Pain Management - Chronic Pain:

Background and Definitions:

• It affects one out of every five Canadians.
• It is defined as pain that persists beyond the usual course of an acute pain syndrome.
• Usually >12 consecutive weeks
• In addition to nociceptive and neuropathic pain, chronic pain includes
• Hyperalgesia: increased painful response to a normally painful stimulus
• Allodynia: pain due to a stimulus that does not normally provoke pain
• It is a significant burden on the lives of patients, their families and the utilization of health resources.

Management:

• A multidisciplinary approach is required to regain function while minimizing side effects.
• Psychiatry, neurology, addiction medicine, physiotherapy, and psychology
• Pharmacological Targets:
• NSAIDs and opioids block noxious transduction (generation of action potentials)
• NSAIDs and Tylenol remain first-line
• Reserve high opioid doses for cancer-related pain
• Local anesthetics from peripheral or neuraxial blocks inhibit transmission
• Ketamine, intrathecal opioids, and clonidine modulate transmission
• IV opioids block pain perception at the cerebral cortex
• If starting opioids, first assess risk of addiction and ask patient to sign opioid contract.
• It is a significant burden on the lives of patients, their families and the utilization of health resources.
• TENS machine is thought to work through neuromodulation.
• Activities such as aquafit and Tai Chi have proven to be beneficial.

Examples of various therapies for chronic pain management:

Medical therapy

Physical therapy

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