Cancer Treatment Centers of America® Midwestern Regional Medical Center
Pain Management Service
Presented by: Dr. Rahman
Date: 5/10/2012 – Thursdaywww.cancercenter.com
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Pain
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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.
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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.
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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
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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
International Association for the Study of
Pain 1979
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Types of Pain : Time vs Location
• Acute vs Chronic
• Nociceptive (S&M) vs Neuropathic
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Acute Pain
• Trauma• Surgery• Infection• Burns• Appendicitis• Inflammatory
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Chronic
• Pancreatitis• Diabetic Peripheral Neuropathy• Osteoarthritis• Headache• Fibromyalgia• Phantom Pain
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Nociceptive
• Osteoarthritis• Rheumatoid Arthritis• Muscle Injury• Inflammation• Neoplasm• Degenerative Disc Disease
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Neuropathic
• Diabetic Peripheral Neuropathy• Stroke Pain• Post Herpetic Neuralgia• Complex Regional Pain Syndrome• Multiple Sclerosis• Neoplasm
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The 5th Vital Sign
• Vitals Signs:– Temperature– Pulse– Respiratory Rate– Blood Pressure
– Pain Score
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
• 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
Pain Assessment
• Pain History• Pain Physical Exam• Labs/Imaging Studies• Pain Diagnosis• Pain Plan
• Then Follow-up Evaluation
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Pain Assessment
Spinal Pain Generators
Multi-Disciplinary Care
MRI
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Potential Pain Therapies
• A. Nonpharmacologic
• B. Pharmacologic
• C. Interventional
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Nonpharmacologic
• Acupuncture• Biofeedback• Chiropractic Care• Massage• Physical Therapy• TENS unit• Cognitive Behavioral Therapy
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Pharmacologic
• Topical Agents• NSAIDS• Oral/IV steriod• Opioids• Antidepressants • Anticonvulsants• Infusions
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Interventional
• Trigger Point Injections• Medial Branch Block• Epidural Steroid• Intradiscal Therapy• Laminectomy/Fusion• Vertobroplasty• Discectomy
Interlaminar approach
Transforaminal approach
Anterior Approach
Greater Trochanter Injection
Shoulder/Bursa Injections
Elbow Bursa Injections
FJI
Retrobulbar Block
Stellate Ganglion Block
Sacrum Injections
SCS
ITP
TPI
Lower Cranial Nerve Blocks
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
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