1.1 Pain and pain management (pt.2)

McGill Melzack Pain Questionnaire

a multidimensional assessment tool composed of 20 words descriptors grouped into 4

• Sensory (1-10)

• Affective (11-15)

• Evaluative (16)

• Miscellaneous (17-20)

The McGill Melzack Pain Questionnaire is composed of 20 word descriptors grouped into 4 namely..

Simple descriptive pain intensity scale

from no pain to worst possible pain

Pain management

refers to the techniques used to prevent, reduce or relieve pain.

NSAIDs

nonspecific analgesics and can potentially be used for any type of acute or chronic pain.

Adjuvant drug therapy

Drugs that are on the market for indications other than pain but may be analgesic in selected circumstances. They include a very large number of drugs in numerous drug classes

Opioid analgesics

The most effective analgesics (Ellison, 1998). This includes all drugs that interact with opioid receptors in the nervous system.

Opioid antagonists

have no analgesic effect and are used to block the effects of opioid drugs. Ex. Naloxone, Naltrexone, Nalmafene

Opioid agonist-antagonist

have analgesic effect. Ex. Buprenorphine, Butorphanol, Nalbuphine, Dezocine

Ice

Use __ for acute injuries or pain, along with inflammation and swelling

Heat

Use __ for muscle pain or stiffness

Heat therapy

works by improving circulation and blood flow to a particular area due to increased temperature

Dry heat/Conducted heat therapy

includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.

Moist heat/Convection heat

includes sources like steamed towels, moist heating packs or hot baths. Moist heat may be slightly more effective as well as require less application time for the same.

When not to use heat therapy

• Bruised or swollen (or both)

• Open wound

• Conditions:

•   diabetes

•   dermatitis

•   vascular diseases

•   deep vein thrombosis

•   multiple sclerosis (MS)

20

Heat packs should not be used for more than __ minutes

Cold therapy/Cryotherapy

It works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

Cryostretching

uses cold to reduce muscle spasms during stretching

Cryokinetics

combines cold treatment and active exercise and can useful for ligament sprains

Transcutaneous Electrical Stimulation (TENS)

The device is an electrical unit that delivers different frequencies and intensities of stimulation to the skin through electrodes.

Acupressure

is a method of sending a signal to the body via needles or other means, to turn on its own self-healing or regulatory mechanisms.

Percutaneous Electrical Nerve Stimulation (PENS)

combines electro-acupuncture and TENS which uses acupuncture like needle probes as electrodes placed at dermatomal levels corresponding to local pathology.

Mind/Body Therapy

address these issues and provide a variety of benefits, including a greater sense of control, improved coping skills, decreased pain intensity and distress, changes in the way pain is perceived and understood, and increased sense of well being and relaxation. These approaches may be very valuable for adults and children with pain (Rusy, 2000).

Cognitive - Behavioral Therapy

• addresses psychological component of pain including attitudes, feelings, coping skills and a sense of control over one’s condition;

• effective in reducing pain and disability when used as part of a therapeutic treatment for chronic pain.

• provides educational information and diffuse feelings of fear and helplessness;

• helps patient to find a more realistic and balanced view of the pain problem;

• includes teaching of life skills and coping skills that can assist the patient in productive problem solving and the prevention or minimization of future pain episodes.  

Imagery

is the use of imagined pictures, sounds, or sensations for generalized relaxation or for specific therapeutic goals, such as the reduction of pain.

Biofeedback

provides biophysiological feedback to patient about some bodily process the patient is unaware of (e.g., forehead muscle tension).

Hypnosis

relaxation + suggestion + distraction + altering the meaning of pain.

Prayer

Changes in the concept of health and illness, a broadening view of healing and curing, and interest in other cultural systems of medicine have created a growing openness to the spiritual dimensions of health

Physical therapy

Useful in teaching patients to control pain, to move in safe and structurally correct ways, to improve range of motion, and to increase flexibility, strength and endurance. "Active" and "passive" modalities can both be used, but active modalities, such as therapeutic exercise, are particularly important when the goal is to improve both comfort and function.

Exercises

have a variety of benefits that produce better stamina and function. May reduce the risk of secondary pain problems like muscle strains, and may also lead to improved confidence and sense of well-being.