1. Preventing acute pain from transitioning to chronic pain requires early intervention, as chronic pain is defined as persisting over 3 months and is associated with physiological and psychological changes.
2. Chronic pain poses therapeutic challenges and carries a large economic burden in terms of healthcare costs, lost productivity, and reduced quality of life.
3. Certain surgeries and medical conditions are associated with higher risks of developing chronic postsurgical pain, emphasizing the need for optimal acute pain management after such procedures.
This document discusses interventional pain management techniques for cancer pain, specifically neurolytic blocks. It begins by noting that drug therapy is usually effective for cancer pain but invasive procedures may be necessary for refractory cases. Various neurolytic blocks are described such as celiac plexus block, which can provide pain relief for upper abdominal cancer pain. Evidence is presented that neurolytic celiac plexus block reduces pain and morphine use. Peripheral nerve blocks and neuraxial blocks like subarachnoid and epidural neurolysis are also discussed. Safety and effectiveness of different neurolytic techniques depends on practitioner skill and patient selection.
The document summarizes a study on the effect of preemptive gabapentin on postoperative pain and opioid requirement following head and neck surgeries. The study involved 60 patients divided into a gabapentin group and a control group. Pain scores and opioid requirements were significantly lower in the gabapentin group compared to the control group over 24 hours post-surgery. Heart rate, blood pressure and nausea were also lower in the gabapentin group. The study concludes that preemptive gabapentin effectively reduces postoperative pain and opioid needs following head and neck surgeries.
Pain management involves treating all types of pain through various modalities beyond just pharmacotherapy. Unrelieved pain can have negative physiological, psychological and cognitive effects. Chronic pain is difficult to treat due to central nervous system sensitization and modulation. Interventional pain management utilizes targeted nerve blocks, ablations, and advanced procedures like spinal cord stimulation to diagnose and treat various pain conditions and syndromes. The goal is to correct underlying pathologies and break pain cycles through non-pharmacological means.
This document provides information on new developments in interventional pain management over the past 20 years. It summarizes the goals of interventional pain management as relieving, reducing, or managing pain through minimally invasive techniques to diagnose and treat painful conditions. It also highlights some spine interventions like percutaneous discectomy and intradiscal electrotherapy that can be performed to relieve pain from conditions like herniated discs.
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
This document discusses conservative treatment options for low back pain, including medication, spinal manipulation, and adjunctive therapies. It summarizes the findings of studies comparing the effectiveness of medication, acupuncture, and spinal manipulation for chronic spinal pain. The document also reviews evidence on musculoskeletal relaxants and opioids for pain management. While no single superior treatment was identified, spinal manipulation was found to provide short-term benefits for neck pain and favorably influence long-term outcomes for low back pain compared to other options.
This document discusses interventional pain management techniques for cancer pain, specifically neurolytic blocks. It begins by noting that drug therapy is usually effective for cancer pain but invasive procedures may be necessary for refractory cases. Various neurolytic blocks are described such as celiac plexus block, which can provide pain relief for upper abdominal cancer pain. Evidence is presented that neurolytic celiac plexus block reduces pain and morphine use. Peripheral nerve blocks and neuraxial blocks like subarachnoid and epidural neurolysis are also discussed. Safety and effectiveness of different neurolytic techniques depends on practitioner skill and patient selection.
The document summarizes a study on the effect of preemptive gabapentin on postoperative pain and opioid requirement following head and neck surgeries. The study involved 60 patients divided into a gabapentin group and a control group. Pain scores and opioid requirements were significantly lower in the gabapentin group compared to the control group over 24 hours post-surgery. Heart rate, blood pressure and nausea were also lower in the gabapentin group. The study concludes that preemptive gabapentin effectively reduces postoperative pain and opioid needs following head and neck surgeries.
Pain management involves treating all types of pain through various modalities beyond just pharmacotherapy. Unrelieved pain can have negative physiological, psychological and cognitive effects. Chronic pain is difficult to treat due to central nervous system sensitization and modulation. Interventional pain management utilizes targeted nerve blocks, ablations, and advanced procedures like spinal cord stimulation to diagnose and treat various pain conditions and syndromes. The goal is to correct underlying pathologies and break pain cycles through non-pharmacological means.
This document provides information on new developments in interventional pain management over the past 20 years. It summarizes the goals of interventional pain management as relieving, reducing, or managing pain through minimally invasive techniques to diagnose and treat painful conditions. It also highlights some spine interventions like percutaneous discectomy and intradiscal electrotherapy that can be performed to relieve pain from conditions like herniated discs.
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
This document discusses conservative treatment options for low back pain, including medication, spinal manipulation, and adjunctive therapies. It summarizes the findings of studies comparing the effectiveness of medication, acupuncture, and spinal manipulation for chronic spinal pain. The document also reviews evidence on musculoskeletal relaxants and opioids for pain management. While no single superior treatment was identified, spinal manipulation was found to provide short-term benefits for neck pain and favorably influence long-term outcomes for low back pain compared to other options.
The document summarizes a study comparing postoperative pain experiences in adolescent and adult athletes after anterior cruciate ligament (ACL) surgery. Twenty athletes (10 adolescents and 10 adults) who underwent ACL reconstruction surgery completed questionnaires assessing pain, catastrophizing, depression, and anxiety 24 hours after surgery. The results showed that adolescents reported significantly greater pain, catastrophizing, and anxiety than adults after surgery. Further analysis revealed that catastrophizing, particularly feelings of helplessness and rumination, largely accounted for the differences in reported pain between adolescents and adults.
This document discusses managing pain after surgery. It notes that persistent postsurgical pain is often overlooked and can be prevented. A multimodal approach using combinations of analgesics like opioids, NSAIDs, and nerve blocks can improve pain relief while reducing side effects from individual drugs. Identifying patients at risk of chronic pain and using multimodal acute pain management may decrease the risk of acute pain becoming persistent after surgery.
