9.10 Rehab medicine approaches to pain management Flashcards
rehab medicine is particularly focussed on what? what type of pain does the filed generally involve itself with? How are the approaches in rehab medicine to be used compared to conventional pain management principles?
Rehabilitation medicine is focussed on optimizing patient function irrespective of their symptom burden or impairments, has developed strategies that may reduce pain in general, but are particularly targeted to movement-related pain.
- serve as adjuncts to, rather than replacements for, conventional analgesic approaches
What are the four major groups of interventions that are utilized by rehab medicine?
(1) modulating nociception
(2) stabilizing and unloading painful musculoskeletal structures
(3) influencing pain perception
(4) alleviating musculotendinous pain
What are the two main approaches used by rehab medicine to modulate the input of nociceptive input into the CNS?
- use of heat and cold
- rather than trying to block the input of painful stimuli, uses benign afferent sensory input to reduce nociceptive activity (Gate theory of pain)
List three impacts of heat application to a painful area. List three impacts of cold application
Heat: analgesia, hyperaemia, reduced muscle tone
Cold: reduced perfusion, analgesic and tone reduction capabilities
What theory is the use of TENS based on? List two side effects of its use. List one contraindication to the use of TENS. List two structures that TENS should not be used on
Gate theory of pain
Side effects: skin irritation and mild discomfort during use.
Contraindication: cardiac pacemaker
Do not use around carotid sinus, epiglottis, and abdomen/low back of pregnant women
other chapter not to use near mets? increased blood leading to increased spread?
List three factors that might make a patient a good candidate for TENS?
reasonable candidates are patients whose
localized pain is inadequately controlled by conventional treatments, who experience untenable medication side effects, or who prefer to trial non-pharmacological approaches
Other than TENS list three methods of increasing benign sensory afferent input to decrease nociceptive input to the CNS that can be used for pain management
massage
compression garments
desensitization techniques - Tolerance for increasingly intense and unpleasant stimuli is systematically cultivated by gently applying stimuli in an incremental fashion to steadily shift a patient’s threshold for experiencing a stimulus as noxious
What are four general categories of interventions that can be used to stabilize and unload painful MSK structures in rehab medicine
- displacing loads onto external supports
- improving the load bearing capacity of intact anatomic elements
- immobilizing painful joints, or
- reducing the work required by a painful activity
What is dynamic stabilization?
dynamic stabilzation: therapeutic exercises aimed at enhancing the strength and stamina of muscles
capable of splinting a painful body part can be a remarkably effective adjunct to conventional analgesia
Braces can immobilize body structures or just restrict their motion. When is spinal immobilization required rather than motion restriction?
If the spine is unstable, however, surgical stabilization or a body jacket should be considered
What are two techniques that can be used in rehab medicine to influence the perception of pain?
light and laser therapy\manual lymphatic drainage
List four mechanisms through which malignancy can cause MSK pain
(1) direct tumour invasion
(2) maladaptive changes induced by cancer treatment or local tumour effects,
(3) exacerbation of pre-existing musculoskeletal pain
(4) secondary hypertonicity and spasm related to (2), and (3)
List four techniques that can be used to alleviate MSK pain in cancer with the help of rehab medicine
Principals of rest, ice compression and elevation (PRICE)
Injections (steroids and topical anesthetics most common)
Myofascial release techniques and trigger points
Therapeutic exercise
Where can injections be offered by rehab medicine? List three locations. What two medications are most often used?
Inflamed tendons, bursae, and synovium are the most common targets
Injected meds: steroids and local anaesthetics
What is the relationship between physiotherapy and steroids for pain relief in rehab medicine? What is the implication for palliative care?
PT in conjunction with or independent of an injection may offer greater collective benefit than an injection alone.
In contrast, patients with far advanced cancer need near-term relief and may not survive to experience the more delayed and sustained benefits offered by PT.
