Slideshare chronicpain8.10.11

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type and treatment of chronic pain

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  • See a lot of people in pain 08/13/11
  • First drug czar under president nixon Pioneered methadone maint programs in illinois, pioneered addiction medicine currently prof of psych at univ of maryland 08/13/11
  • Lived in 354 framed the concept of original sin, thought sex was not bad only emotions it brought with it, was very wild as a young person 08/13/11
  • Physical vaporized by volcano, hole filled with plaster , anticipation of pain was worse
  • Physical pain 08/13/11
  • Sometings we can fix 08/13/11
  • From africa zimbawe saw at free clinic they I&D it many times in africa Pain became so great came to see us 08/13/11
  • It is what it is need to recognize it for what it is to better treat it and the pain See where it had been opened before in africa scar it there 08/13/11
  • 1 st centrury BC roman writer and poet A lot of us suffer with our thoughts 08/13/11
  • College student video by roommate having sex and then put on the internet is an example but peoples real concerns at end of life 08/13/11
  • Spiritual pain occurs during time of crisis Often involves searching for answers to spiritual questions such as these This also happens when you reach your 50s too you start thinking of this 08/13/11
  • Can be anywhere, police officer in training hit with baton and developed RSD, on wrist nothing visible, ruined his life, they hit each other in training. It worsened, no one believed him Subsequently went on to have pain blocks too late , lost his house new wife, baby and van, taught me lesson not to lend money to patients, I went through a period of trying to fix everyone and everything. There are things beyond our power 08/13/11
  • Nobel and pulitzer prize winning american novelist, editor and professsor her noves known for their epic themes Wrote The Bluest Eye, story of black girl who wanted blue eyes, it was chosen in 2000 for oprahs book club 08/13/11
  • Esophageal burn from radiation 08/13/11
  • Chronic wounds and pain from radiation 08/13/11
  • e 08/13/11
  • Will help you treat pain better If u r aware of pain paths Can tx it better by knowing receptors 08/13/11
  • See this a lot people don’ t want to lose leg Cultural in a lot of way affects how families think about limb loss 08/13/11
  • And spiritual pain did this to self Family dinner had a few drinks got upset 08/13/11
  • Bone pain from breast cancer 08/13/11
  • Carpenter with pain for 14 months no one would help\\ Diaphragm irritation and pull on peritoneum 08/13/11
  • Immediate relief Carpenter with chronic pain could not function 08/13/11
  • Felt better 08/13/11
  • This hurts when it is late This is a nurse in her 30s Breast cancer 08/13/11
  • Emboli to bowel\\visceral pain hurts Hypercagulable state from lung cancer 08/13/11
  • 18 yo Gasoline and fireworks Parents both paramedics
  • Could not stand or sit from massive ascites pain from distention
  • Saved hospital drainage and was able to walk sit and enjoy months of life mechanical treatment for pain Took 9 liters off
  • Manage with pleurex cardioamyloidosis painful not to breath Gave ;him 4 weeks to live he lives 6 months Cathater placed, it’ s a miracle drained 2 liters 08/13/11
  • Saint Teresa of Ávila , also called Saint Teresa of Jesus , baptized as Teresa Sánchez de Cepeda y Ahumada , (March 28, 1515 – October 4, 1582) was a prominent Spanish mystic , Roman Catholic saint , Carmelite nun , and writer of the Counter Reformation , and theologian of contemplative life through mental prayer . She was a reformer of the Carmelite Order and is considered to be, along with John of the Cross , a founder of the Discalced Carmelites . In 1622, forty years after her death, she was canonized by Pope Gregory XV , and in 1970 named a Doctor of the Church by Pope Paul VI . Her books, which include her autobiography, The Life of Teresa of Jesus , and her seminal work, El Castillo Interior (The Interior Castle), are an integral part of the Spanish Renaissance literature as well as Christian mysticism and Christian meditation practices as she entails in her other important work Camino de Perfección (The Way of Perfection).She died in 1582. St Teresa, from the Church of St Marin Bled (Slovenia) Saint Teresa of Ávila , also called Saint Teresa of Jesus , baptized as Teresa Sánchez de Cepeda y Ahumada , (March 28, 1515 – October 4, 1582) was a prominent Spanish mystic , Roman Catholic saint , Carmelite nun , and writer of the Counter Reformation , and theologian of contemplative life through mental prayer . She was a reformer of the Carmelite Order and is considered to be, along with John of the Cross , a founder of the Discalced Carmelites . In 1622, forty years after her death, she was canonized by Pope Gregory XV , and in 1970 named a Doctor of the Church by Pope Paul VI . Her books, which include her autobiography, The Life of Teresa of Jesus , and her seminal work, El Castillo Interior (The Interior Castle), are an integral part of the Spanish Renaissance literature as well as Christian mysticism and Christian meditation practices as she entails in her other important work Camino de Perfección (The Way of Perfection).She died in 1582. St Teresa, from the Church of St Marin Bled (Slovenia) Inflicted pain on herself for bad thoughts 08/13/11
  • Used to be very popular 08/13/11
  • Dilates lung, diuretic effect on kidney, makes heart beat better and gives pt sense of wellness 08/13/11
  • Start with tylenol or motrin and work way up ladder 08/13/11
  • Once people feel better they may want to go to disney 08/13/11
  • Studies shown if you need it This wont happen 08/13/11
  • Pain control Gardens in denver 08/13/11
  • Stage and screeen actor, was voice of broadway Taught communication for over 30 years 08/13/11
  • Albert einstien
  • Slideshare chronicpain8.10.11