The document discusses an innovative neuromodulation technique called Scrambler Therapy (ST) for treating Complex Regional Pain Syndrome (CRPS). A study was conducted on 37 patients with CRPS Type I who received 10 ST treatment sessions. Patients reported pain levels before, during, and 6 months after treatment using the Visual Analog Scale (VAS) and Brief Pain Inventory (BPI). Results showed significantly reduced pain scores after ST compared to before. A control group of 42 neuralgia patients undergoing the same ST treatment showed similar pain reductions. The study provides evidence that ST is an effective treatment for reducing chronic neuropathic pain like CRPS.
The document discusses spinal opioids for postoperative pain relief. It includes 4 activities to help nurses understand the role of spinal opioids, importance of postoperative monitoring, incidence of adverse effects, and challenges in ensuring patients are pain-free after surgery. Tables provide definitions of terms like spinal anesthesia and analgesia. Optimal doses of spinal morphine are suggested for procedures like total knee arthroplasty and hip arthroplasty based on past studies.
This document provides biographical information about Dr. Pankaj N Surange and discusses interventional pain management. It summarizes several case studies where Dr. Surange performed minimally invasive procedures to diagnose and treat pain conditions, including percutaneous disc decompression to treat a herniated disc, intradiscal ozone injection for discogenic pain, and vertebroplasty to treat a fractured vertebra. It also discusses interventional pain management more generally, highlighting its role between pharmacological management and more invasive surgery.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India Divya Khanna
Chronic groin pain, known as inguinodynia, occurs in approximately 11% of patients after hernia surgery, with 1/3 of cases being severe enough to interfere with daily activities. This rate of chronic pain is more common than hernia recurrence. Prevention through careful identification and handling of nerves during surgery is important. For select patients who do not find relief through medications, surgical neurectomy combined with mesh removal provides relief from pain in 80-95% of cases. Proper patient selection and surgical technique are needed to minimize the risk of chronic pain after hernia repair.
Presented and recorded at the Australian Pain Society Annual Scientific Meeting, April 2021 virtual event
Topical Session
3C: Meanings of Cancer-Related Pain
Tuesday, April 20, 2021
11:15 AM – 12:30 PM
Session Description: Cognitive factors are important determinants of cancer-related pain experience. Simon van Rysewyk describes how cancer-related is particularly sensitive to cognitive factors and describes some common cognitions that people with cancer-related pain have and how they influence patient outcomes. Xiangfeng Xu (Renee) presents on the cultural and social factors that influence cancer pain management of Chinese migrants and what culturally congruent strategies may be implemented to improve their pain outcomes. Melanie Lovell compares levels of suffering in people with cancer-related pain versus non-cancer chronic pain, highlighting differential meanings of existential or spiritual distress and mood dysfunction. Lovell outlines management approaches to cancer pain and suffering that are not responsive to analgesia, such as meaning- or peace-centred therapies.
Session Objectives:
At the end of the session, attendees will know:
– Common meanings of cancer-related pain and what meanings influence specific patient outcomes
– Common meanings of suffering in cancer-related pain and the relationship between these meanings and non-cancer chronic pain experience and mood dysfunction
– Effective approaches to diagnosis and management of cancer-related pain symptoms, including interventions based on meaning
– Impact of culture on Chinese migrants’ perspectives and responses to cancer pain and recommendations for clinical practice
Presenter Duties
Chair: Dr Simon van Rysewyk, University of Tasmania
Organiser/Presenter 1: Dr Simon van Rysewyk, University of Tasmania
Presenter 2: Dr Renee Xu, University of Sydney
Presenter 3: Associate Professor Melanie Lovell, University of Sydney
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
This document discusses interventional pain management (IPM) as a specialty focused on diagnosing and treating pain through minimally invasive procedures. It provides an overview of common IPM procedures like diagnostic nerve blocks, radiofrequency ablation, vertebroplasty, and percutaneous discectomy. The document also presents four case studies where IPM procedures like epidurolysis, percutaneous discectomy, vertebroplasty, and radiofrequency rhizotomy successfully treated chronic pain when other options had failed. It concludes that contrary to common beliefs, over 85% of spinal pain causes can be accurately diagnosed through IPM procedures and that IPM can provide long-term relief when pharmacologic treatments and surgery are not suitable options.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
Interventional spine & pain management dr manish rajManish Raj
This document provides an overview of chronic pain and interventional pain management techniques. It defines chronic pain as pain that lasts more than 3 months and outlines its prevalence and impact, noting it affects more Americans than diabetes, heart disease, and cancer combined. Interventional pain management aims to decrease or eliminate pain through minimally invasive techniques like injections, radiofrequency ablation, and spinal cord or peripheral nerve stimulation. The document reviews common causes of back pain and neck pain, as well as conditions treated by interventional techniques. It also discusses evidence-based guidelines for interventional pain management and the multidisciplinary approach needed for successful chronic pain treatment.
This document discusses cancer pain management. It notes that 50-90% of oncology inpatients and 35% of outpatients report breakthrough cancer pain. Common causes of cancer pain include bone metastases, visceral metastases, and neuropathic pain. Barriers to effective pain management include clinical, patient-related, and system-related factors as well as racial and ethnic barriers. A thorough pain assessment considers intensity, location, quality, timeline, alleviating factors, and prior medications. Opioids are the mainstay of cancer pain treatment, with short-acting opioids used for breakthrough pain and long-acting for persistent pain.
This document outlines 10 principles for beating chronic pain. It discusses how chronic pain is complex and requires a biopsychosocial approach. Some key points include: (1) having hope and understanding the relationship between effort and pain intensity, (2) the importance of physical training to reduce pain, and (3) using a systematic approach including evidence-based exercise science, clinical experience, and patient preferences to develop an individualized method. Chronic pain is now viewed as a disease of the central nervous system caused by neuroplasticity.
