““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

The Q FactorThe Q Factor