Pain Management

Question 1

Somatic vs Nerve based

Answer 1

Somatic:

• sore, twisting, throbbing, dull
• common (scrapes, injuries, cramps)
• NSAIDs, APAP, opioids, muscle relaxants help

Nerve:

• burning, its electric! (boogie woogie), pins & needles, numbing
• misunderstood/overlooked: dysfunction & damage to nerve
• anti-depressants/anti-convulsants help

Question 2

non-pharm management

Answer 2

treat from all angles

• bio (incr. working out to build up muscle, simple activities have become painful)
• spiritual (turn yourself to a higher power)
• psycho (find yourself, see psychologists, social workers, and counselors; coping strategies, guided imagery, stress management)
• social (build relationships, get a job, join a club)

definitive link bw pn & mood –> we want to break this connection

Question 3

steps of pn pathway

Answer 3

1. stimuli –> action potential (TRANSDUCTION & TRANSMISSION)
2. modulation in spinal vertebrae (MODULATION: meds)
3. travel thru spine to Thalamus (and rest of brain)
4. interpretation by sensory and emotional portions (PERCEPTION)

Question 4

What do we use for pain assessment?

Answer 4

PQRSTU

P: palliative/aggravating factors
Q: quality of pn
R: radiation from focal pts
S: severity/sleep
T: time of day (relating to pn intensity)
U: upset/angry? (how pn effects pt on personal level)

Question 5

Multi-modal approach:

Answer 5

therapeutic polypharmacy: use lower doses for better outcomes & fewer SE profiles

avoid meds with similar MOAs
try to stay NON-opioid as much as possible
- refer to physical & behavioral tx
- follow-up and monitor regularly

Question 6

Active Based Therapy Programs

Answer 6

PT

• improve strength, flexibility, posture
• effort (by pt)
• initial incr. in pn
• aqua tx (great starting pt!)
• graded motor imaging: mirror tx