Pain management

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Pain management

American Academy of Pain Management, defines pain management as:
i) The systematic study of clinical and basic science and its application for reduction of pain and suffering;
ii) The blending of tools, techniques and principles taken from discrete disciplines and reformulated as a holistic application for the reduction of pain and suffering; and
iii) A newly emerging discipline emphasising an interdisciplinary approach to the goal of reduction of pain and suffering

Steps in management of pain:
1) Diagnosis of the pathological process causing the pain
2) Definitive treatment for the pathological process identified
3) Identification of the particular type of pain involved
4) Interdisciplinary treatment

Generic principles of managing pain :
• believe the client’s description of her or his pain (many patients may have to cope with the doubt of others about the legitimacy of their pain complaint; need to believe if to have a collaborative relationship)
• treat acute pain aggressively (most likely result in less chronic pain)
• always assess the clients pain and its impact on daily life before planning intervention (needed so effect of intervention can be determined)
• avoid ‘leaps to the head’ to explain the clients pain (there can be an unfortunate tendency to jump to ‘psychological’ explanations for pain in absence of obvious tissue damage)
• determine whether the primary goal of intervention is pain reduction or improvement in function
• incorporate evidence based decision making into practice
• combine medical, pharmacological, cognitive – behavioural, occupational and physical strategies
• understand and correct misconceptions about the use of pain medication and addiction risks
• recognise that a positive response to cognitive-behavioural intervention does not mean that a client’s pain has a psychological cause
• help the client to make long term lifestyle changes (especially if the pain is potentially a long term issue)
• involve the clients family whenever possible
• recognise dual responsibilities and obligations
• create a positive therapeutic milieu
• conduct an ethical practice
• participate in research, eduction and professional pain associations

Either modify mediators at the periphery or alter central perception of pain.

have analgesic and anti-inflammatory properties
inhibit peripheral mediators of pain by inhibition of cycloxygenase mediated conversion of arachidonic acid to prostaglandin
Acetaminophen (Tylenol):
• only has analgesic properties
• mediate pain by mimicking effects of endorphins  inhibit release of neurotransmitters in nocioceptive pathway or block C-fibre inputs at the dorsal horn
believed to be effective in chronic pain due to effects on sleep and mood

Spinal analgesia:

Local injection:
Local anaesthetic and/or corticosteroid

Physical agents:
Cold therapy
Electrical stimulation

Psychological management of pain should occur concurrently with the physical management.
Two main psychological approaches are:
• operant behavioural
• cognitive behavioural

Multidisciplinary pain clinics:

Often based on biopsychosocial model

Patient Education (as reported in Herald Sun 8/1/02):
“1. Learn to relax. The more we fight pain the worse it becomes.
2. Increasing meaningful activity helps to put pain in the background. If you cannot do the things you enjoyed, develop interesting activities that are possible.
3. Keep up a graded exercise program. It is important to strengthen your muscles and increase your flexibility.
4. Take care of your relationships. Avoid pain dominating your family life by building in other enjoyable activities that you can share with others and contribute where you are able.
5. Pace your activities. Better that you achieve in small steps rather than trying too much at the one time and feeling a failure
6. Avoid negative self talk. How we talk to ourselves affects our emotional state. Engaging in depressing hopeless, helpless self talk may lead to a depressed mood. This then makes it harder to cope with pain and the pain seems worse.
7. Increase your social activities. Problem solve any barriers to an enjoyable outing.
8. Use lateral thinking to help you find alternative ways of achieving things.
9. Focus off your pain as much as you can. Find distracting activities that help you take your mind off your pain.
10. Pain frequently fluctuates in intensity and when it increases. It helps to remind yourself that it will come down to a more manageable level once again. Remember to reward yourself when you are managing difficult pain episodes”

Role of placebo:
Considerable evidence exists as to the effects of placebos in the management of pain.
Possibly have their effect by enhancing the body’s own tendency to reduce pain.

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