This document provides an overview of pain management. It begins with an introduction defining pain and its prevalence in society. It then covers the pathophysiology and classification of different types of pain such as nociceptive, neuropathic, and chronic pain. The clinical presentation of acute and chronic pain is discussed. Treatment options including pharmacological therapies like opioids and non-opioid drugs as well as non-pharmacological approaches are summarized. Specific drugs like morphine are also described in terms of their use, effects, and side effects.
This document discusses opioid induced hyperalgesia (OIH), where increased pain results from opioid use. OIH is caused by changes in the glutaminergic and descending pain pathways in the central nervous system. Patients at risk include those on long-term opioids, perioperative opioid use, and acute opioid administration. OIH presents as diffuse pain not explained by the original condition and increases with higher opioid doses. Management focuses on tapering opioids while adding adjuvant medications targeting NMDA receptors or other pain mechanisms to modulate OIH. A multidisciplinary approach is needed given the complex pathophysiology.
‘Neurodynamics as a therapeutic intervention; the effectiveness and scientifi...NVMT-symposium
This document discusses the evidence for neural mobilization as a treatment for nerve disorders. It begins by reviewing animal studies showing that movement such as exercise prevents neuropathic pain development, aids nerve recovery after injury, and reduces neuropathic pain. However, the evidence for neural mobilization and nerve gliding exercises in humans is limited. A systematic review found limited evidence that neural mobilization is more effective than minimal interventions for pain and disability in carpal tunnel syndrome, but not more effective than other treatments. Another review found limited evidence for the effectiveness of nerve gliding exercises in carpal tunnel syndrome. The document concludes that while movement may be beneficial, the evidence does not clearly support neural mobilization over other conservative treatments, and more high-quality research is
Epidural adhesiolysis has been accepted as a treatment for post laminectomy syndrome, failed back syndrome, & radicular syndromes.
The efficacy of caudal approach epidural adhesiolysis depends on the proper diagnosis, patient’s condition, and better techinuqe.
The combined use of long term patient education for neural flossing exercises & the inclusion of the facet-delayed treatment in the algorithm further improves patient outcome.
Additional studies are underway to further refine the technique & indications.
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
This document provides information on a presentation by Dr. Ramsin Benyamin on vertebroplasty. It discusses the scope of osteoporosis and vertebral compression fractures (VCFs), risk factors for VCFs, consequences of VCFs such as pain and immobility, and the benefits of vertebroplasty including quick and complete pain relief and improved mobility. It also summarizes several studies that found vertebroplasty provided significant pain relief and increased function for patients with osteoporotic and cancer-related VCFs.
The document summarizes a study comparing postoperative pain experiences in adolescent and adult athletes after anterior cruciate ligament (ACL) surgery. Twenty athletes (10 adolescents and 10 adults) who underwent ACL reconstruction surgery completed questionnaires assessing pain, catastrophizing, depression, and anxiety 24 hours after surgery. The results showed that adolescents reported significantly greater pain, catastrophizing, and anxiety than adults after surgery. Further analysis revealed that catastrophizing, particularly feelings of helplessness and rumination, largely accounted for the differences in reported pain between adolescents and adults.
This document discusses managing pain after surgery. It notes that persistent postsurgical pain is often overlooked and can be prevented. A multimodal approach using combinations of analgesics like opioids, NSAIDs, and nerve blocks can improve pain relief while reducing side effects from individual drugs. Identifying patients at risk of chronic pain and using multimodal acute pain management may decrease the risk of acute pain becoming persistent after surgery.
The document discusses an innovative neuromodulation technique called Scrambler Therapy (ST) for treating Complex Regional Pain Syndrome (CRPS). A study was conducted on 37 patients with CRPS Type I who received 10 ST treatment sessions. Patients reported pain levels before, during, and 6 months after treatment using the Visual Analog Scale (VAS) and Brief Pain Inventory (BPI). Results showed significantly reduced pain scores after ST compared to before. A control group of 42 neuralgia patients undergoing the same ST treatment showed similar pain reductions. The study provides evidence that ST is an effective treatment for reducing chronic neuropathic pain like CRPS.
The document discusses spinal opioids for postoperative pain relief. It includes 4 activities to help nurses understand the role of spinal opioids, importance of postoperative monitoring, incidence of adverse effects, and challenges in ensuring patients are pain-free after surgery. Tables provide definitions of terms like spinal anesthesia and analgesia. Optimal doses of spinal morphine are suggested for procedures like total knee arthroplasty and hip arthroplasty based on past studies.
This document provides biographical information about Dr. Pankaj N Surange and discusses interventional pain management. It summarizes several case studies where Dr. Surange performed minimally invasive procedures to diagnose and treat pain conditions, including percutaneous disc decompression to treat a herniated disc, intradiscal ozone injection for discogenic pain, and vertebroplasty to treat a fractured vertebra. It also discusses interventional pain management more generally, highlighting its role between pharmacological management and more invasive surgery.
Presentatie Drs. Ronald Kan - Even wat rechtzetten NVMT-symposium
1) The document discusses evidence related to the effectiveness of manual therapy (MT) for various pain conditions like acute low back pain, chronic low back pain, and neck pain. It finds small but consistent effects for MT, though not more effective than other conservative treatments.
2) It explores how context, communication, and patient/therapist factors can influence pain through placebo and nocebo effects. Negative or threatening language can increase pain (nocebo), while positive expectations can decrease pain (placebo).
3) The language used by healthcare providers has enduring influence on patient beliefs and can potentially cause or increase disability if not carefully considered. Attention to communication is important to avoid iatrogenic outcomes.
