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Pain A Primer For Adjusters
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Pain A Primer For Adjusters

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  • 1.  Pain is a universal human experience. The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." Pain may be a symptom of an underlying disease or disorder, or a disorder in its own right.
  • 2.  Multiple definitions Google - The English word pain probably comes from Old French (peine), Latin (poena - meaning punishment pain), or Ancient Greek (poine - a word more related to penalty), or a combination of all three Bing - unpleasant physical sensation: › the acutely unpleasant physical discomfort experienced by somebody who is violently struck, injured, or ill feeling of discomfort a sensation of pain in a particular part of the body emotional distress: severe emotional or mental distress
  • 3.  Pain is difficult to define and describe. Essentially, pain is the way your brain interprets information about a particular sensation that your body is experiencing. Information (or "signals") about this painful sensation are sent via nerve pathways to your brain. The way in which your brain interprets these signals as "pain" can be affected by many outside factors, some of which can be controlled by special techniques.
  • 4.  Back pain accounted for 40 percent of absences from work, second only to the common cold. (Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg. 2006;88A(suppl. 2):21-24.)
  • 5.  Acute pain is of short duration, usually the result of an injury, surgery or illness. This type of pain includes acute injuries, post- operative pain and post-trauma pain.
  • 6.  Chronic pain is an ongoing condition, such as back and neck pain, headaches, complex regional pain syndrome Type 1 (reflex sympathetic dystrophy), neuropathic pain (nerve injury pain), musculoskeletal pain, and pain related to illness.
  • 7.  Nocioceptive Neuropathic Psychogenic Idiopathic
  • 8.  Nociceptive pain is caused by stimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity Pain that is associated with tissue injury in the presence of normal neurological function
  • 9.  Pain that is associated with abnormal neuronal function in either the central nervous system or peripheral nervous system
  • 10.  Pain that is associated with emotional conflict or psychosocial problems (aka somatoform pain) that are sufficient to allow the conclusion that they are the main causative influences. Exclusion of organic disorders is not sufficient on its own to warrant the diagnosis.
  • 11.  Pain that is present in the absence of identifiable physical or psychological substrate or is considered excessive for the existing organic process. Difficult to explain why there is pain It is believed to be of psychological origin but may involve both cerebral and peripheral physiological mechanisms.
  • 12.  Chronic pain is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can, and often does, cause severe problems for patients.
  • 13.  Nocioceptive Pain › Anti-inflammatory agents (nonselective) › Anti-inflammatory agents (selective) › Strong non-opiate preparations › Weak opiate preparations › Strong opiate preparations
  • 14.  Anti-inflammatory (nonselective) › Ibuprofen (Motrin) › Naproxen (Aleve or Naprosyn) › Etodolac (Lodine) › Ketoprofen (Orudis) › Ketorolac (Toradol)
  • 15.  Anti-inflammatory- selective (Cox II inhib) › Celecoxib ( Celebrex) › Lumiracoxib (Prexige) › Parecoxib (Dynastat) › Etoricoxib (Arcoxia)
  • 16.  Strong non-opiate › Tramadol Weak opiates › codeine, hydrocodone (Vicodin) – usually in combination with aspirin or acetaminophen
  • 17.  Strong opiate preparations › Oxycodone (Oxycontin) › Morphine sulfate › Methadone › Meperidine (Demerol) › Buprenorphine (Buprenex) › Fentanyl (Duragesic, Actiq)
  • 18.  Neuropathic pain › Anticonvulsants › Tricyclic antidepressants › Selective serotonin reuptake inhibitors (SSRI) › Other antidepressants › Antispasmodic agents › Other agents
  • 19.  Anticonvulsants › Gabapentin – Neurontin (drug of choice as are low side effects) › Oxcarbazepine (Trileptal) › Topiramate (Topamax) › Levetiracetam › Zonisamide › Lamotrigine › Carbamazepine › Phenytoin (Dilantin)
  • 20.  Tricyclic antidepressants › Amitriptyline (Elavil) › Nortriptyline (Pamelor) › Doxepin (Sinequan) › Imipramine (Tofranil) › Desipramine (Norpramin)
  • 21.  SSRI – Selective serotonin reuptake inhibitor Generally less effective for the management of pain, then tricyclic antidepressants  Fluoxetine (Prozac)  Paroxetine (Paxil)  Sertraline (Zoloft)
  • 22.  Others › many additional medications have been tried to varying degrees of success.
  • 23.  In summary, pain is a particularly complex and challenging issue to deal with. Sorting out what is real versus not real is nearly impossible. All pain is real to that individual perceiving that unpleasant situation. Add to this the tangent factors of indemnity benefits, what is felt is owed, and the rest makes this a particularly difficult situation for the workers compensation professional to deal with.
  • 24.  Several things are essential A. A comprehensive physical evaluation of the individual B. A comprehensive assessment as to identify the type of pain C. Development of a treatment plan protocol that is consistent with national published parameters (ODG) N v. Y drugs. Past messages from the Division notes that 48% money spent of meds, were for drugs listed as “N” drugs. D. Use of appropriate medications, particularly sustained release reparations when dealing with chronic pain E. Adjunctive medications should be considered at every level
  • 25. Thank you