Chronic Pain 5 - Medical and alternative management Flashcards
Pharmacological
Opoids Anticonvulsants Antidepressants Anti inflammatory Topical agents
Risk vs. Benefits - opoids
NOT FRONT LINE FOR CHRONIC PAIN! NOT RECOMMENDED
Maybe for acute short term pain with a tapering
If pt comes with opoid rx - ask them what their plan is down the line, ask how it is going and such
Pharm - anticonvulsants - MOA
Block voltage gated Na channels and can suppress spontaneous neural discharges that play a major role in chronic neuropathic pain
More for chronic neuropathic pain - following specific nerve root
Ex = Neurontin, Lyrica, Gabapentin
Need to have a plan with tapering off - but can be helpful to be on these to help assist in initiating the active approach but need to have active approach in place along with taper off of meds
Pharm - antidepressants - MOA
Tricyclic antidepressants may relieve neuropathic pain by unique ability to inhibit presynaptic reuptake of biogenic amines 5HT and noradrenaline
Ex = zoloft, cymbalta, prozac
Pharm - antiinflammatory - MOA
NSAIDs produce therapeutic activity through inhibition of COX - which is they enzyme that makes prostaglandins
GI and renal effects can occur
Ex - aspirin, ibuprofen, aleve, celebrex
Surgical and interventional management
Ortho sx
Injections
Nerve ablation
Spinal stimulation
Need conjunction with these - no research for these working as stand alone
Surgical and interventional management - Ortho sx
Generally not recommended for chronic pain, used only as last resort (but should it be?)
Progressive neuro deficit should be primary indicator for surgical intervention
Typical sx for spine = decompression, fusions, laminectomies
Failed back surgery syndrome!
Surgical and interventional management - Injections
For pain relief they can be more effective than oral meds because deliver directly Common injections = epidural steroid injection selective nerve root block facet joint block facet rhizotomy sacroiliac joint block
Surgical and interventional management - nerve ablation
Radiofrequency ablation (or RFA) is a procedure used to reduce pain An electrical current produced by radio wave is used to heat up a small area of nerve tissue to dec pain signals from that area
Surgical and interventional management - spinal stimulation
Spinal cord stimulation delivers mild electrical stimulation to nerves along the spinal column, modifying or blocking nerve activity in a non medicinal way to minimize the sensation of pain reaching the brain
Complimentary and alternative management
Meditation/Mindfulness Energy based tx Tai chi and Yoga Massage and Body work Nutrition and supplements
Most of the benefit is related to the perceived benefit from these
This can be powerful though - especially because not a lot of risk - the only risk is that they are externalizing their pain a bit - but the perceived benefit can be beneficial
Placebo “meaningfulness”
Nonspecific tx effects (including placebo) are substantial and may exceed the specific effects of tx
Placebo tends to have a negative connotation but it is real - there are real neuroplastic changes occurring and we can use this to our advantage
