Ortiz lesson plan_mn511_05_03_2011

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Teaching about pain

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  • In this picture you can see that the vertebra is a stack of bones that protect the spinal cord. Small nerves enter and exit the spinal cord through spaces in your vertebrae. The vertebrae are held together by muscles, tendons and ligaments. Between each bone there are inter-vertebral disks, which act as shock absorbers. These inter-vertebral disks prevent the vertebrae from hitting one another when you walk, run or jump. They also allow your spine to twist, bend and extend. With time, the vertebrae bones erode and push down on the disks causing friction and pain. With an injury, the disks can slip out of its normal place and pinch the nerve running alongside. The disk can also be compressed by the bone, this causes the disk to bulge also pinching the nerve, the disk may rupture as well, causing extreme pain. If untreated these problems lead to chronic pain. www.mayoclinic.com
  • Pain is an unpleasant experience. The purpose of pain is to protect tissue damage and to prevent further tissue damage. A person also protects the painful limb by immobilizing it due to the pain. Immobilization promotes further damage and promotes healing. Pain is subjective, no two people experience pain in the same way. Disorders of pain perception can make people feel less or more pain.
  • The lower back is the most common place for back injury and pain. The most common cause of back pain is an injury to a muscle (strain) or a ligament (sprain) in your lower back. Strains and sprains can occur when you lift something heavy, if you are carrying excess body weight and if you have poor posture. They can also develop from carrying around a heavy handbag or sleeping at an awkward angle or picking up your baby. As a pivot point for turning at the waist, the lower back is extremely vulnerable to muscle strains! When the ligament becomes loose the disk can slip out or rupture. Other common causes of back pain include osteoporosis, arthritis, scoliosis, etc.
  • Blood tests are useful in determining whether an underlying disease or infection may be contributing to your back pain. X-ray images show the alignment of your bones and whether you have arthritis or broken bones. MRI generate images that show the status of your disks, bones, muscles, tissue, tendons, nerves, ligaments and blood vessels. Bone scan can detect osteoporosis or tumors. Nerve studies (EMG) show the nerve-conduction pathway, if it is slow it may confirm that nerve compression or spinal stenosis (narrowing of your spine due to the wear and tear of the vertebrae)
  • Not all treatment modalities work for everyone. Some people find relief with heat others with cold. Some people find spine traction useful while others experience no relief. You need to find what works for you. Be willing to try different modalities.
  • Many people are fearful of becoming addicted to medications and therefore live in pain. It is important that you know that addiction rarely happens in people who take medication for pain relief. Tolerance and dependence are both easily treatable when the person no longer needs the medication for pain. The doctor may taper the medication down or may use vitamins or other medications short term to relieve the withdrawal side effects. There is no reason to live in pain. http://www.webmd.com/pain-management/guide/drug-tolerance-addiction
  • Muscle relaxers relax the muscles and relief pain. Tylenol and non narcotic pain medications work alone or in combination with other medications. People may take this for mild pain to avoid the side effect of narcotics. Vicodin and other narcotic pain relievers are useful at relieving pain but they have side effects and they do not all work the same. If used for long term a person can develop tolerance, dependence and or addiction. Steroid injections are done with local anesthesia and they relieve pain for a few weeks to a few months. They are useful for some people. May relieve pain while awaiting surgery. Antidepressants relief pain and help improve mood. Although controversial, many people have found that marijuana helps them with their pain. A new drug called Marinol is given to patients who had been smoking or eating marijuana for their pain relief. Marinol; however, has many side effects and should be used with caution in the elderly. Other herbs like willow barks, devils claw, capsicum have been found to reduce joint inflammation. Always take one herbal remedy at a time to find which one works best for you! A tens unit tricks your brain by giving the area small impulses that disturb the pain perception.
  • Physical therapy will teach you different stretches and exercises that may relieve your pain or help you cope with the pain. The National Institute of Medicine have done studies showing that complementary therapy works. Inversion therapy is a form of traction and it is good for short term pain relief but it should not be used by people with high blood pressure or history of brain injury or glaucoma. Surgery is usually the last option for pain management. Chronic pain tends to disturb the pain pathway and a person may suffer chronic pain even after surgery. Having a pain doctor in a pain management clinic can be the best thing for you. The doctor will work with you to give you the best treatment for your pain. The goal of the pain doctor is to improve your quality of life. Cognitive behavior therapy helps the person learn ways to cope with the pain. There are financial stresses and lifestyle changes that may cause stress and difficulty coping. Cognitive behavior therapy is useful for some people just like any other approach is not always useful for everyone. Progressive relaxation involves relaxing and tensing your muscle. It helps the person learn to relax the muscles in the back area to decrease pain. Viniyoga is a special type of yoga for people with back pain. The person learns to postures and breathing exercises to relief pain.
  • Fusion involves joining two vertebra bones together to eliminate painful movement. A bone graft is inserted between the two vertebrae, which are then splinted together with screws, plates or cages. The person may develop arthritis in the spinal bones next to the splint. The surgery may need to be redone because the screws and plates may need to be replaced. Pain is not often relieved with this type of surgery. In a microdiskectomy, the disk tissue pressing the nerve is cut away. If there was numbness on a limb or loss of movement this procedure improves movement and decreases pain. Many people find that the pain may not be completely resolved but can be manageable after this procedure. Partial removal of a vertebra is done to remove bony growth spurs that may be pinching the cord or nerves. People find some pain relief with this procedure but the spurs may return in the future requiring more surgery. Total Disk replacement
  • Most common back surgery today is a microdiskectomy. It is often done to remove the damaged disk tissue thereby reducing the pressure on the adjacent nerve which in turn reduces pain.
  • Walking has been found to be the best exercise for pain sufferers. Swimming is good for some too. Stretching helps to build the abdominal muscles and improve flexibility. You can do more when you are flexible! Extra pounds cause undue stress on a person’s back. Just losing 10 percent of your body weight can improve your pain dramatically. Use proper body mechanics by practicing good posture, sit in a chair that provides arm rests and good back support; hard chairs will cause too much pressure on your back and increase pain. Your feet should touch the floor. If you must stand for long periods use a footstool to rest one foot as this decreases tension on your back. When lifting objects bend at the knees and hold objects close to your body. Don’t ever reach for anything. Use a step tool to get items. Sleep on your side or back only, never on your stomach as this causes a lumbar strain.
  • According to the American Pain Society. There are many treatments and medications available to treat pain; but under-treatment of pain continues to be a huge problem in this country. As a person in pain you need to educate yourself on the treatments available and become a part of your pain management. Continue to enjoy life by learning how to modify the activities you enjoy without increasing pain. Learn to control pain so it does not control you! Learn more at www. aspm.com, www.ampainsoc.org, www.mayoclinic.com, cdc.gov
  • Ortiz lesson plan_mn511_05_03_2011

