Chronic Pain

Question 1

Acute VS Chronic Pain

Answer 1

_ Acute _ _Chronic _

Onset: sudden gradual or sudden

Duration:<3 months or as long >3 months, may start as

                                   as it takes for N healing    acute injury, past N healing

**Severity: ** mild to severe mild to severe

Cause:usually one precipitating can be unknown, cause

event, illness (surgery) may differ from mechanism

Course: over time, goes away does not go away, changes

Pattern: identifiable pattern irregular pattern

Question 2

Characteristics of Chronic Pain

Answer 2

• lasts longer than 3 - 6 months… can be lifelong
• variable –in intensity and duration
• Onset: sudden or slow. Started as something small and wasn’t attended to or, as the result of a critical event ex: MVA
• poor response – to available treatment methods BUT may be OUR perceptions that hinder response. We expect pt with acute pain to get relief but may be less vigilant with chronic pain

Question 3

Common Causes of Chronic Pain

Answer 3

Most common conditions:

• Nociceptive
• Musculoskeletal: low back pain, joint pain, arthritis, inflammation, previous fracture sites

Second most common: neuropathic pain

• damage to nerve cells or in spinal cord
• Not well controlled by opioid analgesics
• Neuralgias: postherpetic, trigeminal, mandibular joint

Question 4

Specific Causes of Chronic pain

Answer 4

• Arthritic conditions (osteo- and rheumatoid)
• Myalgia, neuralgia
• Fibromyalgia
• Headaches, migraines
• Low back pain
• Abd. pain r/t Crohn’s, irritable bowel, pancreatitis
• Myofascial pain
• Peripheral neuropathy
• Phantom limb pain
• Sickle cell disease
• Reflex sympathetic dystrophy
• Cancer
• Temporal mandibular joint dysfunction
• Herpes zoster

Question 5

Chronic Pain: Peripheral Neuropathy

Answer 5

General term for degenerative nerve function in the extremities, most common causes:

1) Diabetes Type 2
2) Alcoholism
3) Drug toxicity: common with chemo agents
4) HIV/AIDS
5) Peripheral vascular disease

Question 6

Chronic Pain: HIV/AIDS
Assessment and Management

Answer 6

Management based on WHO analgesic ladder

Reminder: Approx 33% of pts with AIDS had substance abuse, may need higher dose analgesics for same effect (tolerance)

• Careful administration of Acetominophen: hepatotoxic
• Careful use of NSAIDS: greater risk for GI ulceration
• This population at higher risk for bleeding and coagulation problems
• Fentanyl patch release rate with temperature, caution in febrile pts
• Take many different meds, review drug interactions.

Experience both: nociceptive and neuropathic pain

• Inflammatory (bacterial, viral infections)
• Oral and esophageal ulcers
• Other GI disorders: diarrhea, pancreatitis
• Musculoskeletal disorders (arthritis)
• Herpes Zoster
• Other neuropathic syndromes (periph. neuropathy)

Question 7

Phantom Limb Pain

Answer 7

• Theory: pre-amp pain in limb (brain cell memory), so pain arises in the limb stump or brain remembers in the absence of input form the extremity
• Assessment: patients often reluctant to admit to pain (in their head) important to ask directly
• Management: Preop epidural opioid 1-3 days
• Muscle relaxants and vasodilators after surgery
• Nerve blocks and injection of local anesthetics and steroids after surgery, (not as effective)
• TENS

Question 8

Consequences of Uncontrolled Chronic Pain

Answer 8

• Affects all aspects of human existence and behaviour in adult and older adults:
• Depression, not worth living,* (31%-100%)
• Anxiety, agitation, confusion (delirium)
• Role dysfunction
• Decreased socialization,
• Sleep disturbance,
• Frustration, anger….with self/caregivers/God
• increased health care utilization,