Antidepressants– Muscle Relaxants– Steroids– Anticonvulsants
Non-Drug– Physical– Psychosocial– Sensory
Non-Drug: PhysicalNon-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: PsychosocialNon-Drug: Psychosocial
Relaxation & BreathingReframing (somatic re-education)BiofeedbackImagery: meditation, prayer, hypnosis
– Walking meditation
Group ‘talk” therapies Positive “self” talk
Non-Drug:SensoryNon-Drug:Sensory
AromatherapyNutrition: herbal, organicHomeopathyArt therapyMusic therapyHumor therapyVisualization
Where to go for helpWhere 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 ResourcesExternal 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 ResourcesConsumer-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 ResourcesConsumer-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