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India Divya Khanna
Chronic groin pain, known as inguinodynia, occurs in approximately 11% of patients after hernia surgery, with 1/3 of cases being severe enough to interfere with daily activities. This rate of chronic pain is more common than hernia recurrence. Prevention through careful identification and handling of nerves during surgery is important. For select patients who do not find relief through medications, surgical neurectomy combined with mesh removal provides relief from pain in 80-95% of cases. Proper patient selection and surgical technique are needed to minimize the risk of chronic pain after hernia repair.
Presented and recorded at the Australian Pain Society Annual Scientific Meeting, April 2021 virtual event
Topical Session
3C: Meanings of Cancer-Related Pain
Tuesday, April 20, 2021
11:15 AM – 12:30 PM
Session Description: Cognitive factors are important determinants of cancer-related pain experience. Simon van Rysewyk describes how cancer-related is particularly sensitive to cognitive factors and describes some common cognitions that people with cancer-related pain have and how they influence patient outcomes. Xiangfeng Xu (Renee) presents on the cultural and social factors that influence cancer pain management of Chinese migrants and what culturally congruent strategies may be implemented to improve their pain outcomes. Melanie Lovell compares levels of suffering in people with cancer-related pain versus non-cancer chronic pain, highlighting differential meanings of existential or spiritual distress and mood dysfunction. Lovell outlines management approaches to cancer pain and suffering that are not responsive to analgesia, such as meaning- or peace-centred therapies.
Session Objectives:
At the end of the session, attendees will know:
– Common meanings of cancer-related pain and what meanings influence specific patient outcomes
– Common meanings of suffering in cancer-related pain and the relationship between these meanings and non-cancer chronic pain experience and mood dysfunction
– Effective approaches to diagnosis and management of cancer-related pain symptoms, including interventions based on meaning
– Impact of culture on Chinese migrants’ perspectives and responses to cancer pain and recommendations for clinical practice
Presenter Duties
Chair: Dr Simon van Rysewyk, University of Tasmania
Organiser/Presenter 1: Dr Simon van Rysewyk, University of Tasmania
Presenter 2: Dr Renee Xu, University of Sydney
Presenter 3: Associate Professor Melanie Lovell, University of Sydney
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
This document discusses interventional pain management (IPM) as a specialty focused on diagnosing and treating pain through minimally invasive procedures. It provides an overview of common IPM procedures like diagnostic nerve blocks, radiofrequency ablation, vertebroplasty, and percutaneous discectomy. The document also presents four case studies where IPM procedures like epidurolysis, percutaneous discectomy, vertebroplasty, and radiofrequency rhizotomy successfully treated chronic pain when other options had failed. It concludes that contrary to common beliefs, over 85% of spinal pain causes can be accurately diagnosed through IPM procedures and that IPM can provide long-term relief when pharmacologic treatments and surgery are not suitable options.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
Interventional spine & pain management dr manish rajManish Raj
This document provides an overview of chronic pain and interventional pain management techniques. It defines chronic pain as pain that lasts more than 3 months and outlines its prevalence and impact, noting it affects more Americans than diabetes, heart disease, and cancer combined. Interventional pain management aims to decrease or eliminate pain through minimally invasive techniques like injections, radiofrequency ablation, and spinal cord or peripheral nerve stimulation. The document reviews common causes of back pain and neck pain, as well as conditions treated by interventional techniques. It also discusses evidence-based guidelines for interventional pain management and the multidisciplinary approach needed for successful chronic pain treatment.
This document discusses cancer pain management. It notes that 50-90% of oncology inpatients and 35% of outpatients report breakthrough cancer pain. Common causes of cancer pain include bone metastases, visceral metastases, and neuropathic pain. Barriers to effective pain management include clinical, patient-related, and system-related factors as well as racial and ethnic barriers. A thorough pain assessment considers intensity, location, quality, timeline, alleviating factors, and prior medications. Opioids are the mainstay of cancer pain treatment, with short-acting opioids used for breakthrough pain and long-acting for persistent pain.
This document outlines 10 principles for beating chronic pain. It discusses how chronic pain is complex and requires a biopsychosocial approach. Some key points include: (1) having hope and understanding the relationship between effort and pain intensity, (2) the importance of physical training to reduce pain, and (3) using a systematic approach including evidence-based exercise science, clinical experience, and patient preferences to develop an individualized method. Chronic pain is now viewed as a disease of the central nervous system caused by neuroplasticity.
This document provides an overview of pain management. It begins with an introduction defining pain and its prevalence in society. It then covers the pathophysiology and classification of different types of pain such as nociceptive, neuropathic, and chronic pain. The clinical presentation of acute and chronic pain is discussed. Treatment options including pharmacological therapies like opioids and non-opioid drugs as well as non-pharmacological approaches are summarized. Specific drugs like morphine are also described in terms of their use, effects, and side effects.
This document discusses opioid induced hyperalgesia (OIH), where increased pain results from opioid use. OIH is caused by changes in the glutaminergic and descending pain pathways in the central nervous system. Patients at risk include those on long-term opioids, perioperative opioid use, and acute opioid administration. OIH presents as diffuse pain not explained by the original condition and increases with higher opioid doses. Management focuses on tapering opioids while adding adjuvant medications targeting NMDA receptors or other pain mechanisms to modulate OIH. A multidisciplinary approach is needed given the complex pathophysiology.
‘Neurodynamics as a therapeutic intervention; the effectiveness and scientifi...NVMT-symposium
This document discusses the evidence for neural mobilization as a treatment for nerve disorders. It begins by reviewing animal studies showing that movement such as exercise prevents neuropathic pain development, aids nerve recovery after injury, and reduces neuropathic pain. However, the evidence for neural mobilization and nerve gliding exercises in humans is limited. A systematic review found limited evidence that neural mobilization is more effective than minimal interventions for pain and disability in carpal tunnel syndrome, but not more effective than other treatments. Another review found limited evidence for the effectiveness of nerve gliding exercises in carpal tunnel syndrome. The document concludes that while movement may be beneficial, the evidence does not clearly support neural mobilization over other conservative treatments, and more high-quality research is
Epidural adhesiolysis has been accepted as a treatment for post laminectomy syndrome, failed back syndrome, & radicular syndromes.
