Chronic pain profoma

Question 1

Epidemiology of Chronic pain

Answer 1

• Prevalence increases w/ age.
• 1 in 3 patients over 65 years old affected by CP due to arthritis, osteoporosis w/ fractures &/or lumbar spinal stenosis.
• 3 most common pain locations are back pain (53%), headache (48%) & joint pain (46%).

Question 2

Risk factors of chronic pain?

Answer 2

• More likely if you are female
• Increases with age
• Stress. Physical, emotional or mental abuse [3]
• Genetics (60% of cases)
• Physical trauma
• Alcohol & smoking

Question 3

Criteria for diagnosis for chronic pain?

Answer 3

• Long term pain that continues for longer than 3 months
• medication or treatment not effective
• Overwhelming pain signals affecting everyday function & quality of life
• No clear cause

Question 4

Investigations for chronic pain?

Answer 4

No clinical tests to confirm diagnosis

Blood tests (including FBC)- rule out types of arthritis, cancer, infection, asses kidney and liver function.

Cancer screening
- tumours will press on nerves, bones & organs- can release chemicals which cause pain.

Thyroid function test
- hypothyroidism may lead to: Muscle aches, tenderness &stiffness, especially in the shoulders & hips.

X-rays
- of spine, bones& joints.
- Considered in patients w/ spine pain or joint dysfunction.
- Result can show osteoporosis, fractures or arthritic changes.

MRI
- of spine.
- Used for patients w/ evidence of neurological dysfunction or in patients w/ history of lumbar stenosis.
- Affects lower spine & cause pain on prolonged walking.

Electromyogram & nerve conduction studies
- detects muscle electrical activity in response to nerve stimulation of the muscle
- considered in patients to help identify level of nerve dysfunction.
- to help differentiate between peripheral causes of neuropathic pain.

Question 5

Management for Chronic pain- conservative?

Answer 5

Conservative:
- Red flags - refer urgently or arrange immediate assessment.

• Discuss care plan - understand their priorities, goals, preferred approach to treatment.
• Patient education - advice & information.
• Exercise programme.
• Acupuncture in the community.
• Psychological- changing cognitions & behaviour e.g. CBT. NOTE: when patients have good days, they do too much which leads to a bad day - example of behaviour.

Biopsychosocial pain management- close links btw the mechanisms for anxiety, depression & chronic pain - limbic system.

Question 6

Management for chronic pain- pharmacological?

Answer 6

Antidepressants e.g. sertraline, citalopram, fluoxetine for people aged 18 & over following discussion of benefits and risks.

Paracetamol is the safest pain killer for longer term use.

NSAIDs for mild → moderate pain associated with inflammation e.g. naproxen.

Opioids are often prescribed for acute pain caused by trauma but can be used in chronic e.g. morphine.

COX-2 inhibitors are as effective as NSAIDs but do not destroy the stomach lining at regular doses e.g. Celecoxib

Question 7

Prognosis for Chronic Pain

Answer 7

Usually experience symptoms lasting several months to years.

Decreased QOL

Higher rates of suicide

Factors associated w/ poor prognosis:
- Multiple pain sites
- Longer duration of pain
- History of anxiety & depression