Transcript What is Pain?” - Ehlers-Danlos National Foundation (EDNF)

“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?
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Pain is:
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Biological “red flag”
COMPLEX
SUBJECTIVE
UNIQUE to every individual
Pain is NOT:
– just a symptom
– meant to “build character”
The Pain Experience
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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
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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)
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COMMON
MISCONCEPTIONS
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Clinician
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Educational deficits
Undermedication
Failure of adequate pain assessment
“Cookbook” therapies
Overestimation of risks
Patient
 Regulatory agencies
PAIN TYPES
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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
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CHRONIC (Benign)
– Duration of greater than expected healing time;
greater than 6 months
– ANS usually depleted; psychological impact
from prolonged suffering
PAIN TYPES
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Combination:
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Malignant (Cancer)
HIV/AIDS
Sickle Cell Disease
RA/OA
Diabetes Mellitus
Fibromyalgia
Ehlers-Danlos Syndrome
Common Types of Chronic
Pain
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Arthritis
 Cancer (tumor or treatment-related)
 Chronic Low Back
 Headache
 Neurogenic (Nerve pain disorders)
 Psychogenic (Centralized)
Pain Transmission
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Receptor cells:
– Heat, cold, light touch, pressure
– PAIN
– Majority sense pain; minority sense cold
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Injury stimulates chemical release: signals with
use of “neurotransmitters”
– Substance P, Prostaglandin's
– Endorphins “morphine-like, Enkephalins “in the head”
Pain Transmission
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Sensory pathways from nerve fibers ->
spinal cord -> brain centers
 All or nothing principal
 Many opportunities to block pain before
interpretation
PAIN ASSESSMENT
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Clinical Practice Guidelines
 “The FIFTH vital sign”
 Assessment Tools
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Numeric Scale (0-10)
Faces Scale
Intensity Rating (mild, moderate, severe)
Activity/Function Rating
Keep a Pain Diary
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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
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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
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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
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Drug
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Acetaminophen
NSAID’s (Cox2)
Opioids
Steriods
Tricyclic
Antidepressants
– Muscle Relaxants
– Steroids
– Anticonvulsants
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Non-Drug
– Physical
– Psychosocial
– Sensory
Non-Drug: Physical
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Chiropractic maneuvers
 Acupuncture/Acupressure
 Reconditioning Program (PT/OT)
– TENS
– Pool therapy
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Yoga; Tai Chi
 Therapeutic Massage
 Touch Therapy
 Thermal Techniques
– Counter-irritants
Non-Drug: Psychosocial
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Relaxation & Breathing
 Reframing (somatic re-education)
 Biofeedback
 Imagery: meditation, prayer, hypnosis
– Walking meditation
Group ‘talk” therapies
 Positive “self” talk
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Non-Drug:Sensory
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Aromatherapy
 Nutrition: herbal, organic
 Homeopathy
 Art therapy
 Music therapy
 Humor therapy
 Visualization
Where to go for help
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Primary healthcare professional
– Address acute problem if new onset
– Active listener
– Holistic approach
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Specialist
– Neither dismissive nor indulgent
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Pain Specialist
– Multi-disciplinary approach
External Resources
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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
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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
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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