Pain Management Services at Cancer Treatment Centers of America

1,150 views

Published on

This presentation created by Dr. Rahman, Medical Director of Pain Management at Cancer Treatment Centers of America (CTCA) will describe: the history of pain, what pain is, explain the types of pain, and will give examples of the types of pain.

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,150
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
33
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • We all feel pain and deal with it differently. As a Pain Specialist, I see it in the eyes of my patients every day.
  • Pain Management Services at Cancer Treatment Centers of America

    1. 1. Cancer Treatment Centers of America ®Midwestern Regional Medical Center Pain Management Service Presented by: Dr. Rahman Date: 5/10/2012 – Thursday www.cancercenter.com
    2. 2. Pain 2 © 2011 Rising Tide
    3. 3. ObjectivesTo describe the history of pain.To describe what pain is.To explain the types of pain.To give examples of the types of pain.• Open Discussion – Okay to ask questions during the lecture. 3 © 2011 Rising Tide
    4. 4. History of Pain• Ancient Greeks times: – Aristotle (384 B.C. – 322 B.C.) Pain due to evil spirits who entered the body during injury. – Hippocrates (460 B.C. – 370 B.C.) Pain due to an imbalance in the vitals fluids of the body. Pain was not well understood and was believed to originate outside the body. As a punishment from God. 4 © 2011 Rising Tide
    5. 5. What is Pain?• In the past, pain defined as “whatever the experiencing person says it is, existing whenever s/he says it does.”• Stresses that pain is a subjective experience• The patient not the clinician is the authority• Patient’s self report is the most reliable indicator of pain• Emphasizes that pain is a complex experience with multiple dimensions 5 © 2011 Rising Tide
    6. 6. International Association for the Study of Pain 1979Pain defined as:“An unpleasant sensory and emotionalexperience associated with actual or potentialtissue damage, or described in terms of suchdamage.”Emphasizes that pain is a complex experiencewith multiple dimensions 6 © 2011 Rising Tide
    7. 7. Types of Pain : Time vs Location• Acute vs Chronic• Nociceptive (S&M) vs Neuropathic 7 © 2011 Rising Tide
    8. 8. Acute Pain• Trauma• Surgery• Infection• Burns• Appendicitis• Inflammatory 8 © 2011 Rising Tide
    9. 9. Chronic• Pancreatitis• Diabetic Peripheral Neuropathy• Osteoarthritis• Headache• Fibromyalgia• Phantom Pain 9 © 2011 Rising Tide
    10. 10. Nociceptive• Osteoarthritis• Rheumatoid Arthritis• Muscle Injury• Inflammation• Neoplasm• Degenerative Disc Disease 10 © 2011 Rising Tide
    11. 11. Neuropathic• Diabetic Peripheral Neuropathy• Stroke Pain• Post Herpetic Neuralgia• Complex Regional Pain Syndrome• Multiple Sclerosis• Neoplasm 11 © 2011 Rising Tide
    12. 12. 12© 2011 Rising Tide
    13. 13. The 5th Vital Sign• Vitals Signs: – Temperature – Pulse – Respiratory Rate – Blood Pressure – Pain Score 13 © 2011 Rising Tide
    14. 14. Types of Pain Low Back Pain Headaches & Migraines Myofascial Pain Cancer Pain (Head, Neck, Chest, Abdomen, Pelvis, Extremities, etc.) Complex Regional Pain Syndrome (RSD) Musculoskeletal Disorders Sciatica Post Surgical Pain Neuropathic Pain Syndromes e.g. Diabetic Neuropathy Abdominal and Pelvic Pain Spine Pain Post-Herpetic Neuralgia
    15. 15. • Here are the kinds of painblocks the pain service can offerCaudal, Lumbar, Thoracic, and Cervical Epidural Steroid blocksPatient-Controlled Analgesia (PCA) pumpsPatient-Controlled Epidural (PCEA) pumpsTrigger point injectionsBlocks of Somatic and Visceral Cancer Pain SyndromesFacet Joint InjectionsMinor and Major Joint and Bursa injectionsPeripheral and Central Somatic Nerve and Plexus BlocksTunneled catheter placements for various nerve sheathsRadiofrequency ablative proceduresIntraspinal catheters for intrathecal opioid trials and implanted infusion devicesSpinal cord/Dorsal Column StimulatorsDiscographyUltrasound-Guided ProceduresAnatomical Landmark Guided Procedures
    16. 16. Pain Assessment• Pain History• Pain Physical Exam• Labs/Imaging Studies• Pain Diagnosis• Pain Plan• Then Follow-up Evaluation 16
    17. 17. Pain Assessment 17 © 2011 Rising Tide
    18. 18. Spinal Pain Generators
    19. 19. Multi-Disciplinary Care
    20. 20. MRI
    21. 21. 22© 2011 Rising Tide
    22. 22. Potential Pain Therapies• A. Nonpharmacologic• B. Pharmacologic• C. Interventional 23 © 2011 Rising Tide
    23. 23. Nonpharmacologic• Acupuncture• Biofeedback• Chiropractic Care• Massage• Physical Therapy• TENS unit• Cognitive Behavioral Therapy 24 © 2011 Rising Tide
    24. 24. Pharmacologic• Topical Agents• NSAIDS• Oral/IV steriod• Opioids• Antidepressants• Anticonvulsants• Infusions 25 © 2011 Rising Tide
    25. 25. Interventional• Trigger Point Injections• Medial Branch Block• Epidural Steroid• Intradiscal Therapy• Laminectomy/Fusion• Vertobroplasty• Discectomy 26 © 2011 Rising Tide
    26. 26. Interlaminar approach
    27. 27. Transforaminal approach
    28. 28. OA
    29. 29. Anterior Approach
    30. 30. Greater Trochanter Injection
    31. 31. Shoulder/Bursa Injections
    32. 32. Elbow Bursa Injections
    33. 33. FJI
    34. 34. Retrobulbar Block
    35. 35. Stellate Ganglion Block
    36. 36. Sacrum Injections
    37. 37. SCS
    38. 38. ITP
    39. 39. TPI
    40. 40. Lower Cranial Nerve Blocks
    41. 41. Conclusion• A good history is crucial in helping you develop a Differential Diagnosis• The physical exam maneuvers we use can help us to rule out some cause and in some cases rule in others• Although radiology has become standard, it is no substitute for the clinical exam
    42. 42. 47© 2011 Rising Tide

    ×