The efficacy of caudal approach epidural adhesiolysis depends on the proper diagnosis, patient’s condition, and better techinuqe.
The combined use of long term patient education for neural flossing exercises & the inclusion of the facet-delayed treatment in the algorithm further improves patient outcome.
Additional studies are underway to further refine the technique & indications.
SpAn harus memberi waktu untuk pengelolaan nyeri
SpAn harus mampu mengelola nyeri dengan memilih cara yang paling aman, paling efektif dan paling ekonomis
Berperan aktif pada acute pain
Berperan, minimal partisipatif, dalam chronic pain
Berperan utama pada interventional pain management
This document discusses emerging pharmacological and non-pharmacological aspects in pain management. It notes that multimodal analgesia using combinations of drugs targeting different pain pathways can provide improved pain relief with reduced side effects compared to single drugs. Newer drugs targeting specific receptor subtypes are emerging. Non-invasive options such as topical agents, exercise, and interventional techniques are increasingly utilized before more invasive options. Interventional pain management techniques discussed include injections, neurolysis, and spinal cord stimulation.
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
This document provides information on a presentation by Dr. Ramsin Benyamin on vertebroplasty. It discusses the scope of osteoporosis and vertebral compression fractures (VCFs), risk factors for VCFs, consequences of VCFs such as pain and immobility, and the benefits of vertebroplasty including quick and complete pain relief and improved mobility. It also summarizes several studies that found vertebroplasty provided significant pain relief and increased function for patients with osteoporotic and cancer-related VCFs.
Palliative care aims to relieve suffering and improve quality of life for patients with chronic or terminal illnesses. It provides comprehensive pain and symptom management as well as psychological, emotional, and spiritual support for both patients and their families. Cancer pain is a major problem, with up to 80% of cancer patients experiencing moderate to severe pain at some point. Cancer pain can be somatic, visceral, neuropathic, or breakthrough in nature. A thorough assessment of pain is important for effective management.
1. The document provides general recommendations and principles for effective postoperative pain management. It discusses goals of pain treatment, physiology of pain including peripheral and central sensitization, tools for pain assessment, patient education, treatment options, and special considerations for different patient groups.
2. Key recommendations include using a multimodal balanced analgesia approach, regular pain assessment with specific tools, patient education, and tailoring strategies to individual needs such as in pediatric patients and the elderly.
3. Effective pain management is important for reducing patient suffering as well as facilitating rapid recovery and early discharge from the hospital.
This document discusses optimizing pain management in cancer treatment. It provides an overview of concepts like total pain, the WHO analgesic ladder for treating pain with opioids, and the importance of proper pain assessment and documentation. The key points are:
1) Total pain includes physical, psychosocial, emotional, and spiritual suffering experienced by cancer patients.
2) The WHO analgesic ladder recommends treating mild pain with non-opioids like paracetamol, moderate pain with weak opioids like codeine, and severe pain with strong opioids like morphine.
3) Proper pain assessment involves documenting pain scores, characteristics, causes, and impact on function to effectively guide pain treatment decisions.
This document discusses optimizing pain management in cancer treatment. It provides an overview of concepts like total pain, the WHO analgesic ladder for treating pain with opioids, and the importance of proper pain assessment and documentation. The key points are:
1) Total pain includes physical, psychosocial, emotional, and spiritual suffering experienced by cancer patients.
2) The WHO analgesic ladder recommends treating mild pain with non-opioids like paracetamol, moderate pain with weak opioids like codeine, and severe pain with strong opioids like morphine.
3) Proper pain assessment involves documenting pain scores, characteristics, causes, and impact on function to effectively guide pain treatment decisions.
This document discusses chronic non-cancer pain. It begins by emphasizing the importance of considering pain as the 5th vital sign and properly assessing and treating patients' pain complaints. It then discusses types of pain including acute, cancer, and chronic non-cancer pain. It provides an overview of the chronic pain treatment continuum and targeting approaches based on pain type. Principles of chronic pain treatment include reducing pain, rehabilitation, and coping. Treatment objectives aim to decrease pain frequency/severity and increase activity and quality of life. The document then summarizes pharmacological and non-pharmacological options for chronic pain symptom control.
Regional Anesthesia in the Prevention of Persistent Postsurgical PainEdward R. Mariano, MD
Persistent postsurgical pain (PPSP), or chronic pain that develops after surgery, occurs more frequently than one may expect: up to 50% after relatively common operations. For anesthesiologists, surgeons, and pain physicians, there is an urgent need to discover methods to prevent the development of PPSP which is considered one of the more dreaded adverse outcomes following elective surgery.
The document discusses low back pain (LBP), including its prevalence, costs, and predictors. While the cause of LBP is often unclear, psychosocial factors like depression, fear of reinjury, and catastrophizing are strong predictors. Clinical guidelines recommend non-invasive treatments like exercise and cognitive behavioral therapy as first-line options. However, the management of LBP is often not adherent to guidelines, with overuse of advanced imaging, surgeries, and opioids. Psychologically informed rehabilitation that considers pain perception may help address this problem.
Principles for more cautious and selective opioid prescribing for chronic non...Group Health Cooperative
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502
Presentation by: Jane C. Ballantyne, MD FRCA, with the Department of Anesthesiology and Pain Medicine at UW Medicine.
1. Cancer pain affects a large percentage of cancer patients, with moderate to severe pain reported in over 33% of cases. Proper pain management is important to relieve unnecessary suffering and reduce further weakening of patients.
