Pain Management. University of Illinois at Chicago College of Nursing

Transcription

1 Pain Management University of Illinois at Chicago College of Nursing 1

2 Learning Objectives Upon completion of this module, participants will be better able to: 1. Define pain management 2. Explore various methods for providing pain management Non-invasive: Oral & Topical medications Invasive: Anesthesia Modalities: Physical Therapy Alternative & Holistic: Acupuncture, yoga, weight loss 3. Explore assessment of pain 4. Explore which professionals assist with pain management Physical Therapists, Anesthesiologists, Neurologists, Physiatrists, Primary Care Providers

3 What is Pain Management? Pain Management is a planned effort or intervention intended to reduce the severity and impact of any pain type There are several types of pain, and the different pain types generally correlate with varying causes or types of injury For example: Pain may stem from chronic disease, trauma, post-operative complications, and cancer Treatment modalities can be non-invasive or invasive in nature For example: physical therapy versus surgical correction If oral narcotics are prescribed, discuss with client and provider plan to wean, and alternative and complementary non-invasive treatments

4 Incidence/Prevalence Pain affects ~116 million American adults--more than diabetes, cancer and heart disease combined U.S. population million (2017) Chronic pain is the most common cause of long-term disability, affecting about 50 million Americans annually Aspirin is the most commonly used pain reliever Opiate medication and aspirin were discovered in the early 19th century and are still being used today to treat pain

5 Causes, Risks are somewhat interchangeable Biological Chronic disease (e.g. obesity) Previous injury or post-surgery Psychological History of trauma Having a mood disorder Lifestyle High-risk (e.g. workplace, drug use) Stress

6 Types of Pain Nociceptive Pain Somatic Pain - felt on the skin, muscle, joints, bones and ligaments, temperature response Visceral Pain - felt in the internal organs and main body cavities Both types of pain can cause inflammation Non-Nociceptive Pain Neuropathic or nerve pain - diabetic pain, stroke Sympathetic Pain - pain after a fracture Referred Pain Example: Heart attack pain often local to the left shoulder and arm

7 Assessment : OLDCARTS Onset: When did the pain start? Location: Where is the pain? Does it radiate to other areas? Duration: How long has the pain been a problem (is this similar to a previous issue)? Character: Describe the pain (e.g., sharp, dull, stabbing). Aggravating factors: What makes the pain worse? Relieving factors: What makes the pain better? Timing: Is it constant? Or, does it come and go? Severity: How bothersome, disruptive, or painful is it?

8 Treatment Non-invasive: Oral and topical medications Over-the-counter or OTC (no prescription needed) Non-Steroidal Anti-Inflammatories (NSAIDS) Ibuprofen & Naproxen (Aleve) Salicylates, including Aspirin Paracetamol, Acetaminophen, APAP (Tylenol) Topical analgesics containing salicylates, counterirritants, eucalyptus and capsaicin

9 Treatment, Cont d Non-invasive: Oral Prescription strength Stronger NSAIDS, including Ibuprofen, Naproxen, Voltaren, Indomethacin, & Toradol Muscle Relaxants, including Mobic & Relafen COX-2 Inhibitors, including Celebrex Narcotic pain medications, including Codeine, Hydrocodone, Gabapentin, Methadone, Dilaudid, Demerol, Morphine, Oxycontin, and Tramadol

10 Treatment, Cont d Non-invasive: Oral and topical medications Prescription strength, Cont d Combination Narcotic Medication including Tylenol #3, Lorcet, Lortab, Vicodin, Fioricet Steroids (short course) Voltaren Gel, Fentanyl and Lidocaine patches

11 Treatment, Cont d Non-invasive: Modalities Physical therapies Stretching, massage Hot and cold techniques Ultrasound Therapy Holistic approaches Yoga, acupuncture

12 Treatment, Cont d Invasive Steroid and epidural injections, implantable stimulators Radiofrequency ablation - direct heat applied to nerves Corrective surgery

13 Red Flags, Commonly Associated with Higher Strength (Opiate) Prescription Medications Slowed Breathing/ Respiratory Depression Lethargy Loss of Consciousness Cool and Clammy to touch Slurred Speech Slow Heart Rate Pallor Blue Fingers and Lips Use Narcan for reversal of symptoms

14 Prevention : Monitor and Ask Questions Ask about and assess pain, regularly Monitor for risks and update care plans accordingly Assess for fall/injury risk Assess for signs of, and ask about, medication or substance misuse/abuse Ask about use of prescribed medication(s) is use as directed? Discuss with client and provider about weaning off oral and topical narcotics to prevent dependency Ask about any use of additional medication(s) How acquired? Given by family or friend? Purchased on the street? What is the pattern of use?

15 Client Member Education : Risks Associated with Medications

16 Resources : Pain Management Professionals Physical Therapists Anesthesiologist Physiatrists / Rehab specialists Neurologists Primary Care Providers

17 References American Society of Regional Anesthesia and Medicine. (2017). The Specialty of Chronic Pain Management. Retrieved from Effects of Opiates on Your Body. (2017). Retrieved from Center for Disease Control. (2016). Injury Prevention & Control: Opioid Overdose. Retrieved from List of Pain Relief Medications (2016). Retrieved from P Lierz, B Gustorff, P Felleiter. (2013). Invasive Techniques In Pain-management: From Infiltration To Pump-implantation. The Internet Journal of Pain, Symptom Control and Palliative Care Volume 2 Number 1. Oral Pain Management. (2017). Retrieved from

18 . Thank you all for being here and for your commitment to improving the health and well-being of your client members