Summary of Pain Management Issues

Transcription

1 Chapter 2 / Frequent Treatment Concerns 11 Summary of Pain Management Issues Frequent Concerns in Treating Chronic Pain Patients 2 Chronic pain patients often come to their doctors with a myriad of complaints and expectations. When confronted with the patient with chronic pain, doctors often have their own concerns about the legitimacy of reported pain severity and associated disability, amount of time and resources that may be used by patients to address these concerns, and the inadequate amount of information they received during their medical education and training concerning the management of chronic pain. This book is designed to fill this knowledge gap for the most common chronic pain conditions and to provide useful clinical tools to facilitate the effective approach to patient complaints in a busy office practice. Several concerns about pain legitimacy, significance, and ability to effectively treat patients with pain are addressed here. Each of these issues is addressed in greater detail in the following chapters. Do People Really Have Chronic Pain Long After They ve Recovered From an Injury? Chronic pain is one of the most common reasons for seeing a primary care physician. For example, about one-third of primary care visits are for musculoskeletal pain. Studies in laboratory animals consistently show changes in the nervous system in response to old injuries. Increased nerve sensitivity and the rewiring of nerves to activate pain pathways occur after injuries and correspond to demonstrated pain behaviors. Complete fabrication of pain symptoms, or malingering, is rare. Premorbid depression, work dissatisfaction, poor social support, and smoking increase the risk for a chronic pain complaint. Isn t It Unusual for Children to Report Chronic Pain? Chronic pain complaints are reported by approximately 5 to 15% of children and adolescents. The most common chronic pain complaints in pediatric patients s are headache, stomach pain, and musculoskeletal pain. Children should not be expected to quickly outgrow their pain complaints. For example, chronic musculoskeletal pain persists for at least 1 year in approximately 75% of children. Untreated chronic pain in children is associated with significant distress and disability (including school absences) and may predispose children to chronic pain in adulthood. From: Chronic Pain: A Physician s Guide to Practical Management Edited by: D. A. Marcus Humana Press, Totowa, NJ 11

2 12 Part I / Introduction Aren t Aches and Pain Part of the Normal Aging Process? Approximately one-third of elderly patients are affected by chronic pain, often because of arthritis, osteoporosis-associated fractures, and lumbar stenosis. These conditions are treatable and should not be considered part of the normal aging process. Untreated chronic pain in elderly patients can result in depression, poor quality of life, and loss of independence. The ability to identify and manage pain in elderly patients will become increasingly important in primary care settings because the world population is aging. I ve Heard That You Can t Really Treat Chronic Pain and Patients Just Need to Learn to Live With the Pain. Are There Really Any Effective Treatments for Chronic Pain? Although it is not necessarily curable, chronic pain is definitely a treatable condition. Individual pain conditions often require different treatment modalities. Some treatments e.g., stretching exercises, relaxation techniques, antidepressant therapy, and antiepileptic drugs are beneficial for a wide variety of chronic pain conditions. Are Opioids Effective for Patients With Chronic Pain, or Do They Usually Lead to Addiction? Opioids can help reduce the severity of pain, but they must be used within the context of a comprehensive pain treatment program. Patients with chronic pain who are treated with opioids need to be monitored closely. Approximately 25 to 30% of patients with chronic pain who are treated with opioids will demonstrate medication abuse behavior. Opioid misuse and abuse can be minimized by establishing realistic treatment goals, using low doses of medications, and employing strictly followed opioid contracts. Isn t Caring for Chronic Pain Patients Too Time-Consuming for a Busy Practice? Chronic pain patients may have complicated complaints that cannot all be addressed in a single office visit. Patients may present multiple long-term issues to their primary care doctors: pain severity, sleep disturbance, depressed mood, work disability, and family conflicts. Office tools, such as pain drawings and other self-assessment tools, can help patients focus on short- and long-term goals that can be addressed with treatment. Helping patients focus on specific goals is also facilitated by using goal assessment and attainment tools. These tools can be completed by most patients with minimal instruction. Educational tools, such as written handouts, can reinforce treatment messages and minimize the amount of face-to-face time needed to deliver patient education. Is It Really Important to Address Chronic Pain? Isn t My Office Time Better Spent Focusing on Real Medical Problems, Like Diabetes, Heart Disease, and Hypertension? Chronic pain complaints are very common and frequently bring patients to the doctor s office to request information and seek a diagnosis and treatment. Untreated chronic pain conditions can exacerbate frustration and psychological distress and result in significant disability, including school absences in children and unemployment or underemployment in adults.

3 Chapter 2 / Frequent Treatment Concerns 13 Chronic pain complaints may also be caused by or aggravated by other medical conditions, such as diabetes-related neuropathy and the aggravation of mechanical joint pain by obesity. Compliance with treatment for the primary medical disorder is often enhanced when that treatment also improves a secondary pain condition. Treatment options for patients with chronic pain including exercise, relaxation skills, stress management, and appropriate use of medication are also invaluable for maintaining overall good health and maximizing the efficacy of treatment prescribed for other medical conditions.

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