An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Transcription

1 An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Acute Pain results from disease, inflammation or injury to tissues; generally comes on suddenly and may be accompanied by anxiety or emotional distress. Chronic Pain widely believed to represent disease itself and can be made much worse by environmental and psychological factors as well as stigma; persists over a long period of time and is resistant to medical treatments

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3 Nociceptive Pain (sprains, bone fractures, burns, bruises)-special nerve ending which heal with time Neuropathic Pain (shingles, neuralgia, phantom limb pain, Carpal Tunnel Syndrome /CTS, peripheral neuropathy)-nervous system dysfunction pain Mixed category Pain (migraine headaches)- complex mixture of nociceptive and neuropathic Central Pain-caused by dysfunction of nervous system such as Fibromyalgia

4 Patient Self Report Physical Examination Imaging Studies (X-Ray, CT, MRI, Ultrasound, other) Pain Rating Scales (Verbal, Visual, Observational, other) PT Assessment Psychological Assessment

5 Pharmacologic and Non Pharmacologic Aspirin, Tylenol, Ibuprofen, Aleve Physical Therapy, Massage, Acupuncture Neuroleptics (Neurontin, Lyrica, Topamax, etc.) Short Acting Opiates (Morphine Sulfate, Hydrocodone, Oxymorphone, Codeine, other) Long Acting Opiates (MS Contin, Oxycontin, Fentanyl Duragesic, other) Interventional (injections, nerve ablation, nerve blocks, spinal cord stimulators)

6 Review of Prior Medical Records and Treatments Complete Medical History Review Imaging Studies Review Colorado Prescription Drug Monitoring Program Report (PDMP) Urinary Drug Screening Rule Out Physical Therapy Consider Psychological Assessment and Treatment Opiate Contract (one prescriber, one pharmacy, no early refills, no refills for Lost Prescriptions, No Alcohol Consumption, no illicit substances, no late or missed appointments, no sharing medication, pill and patch counts, etc.) Prescription Pain Medication

7 30 Days for New Patients; 90 Days for Compliant Patients Review of PDMP Pill and Patch Counts (patients must bring remaining patches, pills, and used patches) Urinary Drug Screening Review Imaging Studies, Physical Therapy Notes, Psychological Treatment, etc. Physical and Self-Report Patient Assessment Medication Assessment and Tweaks

8 People with Chronic Pain are often misunderstood and judged by employers, neighbors, family members, spouses, and even their own healthcare providers. Judgement causes feelings of hurt, shame, and anger Judgement puts people on the defense and it can break trust (with healthcare providers, family, etc.) Judgement causes people with Chronic Pain to feel misunderstood, lonely, and depressed Lack of understanding between physical dependence and addiction

9 Taking opiates for as little as seven days can cause physical dependence Physical dependence is predictable and easily managed Tolerance is a common side effect and can occur even when patients take medication as prescribed Many substances - caffeine, nicotine, sugar, anti-depressants, to name a few - can cause physical dependence Physical dependence to opioids is normal and expected and is not necessarily indicative of addiction. The terms dependence and addiction are often interchanged, causing confusion regarding the difference between physical dependence and addiction Addiction is abnormal and often considered a disease in and of itself Addiction is a primary condition manifesting as cravings, inability to control drug use, compulsive drug use, and use despite doing harm to oneself or others Cravings are common to addiction and uncontrollable cravings prompt the destructive behaviors of addiction Cravings are rooted in altered brain biology Addiction is sometimes referred to dependence, substance dependence, and most recently opioid use disorder, but still too often simply dependence, which leads to confusion and stigma