Pain Intervention in Modern Practice
Kees Besse, anesthesiologist, FIPP
Campus Dekkerswald Nijmegen
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IASP definition of pain
An unpleasant sensory and emotional experienceassociated with actual or potential tissue damage, ordescribed in terms of such damage.
Nociception
Activation of sensory transduction in nerves by thermal, mechanical or chemical energy impinging on specializednerve endings. The nerve(s) involved conveysinformation about tissue damage to the central nervoussystem.
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Pain transmission
Neuropathic pain
Pain arising as a direct consequence of a lesion ordisease affecting the somatosensory system.
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Multidimensional Pain neuromatrix:
Melzack R MD Consult 2003
Input in body neuromatrix of:
Cognitive brain sites
Sensorial conduction system
Emotional systems
Output towards brain site responsible for:
Pain perception
Action programming
Stress-related programms
C
S
E
time timeModified Loeser
Pain assessment at intake
• Pain assessment is the responsibility of doctors, nurses and patients
• Careful history and physical examination
• Use of Numeric Rating Scale (NRS) on every visit at the outpatient department
• Use of the Brief Pain Inventory (BPI)
Diagnosis
•Established: treatment proposition
•Preliminary: multidisciplinary assessment
Multidisciplinary assessment
•Pain nurse: social assessment, medication
•Pain psychologist: psychological assessment
•Pain physiotherapist: pain related physical examination
•Pain specialist: coordination
Treatment targets
•Pain reduction
•Rehabilitation
•Resocialisation
Painreduction
•Medication
•Nerve blocks
•Neurostimulation
Nerve blocks
•Diagnostic
•Therapeutic
•Pulsed radiofrequency
•Thermal radiofrequency
Nerve block performance
•Meticulous explanation to the patient of nerve block goal
•Explanation of expected effects and side effects
•Written informed consent
•Block supported by fluoroscopy or echo guided
Neurostimulation
•Transcutaneous Electrical Nerve Stimulation (TENS)
•Dorsal column stimulation
•Motor cortex stimultion
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Spinal cord stimulation
Non anesthesiologic pain treatment
•Cognitive behavioural therapy (psychologist)
•Rehabilitation center
Conclusion
•Assessment and treatment of chronic pain is a
multidisciplinary task
•Anesthesiologists/pain specialist are the preferred
coordinators