This document discusses intractable pain, which is persistent or intermittent pain lasting more than 3 months that is difficult to control. Intractable pain can result from tissue damage or disease and causes the release of chemicals in the body that sensitize nerves to pain over time. Sufferers often experience suicidal thoughts, depression, and immobility. While not curable, treatments may provide relief and include opioids, spinal cord stimulators, nerve blocks, and various medications. Intractable pain is a serious condition that significantly reduces quality of life.

1. INTRACTABLE PAIN
Prepared by: Roxanne Mae E. Birador

2. Intractable - hard to control or hard to
deal with.
It is a persistent or intermittent pain
that lasts more than 3 months.
Intractable pain can result to an early
death if not adequately treated.
INTRACTABLE PAIN

3. Doctors separate pain into
3 categories:
Acute
Chronic
 Intractable

4. The mechanics that cause chronic or intractable pain
are very complex. There usually is tissue damage or a
disease process, which causes chemicals such as
SEROTONIN, HISTAMINE, BRADYKIN &
PROSTAGLANDIN to be released in the human body.

5. These chemicals cause the nerves to become
more sensitive to pain. As time progresses a
chemical called SUBSTANCE “P” is released from
the peripheral nerve endings.

6. This substance carries pain signals. The more
SUBSTANCE P that the nerves release, the more
sensitive the person becomes to pain.

7. Many report suicidal thoughts for the sole
purpose of stopping the pain, incessant crying
spells, fatigue, depression, social isolation,
restriction of mobility, and numerous bed- or
couch-bound days.

8. California, Oregon, and Washington have passed
“Intractable Pain” Laws, primarily to allow
physicians to legally prescribe opioids to needy
pain patients.

9. Long-term opioid use changes the way nerve
cells work in the brain. This happens even to
people who take opioids for a long time to treat
pain, as prescribed by their doctor.

10. The nerve cells grow used
to having opioids around, so that
when they are taken away
suddenly, the person can have
lots of unpleasant feelings and
reactions. These are known as
withdrawal symptoms.

11. CAUSES
There are many painful conditions that can
cause intractable pain disease. Not every patient
with these conditions will develop intractable pain,
but the following conditions are known to cause
Intractable Pain in some patients:

12. Failed Back Syndrome

13. Scoliosis, Kyphosis, Kyphoscoliosis

14. Degenerative Disk Disease

15. Rheumatoid Arthritis

16. Central Pain Syndrome (CPS)

17. Cancers

18. OTHER UNDERLYING CAUSE OF I.P.

20. John F Kennedy (35th President of the
United States) has suffered from Intractable Pain.
He developed a genetic autoimmune disease;
development of centralized pain - a permanent
imprinting of pain memory in brain cells.

21. Is Intractable Pain is Curable?
Intractable Pain is not curable, but there are
treatments.

22. Intractable pain is sometimes called as
LIFE LONG PAIN

23. Not every patient will respond to every treatment,
but some more common treatments include:
 Surgical repair, such as spinal fusion for
scoliosis
 Opioid medications

24.  TENS Unit Transcutaneous electrical nerve
stimulation (TENS or TNS) is the use of electric
current produced by a device to stimulate the
nerves for therapeutic purposes.

25.  Spinal cord stimulator (SCS) - utilizes the gate
control theory to block painful signals by sending
benign electrical signals along the nerve roots.

26.  Intrathecal Pain Pump - delivers a very small
amount of the chosen medication directly to the
thecal space (next to the spinal cord, even
closer than an epidural).

27.  Epidural, nerve root, and/or trigger point
corticosteroid injections.

28.  mu-Opioids - Depending on the specific drug,
opioids can be oral, transdermal, IV,
intramuscular, subcutaneous, transmucosal,
sublingual, intranasal, epidural, or intrathecal.
Examples include morphine, hydromorphone,
oxymorphone, hydrocodone, oxycodone,
codeine, buprenorphine.

29.  Methadone - methadone is a mu-opioid, kappa-
opioid, and NMDA receptor antagonist. It is
especially useful for neuropathic pain, however it
is also useful for other types of pain, such as
bone pain, and musculoskeletal pain.

30. MEDICATIONS
Muscle Relaxants
Mood Stabilizers (anti-epileptics and antipsychotics),
such as gabapentin (Neurontin/Gralise/Horizant),
pregabalin (Lyrica), topiramate (Topamax), quetiapine
(Seroquel), risperidone (Risperdal), aripiprazole
(Abilify), paliperidone (Invega), iloperidone (Fanapt),
ziprasidone (Geodon), lamotrigine (Lamictal), valproic
acid (Depakene/Stavzor), or divalproex acid
(Depakote).

31. SSRI antidepressants, such as
fluoxetine (Prozac/Sarafem),
fluvoxamine (Luvox), paroxetine
(Paxil), sertraline (Zoloft),
citalopram (Celexa), or
escitalopram (Lexapro)

32. SNRI antidepressants, such
as duloxetine (Cymbalta),
venlafaxine (Effexor),
desvenlafaxine (Pristiq, or
milnacipran (Savella)

33. NSAIDs – Ibuprofen (Advil/Motrin), naproxen
(Naprosyn/Aleve), celecoxib (Celebrex), diclofenac
(Voltaren/Flector), or ketorlac (Toradol)

34. The person is already suffering, DYING…
How much longer would you have them to suffer?
Would you let someone you love to undergo euthanasia if
they wish so?