    1. 1. Course Title: Understanding Your Back Pain<br />Sarah Ortiz RN, BSN, PHN<br />Kaplan University<br />MN 510 Mary Ann Theiss<br />May 3, 2011<br />
    2. 2. Course Description<br />In this course you will learn about back pain <br />I will discuss some of the causes of back pain, diagnostic tools, and some common treatments <br />You will learn the difference between tolerance, dependence and addiction<br />Discuss the importance of stretch, posture and exercise in the management of pain<br />
    3. 3. Course Objectives: You will be able to:<br />Describe the difference between chronic back pain and acute pain<br />Understand and describe the causes of back pain<br />Learn about the different diagnostic procedures <br />Learn about recent treatments available<br />Describe the importance of daily stretching, good posture and exercise<br />Feel empowered to live and enjoy life in spite of having back pain! <br />
    4. 4. Your Back<br />
    5. 5. Signs and Symptoms: <br />Muscle ache<br />Shooting or stabbing pain<br />Pain that radiates down your leg<br />Limited flexibility or range of motion of your back<br />Inability to stand straight<br />
    6. 6. Causes of Pain<br />Most common causes of back pain are a strain or sprain in the lower back<br />
    7. 7. Diagnosis<br />Blood and urine tests. <br />X-ray. <br />Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. <br />Bone scan. <br />Nerve studies (electromyography, or EMG). <br />
    8. 8. Treatment<br />Acute pain: <br />Aspirin, ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others). <br />Heat and cold<br />Medicated patches<br />Herbal remedies<br />Physical therapy<br />Complementary therapy; massage, acupuncture, chiropractor, etc<br />
    9. 9. So what is it? <br />The current therapeutic dose of a substance loses its effectiveness over time.<br />Withdrawal symptoms occur when a substance is suddenly stopped<br />Person takes more medication than it is necessary to effectively reduce pain<br />Addiction<br />Tolerance<br />Dependence <br />C<br />A<br />B<br />
    10. 10. Chronic Pain Management: <br />Muscle relaxers: Naproxen, Flexeril, Norflex<br />Non narcotic pain relievers: Tramadol, Ibuprofen, Tylenol<br />Narcotic pain relievers; such as, Vicodin<br />Steroid injections<br />Antidepressants<br />Herbal remedies<br />Medicated patches<br />Transcutaneous Nerve Stimulator (TENS)<br />
    11. 11. Physical therapy<br />Complementary medicine: acupuncture, chiropractor, massage<br />Spinal traction<br />Surgery<br />Cognitive behavior therapy<br />Progressive relaxation<br />Viniyoga<br />
    12. 12. Fusion<br />Partial removal of disk <br />Partial removal of a vertebra<br />Disk replacement <br />
    13. 13. Surgical Treatment: Microdiskectomy<br />
    14. 14. Prevention<br />Exercise<br />Improve your muscle strength and flexibility<br />Maintain a healthy weight<br />Use proper body mechanics<br />
    15. 15. In conclusion: <br />Let to control your pain so it does not control you!<br />Be an advocate for your pain by learning about treatments available<br />Be willing to try different treatments<br />Practice relaxation techniques<br />Know your limits and be patient with yourself<br />Stretch and exercise 30 minutes a day on most days<br />Continue to do the things you enjoy! <br />
    16. 16. References<br />The American Pain Society (2011). Back pain. Retrieved May 1, 2011, from http://www.ampainsoc.org<br />American Society for Pain Management (2011). Back pain. Retrieved May 1, 2011 from http://www.aspmn.org/<br />Mayo Clinic (2011). Back Pain. Retrieved May 1, 2011 from http://www.mayoclinic.com/health/back-pain/DS00171<br />Pain tolerance, dependence and addiction (2011)http://www.webmd.com/pain-management/guide/drug-tolerance-addiction<br />

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