2. Cancer pain can be nociceptive (from tissue damage) or neuropathic (from nerve damage) in nature, with bone pain being very common. Treatment involves modifying the pathological process, elevating pain thresholds, interrupting pain pathways, and lifestyle modifications.
3. Effective cancer pain management requires a rational approach using the WHO guidelines, with an emphasis on relieving pain at all stages of disease through various pharmacological and non-pharmacological means.
The document provides an overview of pain management for nurses. It discusses [1] the prevalence and impact of pain, common barriers to treatment, and types of pain experienced by patients. It also [2] outlines principles of effective pain management including thorough assessment, appropriate medication selection and dosing, and multidisciplinary treatment. [3] Barriers to treatment include patients' and clinicians' attitudes as well as institutional factors, and uncontrolled pain negatively impacts multiple aspects of patients' lives.
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
This document summarizes a presentation on physiotherapy for non-cancer chronic pain. It discusses that physiotherapy aims to restore and promote optimal physical function and quality of life for those with persistent pain. It provides an overview of evaluation processes in physiotherapy and various treatment modalities. It also summarizes evidence on approaches for common persistent pain conditions like low back pain, whiplash associated disorder, and osteoarthritis. Screening tools for risk of long-term disability are also briefly covered.
Pain and Modern Medicine, Stephanie Davies, Head of Service, Pain Medicine Un...ArthritisNT
The document discusses pain and modern medicine. It defines pain and chronic pain. It notes that chronic pain is common, affecting 20% of Australians and costing $34 billion per year. While scans cannot detect pain, medications only help reduce pain in 30-40% of cases. The document discusses how views of pain have changed from being tissue-based to involving brain and spinal cord patterns. It advocates addressing all pain inputs using a biopsychosocial approach.
Chronic pain: Role of tricyclic antidepressants, dolsulepinSudhir Kumar
Chronic pain is common. Depression often co-exist with chronic pain. This article looks at the pathophysiology, prevalence of chronic pain and depression. The role of TCA, especially dosulepin and amitriptyline has been discussed.
Austin Pain & Relief is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pain & Relief.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pain & Relief. Austin Pain & Relief accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pain and relief.
Austin Pain & Relief strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Similar to Preventing pain from becoming chronic short1 (20)
1. Preventing Pain From Becoming
Chronic With Early Intervention
Dr Yeo Sow Nam
Director, The Pain Specialist,
Mount Elizabeth Hospital &
Founder and Past Director,
Pain Management and Acupuncture Services,
Singapore General Hospital
MBBS (Singapore)
MMED (Anesthesiology, S’pore)
FANZCA (Anesthesiology, Aust/NZ)
FFPMANZCA (Pain Medicine, Aust/NZ)
FAMS, Registered Acupuncturist
2. What Is Chronic Pain?
• Defined as pain persisting over 3 months
• Subdivided into chronic malignant pain
and chronic non-malignant pain
• Probably not directly related to initial
injury or disease but is secondary to
physiological changes in pain signalling
and detection
• Often associated with the emergence of a
complex set of physical and psychological
changes that are an integral part of the
chronic pain problem
• Poses particular therapeutic challenges
1. Merskey H, Bogduk N., Classification of Chronic Pain, 1994, IASP Press. ISBN-13: 978-0-931092-05-3
2. Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet. 1999;353:1959-64.
(Page 1959)
3. Ashburn MA, Staats PS. Management of chronic pain. Lancet. 1999;353:1865-9. (Page 1865 / 1866)
4. Portenoy RK, Kanner RM. Pain Management: Theory and Practice. Philadelphia PA: FA Davis & Co; 1996. (Page 7, Table 1-2)
3. Chronic Pain: A Disease In Its Own Right
The World Health Organization
(WHO) notes that “chronic pain
should be accepted as condition in
its own right and highlights the
great burden of chronic pain on
individuals”.
World Health Organization. WHO Normative Guidelines on Pain Management. June 2007. Available at
http://www.who.int/medicines/areas/quality_safety/delphi_study_pain_guidelines.pdf (Page 17) Accessed June 25th 2012.
5. Burden Of Chronic Pain
Carries great economic costs – Direct and Indirect
Financial cost of chronic pain is roughly the same as Cancer or CV diseases.
The costs include –
• Healthcare and medication expenses
• Absenteeism from work, impaired
performance and work disruptions
• Income loss
• Loss of productivity in sufferer’s home
• Financial burden on family, friends and
employers
• Social and compensation costs
Unrelieved pain: Major Global Healthcare Problem. IASP & EFIC document. Available at http://www.iasp
pain.org/AM/Template.cfm?Section=Home&Template=/CM/ContentDisplay.cfm&ContentID=2908 accessed June 28th 2012
6. Burden of Chronic Pain
Impact on daily life
Breivik H et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. al. EurJ JPain.2006;10:287-333
Breivik H et
Eur Pain 2006;10:287-
333. (Page 295/309)
7. Chronic Postsurgical Pain Is A Common But Under-
recognized Problem
Estimated incidence Estimated incidence of Estimated US surgical
of chronic severe (disabling) pain volumes (1000s)
postsurgical pain
Inguinal hernia repair 10% 2–4% 600
Lower limb amputation 30–50% 5–10% 160
Breast surgery 20–30% 5–10% 480
(lumpectomy or
mastectomy)
Thoracotomy 30–40% 10% 200
Total knee arthroplasty 12% 2–4% 550
Coronary artery bypass 30–50% 5–10% 598
surgery
Caesarean section 10% 4% 220
7
1. Kehlet H, et al. Lancet 2006;367:1618-1625;
2. Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758.
