Challenges in managing chronic pain.

1. Navigating Chronic Pain A Clinician’s Guide

2. OBJECTIVES Definition of Chronic Pain Challenges in treatment of Chronic Pain Disorders Indications for referral to chronic pain physicians

3. Defining Chronic Pain Pain that has become dissociated from its original physical basis Pain that slowly becomes a self sustaining condition that is resistant to traditional medical management Pain that persists beyond 6 months Associated with emotional distress, depression, failed treatments, & adoption of the sick role

4. Canadian National Pain Study 2002 Chronic pain is present in 22 – 39% adults #1 reason for chronic pain: arthritic conditions Prevalence of pain increases with aging Only 36% of patients felt that their pain was effectively Rx 68% of MD’s believed that chronic pain could be treated more effectively Moulin D., PR&M, 2002,2003

5. ECONOMIC IMPACT 13% of workers lose a mean of 4.6 hours /wk of productive work time due to common pain conditions Costs to industry $6.2 B/yr (US) 76 % due to reduced performance at work Costs of depression to industry $31 B/yr Equal to impact of CV disease, or Cancer Stewart et al. JAMA 2003

6. TREATMENT OF CHRONIC PAIN

7. ASSOCIATED CONDITIONS

9. INDICATIONS FOR REFERRAL Multifactorial causes for pain Pre-operative chronic pain needs to be controlled Post operatively still having pain Non operative pain Not yet surgical On the fence about surgical intervention

10. GREATEST BENEFIT FROM CHRONIC PAIN MANAGEMENT Non malignant pain Headaches Neck Pain Shoulder Pain Lumbar pain Radicular pain Pain dissociated from physical findings Patients requiring medication regiment