Conservative Pain Management

Question 1

What is Pain?

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Question 2

Pain classification by clinical management:

Answer 2

Transient
Acute
Chronic pain due to cancer
Chronic pain due to nonmalignant diseases

Question 3

Pain management by presumed source:

Answer 3

Nociceptive
Neuropathic
Mixed/unspecified
Psychiatric

Question 4

Medication Efficacy With Age

Answer 4

Reduction in renal and hepatic clearance with age
Increased time needed for elimination of pharmaceutical agents
Elderly: increased fat mass, lower muscle mass, lower water

Question 5

If Not Meds, Then What?

Answer 5

Psychological Support
Physical Rehabilitation
Interventional Modalities

Question 6

Psychological Support

Answer 6

Psychophysiological (biofeedback)
Behavioral approaches
Acceptance-based approaches

Question 7

Behavioral Approaches

Answer 7

Relaxation Training
Operant conditioning (stimulus-response)
Cognitive-behavioral therapy
Acceptance-based

Question 8

Operant conditioning (stimulus-response)

Answer 8

Graded activation (exposure)
Fear avoidance

Question 9

Cognitive-behavioral therapy

Answer 9

correct maladaptive coping strategies

Question 10

Acceptance-based

Answer 10

acceptance, mindfulness, psychological flexibility

Question 11

What is associated with a lack of improvement in PT?

Answer 11

Catastrophizing and depression

Question 12

Interventional Modalities

Answer 12

TENS
Low level laser therapy
Thermal Agents
Bracing/Splinting

Question 13

Patient Specific Functional Scale MCID:

Answer 13

varies by diagnosis, 2-3 is reasonable

Up to 3 patient selected activities

Question 14

Visual Analogue Scale (VAS, NPRS)

Answer 14

2 point improvement is MCID for non-cancer pain

Consider balance between asking about pain and catastrophizing

Question 15

Brief Pain Inventory

Answer 15

Regular: 32 items

Short form: 9 items

Question 16

McGill Pain Questionnaire

Answer 16

Meant to describe pain, not measure change over time
Higher score = greater pain
Original form scored 0 to 78
Short form reduced to 15 items

Question 17

FABQWA

Answer 17

> 34 is a high score, <19 is a low score

Question 18

FABQPA

Answer 18

> 15 is a high score, <9 is a low score

Question 19

Oswestry Low Back Disability Questionnaire

Answer 19

Self-report measure scored 0-100, higher number = greater disability
Scores 80 and over = bed-bound or exaggerating
MCID = 10