8. 8
Sub-optimal Pain Management
Can Have Economic Consequences
Re-admissions following day-care surgery
Other
17%
Surgical • Mean charges for patients
21% re-admitted
due to pain were
ADE
3%
$1,869±4,553 per visit*
Medical • Of patients re-admitted for
14% pain, 38% had undergone
orthopaedic procedures
Bleeding
Pain 4%
38% N/V
3%
*Mean inpatient re-admissions for pain $13,902±11,732 per visit
ADE, adverse drug event
N/V, nausea/vomiting
Coley KC, et al. J Clin Anesth 2002;14:349-353.
9. Risk Factors For Development Of Persistent
Postsurgical Pain
1. Genetic susceptibility
2. Moderate to severe preoperative
pain
3. Psychosocial factors
4. Age and sex
5. Surgical approach with risk of
nerve damage
6. Poorly controlled postoperative
pain
1. Kehlet H, et al. Lancet 2006;367:1618-1625;
2. Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758;
3. Schug SA, Pogatzki-Kahn EM. Pain: Clinical Updates 2011;19:1-5. 9
10. Transition Of Acute To Chronic Pain
– Psychological Variables
• Acute pain intensity and depressive
symptoms each positively and directly
influence the persistence of neck and back
pain and disability and are also positively
intercorrelated
• Research suggests exposure to severe
stressors can permanently change
neurobiological processes or structures,
negatively affecting arousal thresholds
and ability to cope with subsequent stress
Casey Y et al. Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma
factors. Pain 2008;134:69–79
11. Hypothesized Model Of Transition From Acute To
Chronic Pain And Disability
Casey Y et al. Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma
factors. Pain 2008;134:69–79
12. Predictive Factors Of Pain Transition
• Greater exposure to past traumatic life events
and depressed mood is most predictive of
chronic pain
• Depressed mood and negative pain beliefs is
most predictive of chronic disability
• More cumulative traumatic life events, higher
levels of depression in the early stages of a new
pain episode, and early beliefs that pain may be
permanent significantly contribute to increased
severity of subsequent pain and disability
Casey Y et al. Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma factors.
Pain 2008;134:69–79
13. Reducing Pain Related Fears Could Reduce Chronicity
• Highest correlations were found
among the pain-related fear
measures and measures of self-
reported disability and behavioural
performance
• Questionnaires to quantify pain-
related fears, include –
– Fear-Avoidance Beliefs
Questionnaire (FABQ)
– Tampa Scale for Kinesiophobia
(TSK)
– Pain Anxiety Symptoms Scale
(PASS)
Crombez G et al. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back
pain disability. Pain. Mar 1999; 80(1-2):329-39.
14. Reducing Pain Related Fears Could Reduce Chronicity
• Controlling for socio-demographics,
multiple regression analyses revealed
that the subscales of the FABQ and the
TSK were superior in predicting self-
reported disability and poor behavioral
performance
• PASS appeared more strongly associated
with pain catastrophizing and negative
affect, and was less predictive of pain
disability and behavioral performance
Crombez G et al. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back
pain disability. Pain. Mar 1999; 80(1-2):329-39.
15. Early Intervention For Pain
• Inefficient or ineffective
treatment of acute pain can lead
to chronic pain states
• Chronic pain is associated with
morphological changes in the CNS
Early intervention can benefit patients at high risk of
developing chronic pain
Gatchel RJ et al. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year
prospective study. J Occup Rehabil. Mar 2003;13(1):1-9.
16. Results Of Early Intervention
• Gatchel et al., reported the effect of early intervention
on 124 patients with acute low-back pain
• High-risk patients randomly assigned to –
– Early intervention group (n = 22),
– Non intervention group (n = 48)
• Low-risk subjects (n = 54) who did not receive any early
intervention was also evaluated
• All these subjects were prospectively tracked at 3-month
intervals starting from the date of their initial evaluation,
culminating in a 12-month follow-up
Gatchel RJ et al. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year
prospective study. J Occup Rehabil. Mar 2003;13(1):1-9.
17. Results Of Early Intervention
• The early intervention program involved an
interdisciplinary team approach consisting of
four major components—
• Psychology
• Physical therapy
• Occupational therapy
• Case management
Gatchel RJ et al. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year
prospective study. J Occup Rehabil. Mar 2003;13(1):1-9.
18. Results Of Early Intervention
Gatchel RJ et al. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year
prospective study. J Occup Rehabil. Mar 2003;13(1):1-9.
19. Results Of Early Intervention
Gatchel RJ et al. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year
prospective study. J Occup Rehabil. Mar 2003;13(1):1-9.
20. Results Of Early Intervention
• High-risk subjects who received early intervention displayed
statistically significant fewer indices of chronic pain
disability on a wide range of work, healthcare utilization,
medication use, and self-report pain variables, relative to
the high risk subjects who do not receive such early
intervention
• In addition, the high-risk non intervention group displayed
significantly more symptoms of chronic pain disability on
these variables relative to the initially low risk subjects
• There were greater cost savings associated with the early
intervention group versus the no early intervention group
Gatchel RJ et al. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year
prospective study. J Occup Rehabil. Mar 2003;13(1):1-9.
21. Summary
• Pain can broadly be classified as acute & chronic
• Chronic pain is often associated with the emergence of a complex set of physical and
psychological changes that are an integral part of the chronic pain problem
• Chronic pain poses special therapeutic challenges
• Chronic pain carries direct and indirect economic costs and has great impact on daily life
• Although most episodes of acute pain resolve within 6 weeks, nearly half of the pain sufferers
have symptoms which persist and debilitate them for years
• Inefficient or ineffective treatment of acute pain can lead to chronic pain states
• Subjects at risk of acute pain turning chronic who receive early intervention show fewer indices
of chronic pain disability and include more work efficiency, less healthcare utilization, medication
use and self-reported pain
• There are greater cost savings associated with early intervention
Editor's Notes
Nociceptive pain*Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.Note: This term is designed to contrast with neuropathic pain. The term is used to describe pain occurring with a normally functioning somatosensory nervous system to contrast with the abnormal function seen in neuropathic pain.Neuropathic pain*Pain caused by a lesion or disease of the somatosensory nervous system.Visceral pain is caused by inflammation of serous surfaces, distention of viscera and inflammation or compression of peripheral nerves. It is diffuse and often referred to somatic sitesRef: Merskey H, Bogduk N., Classification of Chronic Pain, 1994, IASP Press ISBN-13: 978-0-931092-05-3 Cervero F, Laird JMA. Visceral pain. Lancet 1999; 353:2145–2148.
