Brian S. Kahan, D.O.

Transcription

1 Brian S. Kahan, D.O. Center for Pain Medicine and Physiatric Rehabilitation Board Certified Pain Medicine Physical Medicine and Rehabilitation Fellow Interventional Pain Physicians

2 Chronic Pain

3 Many Americans Suffer from Chronic Pain 86 million Americans suffer from chronic pain 1 66 million are partially or totally disabled 1 8 million are permanently disabled by back pain 2 At least 40 million Americans suffer from chronic, recurrent headaches and spend $4 billion annually on medication. 1 An estimated eight million people in the U.S. experience chronic facial and neck pain. 1 There are 65,000 new cases of permanent disability diagnosed each year 2 Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite

4 Psychosocial Effects of Chronic Pain Loss of employment / income Depression, fear, anxiety Isolation Sleep disorders Marital and family dysfunction Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite

5 Chronic Pain is Expensive Chronic pain disables more people than cancer or heart disease and costs the American people more than both combined. Pain problems cost $70 billion a year in medical costs, lost working days, and workers compensation. J. Bonica, International Association for the Study of Pain (IASP) Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite

6 Pain In Maryland 66% of Maryland households has someone who suffers from pain on a monthly basis 40% experience pain on an almost daily basis 25% rate their pain as moderate to severe 40% felt it interferes with work and productivity Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite

7 Individual Perception of Pain Affects sleep Affects work Affects QOL Affects enjoyment Affects energy Affect mental Affects mood Irritable 0 Percentage Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite

8 Obstacles to Treatment Physicians knowledge Physician fear Understanding how pain occurs Lack of Trust/ Disbelief Cookbook treatment plans Medical certification Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite

9 Lower Back Pain- What Hurts?

10 Overview of Management Low back pain differs from the traditional model of problem-solving. The assessment differs in that the physical examination frequently does not allow the determination of a precise diagnosis. Therefore the key to management of the patient with low back pain is education and cooperation. In industrial rehabilitation the cooperation of employers is paramount. Making transitional work available increases the rate of return and decreases the risk of chronicity

11 Frequency 80% of all adults will experience low back pain in their lifetime. It is the second leading reason for patients to visit a physician in ambulatory medicine (Cypress 1983 Am J Public Health) 90 % of the time it is self limiting( 6-12 weeks) 5% working population will be affected per year

12 Functional Anatomy Lumbar region Vertebral body Zygapophyseal joints Intervertebral foramen Intervertebral disc Ligamentum flavum PLL ALL

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14 Pathogenesis of LBP Pathogenesis of LBP Posterior degeneration 3-joint complex Disk Degeneration Synovial reaction Post Jt syndrome Circumferential tears Cart. Deg. Herniation Radial tears Capsular laxity Dyn. Lat. Sten Internal disruption Subluxation Deg. Spondylisthesis Disk Narrowing Osteophytes Fixed Lat Sten Osteophytes Facet Hyper Central Sten Vert. Hyper Multi. Spondylosis

15 Pathogenesis of Nerve Root Entrapment Three Joint Complex Facet Joint Synovial reaction Cartilage Destruction Osteophyte Formation Capsular Laxity Subluxation Entrapment of Articular Process Herniation Instability Lateral Nerve Entrapment One level central Stenosis Intervertebral Disc Circumferential tear Radial Tear Internal Derangement Loss of Disc Height Disc Resorption Osteophyte at Back of Vertebral bodies Multilevel Spondylosis and Stenosis

16 What Can We Treat Non Operatively Pathoogenesis of LBP Posterior degeneration 3-joint complex Disk Degeneration Synovial reaction Post Jt syndrome Circumferential tears? Cart. Deg. Herniation Radial tears Capsular laxity Dyn. Lat. Sten Internal disruption Subluxation Deg. Spondylisthesis Disk Narrowing Osteophytes Fixed Lat Sten Osteophytes Facet Hyper Central Sten Vert. Hyper Multi. Spondylosis