INTRACTABLE PAIN

Prepared by: Roxanne Mae E. Birador

Intractable - hard to control or hard to deal with.

It is a persistent or intermittent pain that lasts more than 3 months.

Intractable pain can result to an early death if not adequately treated.

INTRACTABLE PAIN

Doctors separate pain into 3 categories:

AcuteChronic Intractable

The mechanics that cause chronic or intractable pain are very complex. There usually is tissue damage or a disease process, which causes chemicals such as SEROTONIN, HISTAMINE, BRADYKIN & PROSTAGLANDIN to be released in the human body.

These chemicals cause the nerves to become more sensitive to pain. As time progresses a chemical called SUBSTANCE “P” is released from the peripheral nerve endings.

This substance carries pain signals. The more SUBSTANCE P that the nerves release, the more sensitive the person becomes to pain.

Many report suicidal thoughts for the sole purpose of stopping the pain, incessant crying spells, fatigue, depression, social isolation, restriction of mobility, and numerous bed- or couch-bound days.

California, Oregon, and Washington have passed “Intractable Pain” Laws, primarily to allow

physicians to legally prescribe opioids to needy pain patients.

Long-term opioid use changes the way nerve cells work in the brain. This happens even to people who take opioids for a long time to treat pain, as prescribed by their doctor.

The nerve cells grow used to having opioids around, so that when they are taken away suddenly, the person can have lots of unpleasant feelings and reactions. These are known as withdrawal symptoms.

CAUSES

There are many painful conditions that can cause intractable pain disease. Not every patient with these conditions will develop intractable pain, but the following conditions are known to cause Intractable Pain in some patients:

Failed Back Syndrome

Scoliosis, Kyphosis, Kyphoscoliosis

Degenerative Disk Disease

Rheumatoid Arthritis

Central Pain Syndrome (CPS)

Cancers

OTHER UNDERLYING CAUSE OF I.P.

John F Kennedy (35th President of the United States) has suffered from Intractable Pain. He developed a genetic autoimmune disease; development of centralized pain - a permanent imprinting of pain memory in brain cells.

Is Intractable Pain is Curable?

Intractable Pain is not curable, but there are treatments.

Intractable pain is sometimes called asLIFE LONG PAIN

Not every patient will respond to every treatment, but some more common treatments include:

Surgical repair, such as spinal fusion for scoliosis

Opioid medications

TENS Unit Transcutaneous electrical nerve stimulation (TENS or TNS) is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes.

Spinal cord stimulator (SCS) - utilizes the gate control theory to block painful signals by sending benign electrical signals along the nerve roots.

Intrathecal Pain Pump - delivers a very small amount of the chosen medication directly to the thecal space (next to the spinal cord, even closer than an epidural).

Epidural, nerve root, and/or trigger point corticosteroid injections.

mu-Opioids - Depending on the specific drug, opioids can be oral, transdermal, IV, intramuscular, subcutaneous, transmucosal, sublingual, intranasal, epidural, or intrathecal. Examples include morphine, hydromorphone, oxymorphone, hydrocodone, oxycodone, codeine, buprenorphine.

Methadone - methadone is a mu-opioid, kappa-opioid, and NMDA receptor antagonist. It is especially useful for neuropathic pain, however it is also useful for other types of pain, such as bone pain, and musculoskeletal pain.

MEDICATIONS

Muscle Relaxants Mood Stabilizers (anti-epileptics and antipsychotics), such as gabapentin (Neurontin/Gralise/Horizant), pregabalin (Lyrica), topiramate (Topamax), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), paliperidone (Invega), iloperidone (Fanapt), ziprasidone (Geodon), lamotrigine (Lamictal), valproic acid (Depakene/Stavzor), or divalproex acid (Depakote).

SSRI antidepressants, such as fluoxetine (Prozac/Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), or escitalopram (Lexapro)

SNRI antidepressants, such as duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq, or milnacipran (Savella)

NSAIDs – Ibuprofen (Advil/Motrin), naproxen (Naprosyn/Aleve), celecoxib (Celebrex), diclofenac (Voltaren/Flector), or ketorlac (Toradol)

The person is already suffering, DYING…

How much longer would you have them to suffer?

Would you let someone you love to undergo euthanasia if they wish so?