The World Health Organization (WHO) notes that chronic pain should be accepted as condition in its own right and highlights the great burden of chronic pain on individuals
Key points: Genetic susceptibility – A number of single nucleotide polymorphisms (SNPs) have been identified to closely correlate with persistent postsurgical pain. For example, specific haplotypes of catechol-O-methyltransferase (COMT) are correlated with an increased risk of developing chronic temporomandibular joint pain. Moderate to severe preoperative pain – Preoperative pain is consistently found to be a predictor for persistent postsurgical pain, which might reflect an independent risk factor, but which may also be a manifestation of predisposing factors. Psychosocial factors – Expectation of pain, fear, past memories, social environment, work, and levels of physical activity, all affect the response to noxious stimuli. Age and sex – In post-herniorrhaphy pain, older patients have a reduced risk of developing chronic pain; in contrast, it has been shown that there is a reduced incidence of post-thoracotomy pain syndrome in children and adolescents. Findings of several studies show that women have higher postoperative pain than men. Surgical approach with risk of nerve damage – Operations with a high risk of nerve injury carry a high risk of persistent postsurgical pain. This will be discussed in the following slides. Poorly controlled postoperative pain – Severity of acute postoperative pain is closely correlated with development of persistent postsurgical pain. This will be discussed in a later slide.References:Kehlet H, et al. Lancet 2006;367:1618-1625.Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758.Schug SA, Pogatzki-Kahn EM. Pain: Clinical Updates 2011;19:1-5.
Acute pain intensity and depressive symptoms each positively and directly influence the persistence of neck and back pain and disability and are also positively intercorrelatedResearch suggests exposure to severe stressors can permanently change neurobiological processes or structures, negatively affecting arousal thresholds and ability to cope with subsequent stress
Greater exposure to past traumatic life events and depressed mood is most predictive of chronic painDepressed mood and negative pain beliefs is most predictive of chronic disabilityMore cumulative traumatic life events, higher levels of depression in the early stages of a new pain episode, and early beliefs that pain may be permanent significantly contribute to increased severity of subsequent pain and disability
Questionnaires to quantify pain-related fears, include –Fear-Avoidance Beliefs Questionnaire (FABQ)Tampa Scale for Kinesiophobia (TSK)Pain Anxiety Symptoms Scale (PASS)Highest correlations were found among the pain-related fear measures and measures of self-reported disability and behavioral performance
Controlling for sociodemographics, multiple regression analyses revealed that the subscales of the FABQ and the TSK were superior in predicting self-reported disability and poor behavioral performancePASS appeared more strongly associated with pain catastrophizing and negative affect, and was less predictive of pain disability and behavioral performance
Poorly managed acute pain can lead to chronic pain statesIf pain is not treated adequately at an early stage, it often becomes more difficult to treatChronic pain, a history of pain-associated surgeries and low social support are negative predictors for treatment outcomeOver time, chronic pain leads to morphological changes in the central nervous systemReferences:1 Schulte E, Hermann K, Berghöfer A, et al. Referral practices in patients suffering from non-malignant chronic pain. Eur J Pain. 2010;14:308.e1-308. (Page 308, e1)2 Tracey I, Bushnell MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain. 2009;10:1113-20. (Page 1117)3 Apkarian AV, Sosa Y, Sonty S, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24:10410-5 (Page 10410)
In an attempt to prevent acute low back pain from becoming a chronic disability problem, an earlier study developed a statistical algorithm which accurately identified those acute low back pain patients who were at high risk for developing such chronicity. The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a one-year follow-up. Approximately 700 acute low back pain patients were screened for their high-risk versus low-risk status. On the basis of this screening, high-risk patients were then randomly assigned to one of two groups: a functional restoration early intervention group (n=22), or a non-intervention group (n=48). A group of low-risk subjects (n=54) who did not receive any early intervention was also evaluated. All these subjects were prospectively tracked at 3-month intervals starting from the date of their initial evaluation, culminating in a 12-month follow-up. During these follow-up evaluations, pain disability and socioeconomic outcomes (such as return-to-work and healthcare utilization) were assessed.
The early intervention program involved an interdisciplinary team approach consisting of four major components—PsychologyPhysical therapyOccupational therapyCase management
Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chronic pain disability on a wide range of work, healthcare utilization, medication use, and self-report pain variables, relative to the high-risk subjects who do not receive such early intervention.
In addition, the high-risk non-intervention group displayed significantly more symptoms of chronic pain disability on these variables relative to the initially low risk subjects. Cost-comparison savings data were also evaluated. These data revealed that there were greater cost savings associated with the early intervention group versus the no early intervention group. The overall results of this study clearly demonstrate the treatment- and cost-effectiveness of an early intervention program for acute low back pain patients.
High-risk subjects who received early intervention displayed statistically significant fewer indices of chronic pain disability on a wide range of work, healthcare utilization, medication use, and self-report pain variables, relative to the highrisk subjects who do not receive such early intervention.In addition, the high-risk nonintervention group displayed significantly more symptoms of chronic pain disability on these variables relative to the initially low risk subjectsThere were greater cost savings associated with the early intervention group versus the no early intervention group