    1. 1. Treatment of Pain Control Revised: Aug.,9 2011 Barry Miskin, MD, FACS
    2. 2. “ No patient should ever wish for death because of a physician’s reluctance to use adequate amounts of effective opioids.” -Jerome H. Jaffe
    3. 3. “ The greatest evil is physical pain” Saint Augustine
    4. 4. Physical Pain
    5. 5. Pressing on Nerves
    6. 6. Relief with Surgery
    7. 7. Pain from Sarcoma
    8. 8. Few Options for Relief
    9. 9. “ Pain of mind is worse than pain of body.” Publilius Syrus
    10. 10. Spiritual Pain
    11. 11. Spiritual Pain <ul><li>Why am I here? </li></ul><ul><li>Have I lived for nothing? </li></ul><ul><li>Does my life have any meaning? </li></ul><ul><li>Is there a higher power? </li></ul><ul><li>Why do I have to suffer </li></ul><ul><li>How can I find meaning in my current situation </li></ul><ul><li>Why do I have to die? </li></ul>
    12. 12. Chronic Pain
    13. 13. “ Then there is pain, there are no words. All pain is the same” Toni Morrison
    14. 14. Pain From Tumor & Radiation
    15. 15. Pain from Cancer Treatment
    16. 16. Types of Pain - Nociceptive <ul><li>Somatic Pain – arises from bone, joint, muscle, skin or connective tissue. Usually aching or throbbing in quality. </li></ul><ul><li>Visceral Pain - arises from visceral organs such as the GI tract or pancreas. Can be due to tumor involvement causing aching. </li></ul><ul><li>Obstruction of hollow viscera, causes cramping. </li></ul>
    17. 17. Different Pain Pathways
    18. 18. Ischemic Pain
    19. 19. Visceral Pain
    20. 20. Pathologic Fracture Bone Pain
    21. 21. Is This Normal?
    22. 22. From Lymphoma
    23. 23. This Causes Pain
    24. 24. Carcinomatosis
    25. 25. Infarcted Bowel
    26. 26. Burns Are Painful
    27. 27. Liver Cancer Pain from Distention
    28. 28. Catheter In Place
    29. 29. Pain & Dyspnea
    30. 30. “ Pain is never permanent.” Saint Teresa of Avila
    31. 31. We Are Not Ready For Morphine
    32. 32. MSIR The Myth The Legend The Drug
    33. 33. Pain Ladder
    34. 34. Opioid Myths <ul><li>Morphine shortens life - it may lengthen life by relieving distress and exhaustion </li></ul><ul><li>Morphine causes sedation - initially but sedation may represent catch-up rest </li></ul>
    35. 35. Pain Medicine Leads to This
    36. 36. Equianalgesic Chart Injection (mg) 10 Opioid Morphine PO Dose (mg) 30 1.5 Dilaudid 7.5 N/A Oxycodone 20
    37. 38. What Would Yoda Do?
    38. 39. Take Them to a More Peaceful Place
    39. 40. Music Therapy <ul><li>“ One good thing about music, when it hits you, you feel no pain” </li></ul><ul><li>-Bob Marley </li></ul>
    40. 41. “ Our stories are different; our pain is the same.” Betty Buckley
    41. 42. Knowledge is Power
    42. 43. The End

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