This document discusses modern approaches to pain intervention and management. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain transmission involves the activation of sensory nerves by thermal, mechanical, or chemical stimuli, which conveys information about tissue damage to the central nervous system. A multidimensional pain neuromatrix involves cognitive, sensory, and emotional brain systems that influence pain perception, actions, and stress responses. A multidisciplinary team approach is recommended for pain assessment, diagnosis, and treatment targeting pain reduction, rehabilitation, and resocialization using medications, nerve blocks, neurostimulation, cognitive behavioral therapy, and rehabilitation.

1. Pain Intervention in Modern
Practice
Kees Besse, anesthesiologist, FIPP

2. Campus Dekkerswald Nijmegen
2

3. IASP definition of pain
An unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage.

4. Nociception
Activation of sensory transduction in nerves by thermal,
mechanical or chemical energy impinging on specialized
nerve endings. The nerve(s) involved conveys
information about tissue damage to the central nervous
system.

5. 5
Pain transmission

6. Neuropathic pain
Pain arising as a direct consequence of a lesion or
disease affecting the somatosensory system.

8. 8
Multidimensional Pain neuromatrix:
Melzack R MD Consult 2003
Input in body neuromatrix of:
Cognitive brain sites
Sensorial conduction system
Emotional systems
Output towards brain site
responsible for:
Pain perception
Action programming
Stress-related programms
C
S
E
time time
Modified Loeser

9. Pain assessment at intake
• Pain assessment is the responsibility of doctors, nurses and
patients
• Careful history and physical examination
• Use of Numeric Rating Scale (NRS) on every visit at the
outpatient department
• Use of the Brief Pain Inventory (BPI)

10. Diagnosis
•Established: treatment proposition
•Preliminary: multidisciplinary assessment

11. Multidisciplinary assessment
•Pain nurse: social assessment, medication
•Pain psychologist: psychological assessment
•Pain physiotherapist: pain related physical examination
•Pain specialist: coordination

12. Treatment targets
•Pain reduction
•Rehabilitation
•Resocialisation

13. Painreduction
•Medication
•Nerve blocks
•Neurostimulation

14. Nerve blocks
•Diagnostic
•Therapeutic
•Pulsed radiofrequency
•Thermal radiofrequency

15. Nerve block performance
•Meticulous explanation to the patient of nerve block goal
•Explanation of expected effects and side effects
•Written informed consent
•Block supported by fluoroscopy or echo guided

18. Neurostimulation
•Transcutaneous Electrical Nerve Stimulation (TENS)
•Dorsal column stimulation
•Motor cortex stimultion

20. 20
Spinal cord stimulation

21. Non anesthesiologic pain treatment
•Cognitive behavioural therapy (psychologist)
•Rehabilitation center

22. Conclusion
•Assessment and treatment of chronic pain is a
multidisciplinary task
•Anesthesiologists/pain specialist are the preferred
coordinators