Pain Management Services at Cancer Treatment Centers of America
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Thank you for the presentation on pain management. A multidisciplinary approach utilizing both pharmacological and non-pharmacological therapies can help address different types of acute and chronic pain.
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Pain Management Services at Cancer Treatment Centers of America
- 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. Pain 2 © 2011 Rising Tide
- 3. Objectives To 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. 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. 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. International Association for the Study of Pain 1979 Pain defined as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Emphasizes that pain is a complex experience with multiple dimensions 6 © 2011 Rising Tide
- 7. Types of Pain : Time vs Location • Acute vs Chronic • Nociceptive (S&M) vs Neuropathic 7 © 2011 Rising Tide
- 8. Acute Pain • Trauma • Surgery • Infection • Burns • Appendicitis • Inflammatory 8 © 2011 Rising Tide
- 9. Chronic • Pancreatitis • Diabetic Peripheral Neuropathy • Osteoarthritis • Headache • Fibromyalgia • Phantom Pain 9 © 2011 Rising Tide
- 10. Nociceptive • Osteoarthritis • Rheumatoid Arthritis • Muscle Injury • Inflammation • Neoplasm • Degenerative Disc Disease 10 © 2011 Rising Tide
- 11. Neuropathic • Diabetic Peripheral Neuropathy • Stroke Pain • Post Herpetic Neuralgia • Complex Regional Pain Syndrome • Multiple Sclerosis • Neoplasm 11 © 2011 Rising Tide
- 12. 12 © 2011 Rising Tide
- 13. The 5th Vital Sign • Vitals Signs: – Temperature – Pulse – Respiratory Rate – Blood Pressure – Pain Score 13 © 2011 Rising Tide
- 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. • Here are the kinds of pain blocks the pain service can offer Caudal, Lumbar, Thoracic, and Cervical Epidural Steroid blocks Patient-Controlled Analgesia (PCA) pumps Patient-Controlled Epidural (PCEA) pumps Trigger point injections Blocks of Somatic and Visceral Cancer Pain Syndromes Facet Joint Injections Minor and Major Joint and Bursa injections Peripheral and Central Somatic Nerve and Plexus Blocks Tunneled catheter placements for various nerve sheaths Radiofrequency ablative procedures Intraspinal catheters for intrathecal opioid trials and implanted infusion devices Spinal cord/Dorsal Column Stimulators Discography Ultrasound-Guided Procedures Anatomical Landmark Guided Procedures
- 16. Pain Assessment • Pain History • Pain Physical Exam • Labs/Imaging Studies • Pain Diagnosis • Pain Plan • Then Follow-up Evaluation 16
- 17. Pain Assessment 17 © 2011 Rising Tide
- 21. MRI
- 22. 22 © 2011 Rising Tide
- 23. Potential Pain Therapies • A. Nonpharmacologic • B. Pharmacologic • C. Interventional 23 © 2011 Rising Tide
- 24. Nonpharmacologic • Acupuncture • Biofeedback • Chiropractic Care • Massage • Physical Therapy • TENS unit • Cognitive Behavioral Therapy 24 © 2011 Rising Tide
- 25. Pharmacologic • Topical Agents • NSAIDS • Oral/IV steriod • Opioids • Antidepressants • Anticonvulsants • Infusions 25 © 2011 Rising Tide
- 26. Interventional • Trigger Point Injections • Medial Branch Block • Epidural Steroid • Intradiscal Therapy • Laminectomy/Fusion • Vertobroplasty • Discectomy 26 © 2011 Rising Tide
- 29. OA
- 34. FJI
- 38. SCS
- 39. ITP
- 40. TPI
- 41. Lower Cranial Nerve Blocks
- 46. 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
- 47. 47 © 2011 Rising Tide
Editor's Notes
- We all feel pain and deal with it differently. As a Pain Specialist, I see it in the eyes of my patients every day.