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
Pharmacological:
- Opioids
- Anticonvulsants
- Antidepressants
- Topical agents
- Membrane stabilizing agents
Interventional:
- Epidural steroid injection
- Peripheral nerve/joint injections
- Spinal cord stimulation
Surgical:
- Rotator cuff repair
- Knee replacement surgery
- Spine surgery
Physical therapy
- Physiotherapy
- TENS
- Heat/cold therapy
- Massage therapy
- Strength exercise
- Acupuncture