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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 “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? Pain is: – – – – Biological “red flag” COMPLEX SUBJECTIVE UNIQUE to every individual Pain is NOT: – just a symptom – meant to “build character” 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 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 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 Clinician – – – – – Educational deficits Undermedication Failure of adequate pain assessment “Cookbook” therapies Overestimation of risks Patient Regulatory agencies 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 TYPES CHRONIC (Benign) – Duration of greater than expected healing time; greater than 6 months – ANS usually depleted; psychological impact from prolonged suffering PAIN TYPES Combination: – – – – – – – Malignant (Cancer) HIV/AIDS Sickle Cell Disease RA/OA Diabetes Mellitus Fibromyalgia Ehlers-Danlos Syndrome Common Types of Chronic Pain Arthritis Cancer (tumor or treatment-related) Chronic Low Back Headache Neurogenic (Nerve pain disorders) Psychogenic (Centralized) 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 Transmission Sensory pathways from nerve fibers -> spinal cord -> brain centers All or nothing principal Many opportunities to block pain before interpretation 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 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 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 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 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 Relaxation & Breathing Reframing (somatic re-education) Biofeedback Imagery: meditation, prayer, hypnosis – Walking meditation Group ‘talk” therapies Positive “self” talk Non-Drug:Sensory Aromatherapy Nutrition: herbal, organic Homeopathy Art therapy Music therapy Humor therapy Visualization 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 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 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 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