Acute pain acts as a warning, signalling that you’ve been hurt. It is typically mild and short-lasting, or severe, lasting for a few weeks or months, disappearing when the underlying cause of pain is treated (eg. surgical wounds, broken bones and childbirth). On the other hand, chronic pain can last for months or years, and has no definite cause (eg. arthritis, back and neck pain, fibromyalgia, CRPS and headaches). Chronic pain management can help reduce the negative impact on an individual’s quality of life, however, complete pain relief is quite difficult to achieve.
Ineffective chronic pain management can be the result of:
- inaccurate pain assessment leading to inadequate pain treatment
- opioids misconceptions by clinicians and patients
- fears about pain management side effects
Biopsychosocial Model of Pain
Biopsychological – Spiritual Model of Pain
Chronic Pain Management Patient Journey:
- Consultation resulting in a referral
- Outpatient visit
- Consultant review
- Follow-up
The nurse’s role during an outpatient visit requires him/her to:
- Listen and assess the patient’s situation
- Evaluate and take action
- Advise
- Organise care and/or treatment
- Prepare the patient for any required pain intervention
- Follow-up
- Document all information
Alternative Treatments for Chronic Pain Management
- Psychotherapy
- Psychiatric assessment
- Psychological support
- Acupuncture
- Reflexology
- Meditation and spirituality
- Yoga and pilates
NSAIDs and Over-the-Counter Drugs for Chronic Pain Management
- Ibuprofen
- Naproxen
- Diclofenac
- Arcoxia
- Analgesic Creams
- Paracetamol
- Sulphadol
Injection Based Interventions
- Occipital Nerve Block
- Trigger Points Injections
- Sympathetic Block
- Joint Infiltration – Facets, Sacroiliac, Knees & Elbows (effect may last for up to a year, but may also prove to be ineffective, depending on the individual)
- Epidural (usually infiltrated with Fentanyl, Morphine or Steroid)
- Dorsal Root Ganglion PRF
- Radiofrequency Neuroablation / Denervation (effect lasting for 6-12 months, at times for years, however, procedure is more risky and may result in deficits in the lower limbs…usually combined with other interventions including multimodal analgesia and alternative therapies)
Medication used in most spinal injections is Lidocaine, which is a local anaesthetic. Marcaine is a different type of anaesthetic which is used along with a strong anti-inflammatory steroid, namely Depomedrone.
Long Term Medication for Chronic Pain Management
- Codeine
- Tryptizol
- Baclophen
- Lyrika / Pregabalin
- Tramodol
- Palexia / Tapentadol
- Morphine
- Fentanyl Patches
- Methadone
- Cannabis Oil
Intrathecal Pump and Dorsal Column Stimulator
Intrathecal drugs are perceived to be much stronger than oral medication, making this an ideal option for nerve pain that is difficult to treat.
The intrathecal pump’s battery life span is usually 5-7 years long. The pump is refilled with medication by inserting a needle through the skin directly into the filling port located at its centre. Medication dose adjustments can be made through an external program device.
Prior to implant, a trial is performed to assess toleration. Pump provides relief in spasticity and chronic pain through a catheter, releasing a medicinal directly to the intrathecal space (spinal cord area), preventing pain signals from reaching the brain.
In the Spinal Cord Stimulator, an electrode (or sometimes multiple electrodes) is implanted through the skin into the epidural space of the spinal canal. An electrical stimulation that feels like a gentle vibratory sensation causes the pain sensation to be blocked. The electrodes used in this procedure are highly expensive, and so, a trial with a temporary system is necessary prior to a permanent device being implanted.
Below you can find a collection of videos that can help provide a more visual approach to Chronic Pain Management.
Acute vs Chronic Pain
Pain Management – Chronic vs Acute
Gate Control Theory of Pain
Biopsychosocial Model of Pain
Biopsychosocial-Spiritual Model of Pain
WHO Analgesic Pain Management Ladder
Managing Chronic Pain Without Narcotics
Physiotherapy for Chronic Pain management
TENS – Transcutaneous Electrical Nerve Stimulation
Alternative Treatments for Chronic Pain Management
Reflexology
Mindfulness and Chronic Pain
Yoga and Pilates for Pain Management
Trigger Point INjections
Occipital Nerve Block Injection
Sympathetic Block Injection
Joint Infiltration – Facet Injection
Dorsal Root Ganglion PFR
Epidural for Chronic Pain Management
Pulsed Radiofrequency Generator
Radiofrequency Neuroablation / Denervation
Spinal Cord Stimulator – Implantable Therapy
MyStim Programmer
Special thanks to the creators of the featured videos on this post, specifically Youtube Channels Health Navigator NZ, Cincinnati Children’s, Covenant Health, Corporis, Deutsches Kinderschmerzzentrum, Reset Ketamine, Rhesus Medicine, UCLA Health, The London Pain Clinic, Omron Healthcare, Inc., Drug Free Health Secrets, Strength-N-U, UMNCSH, Howcast, Vitality Medical Centers of West Columbia, Prof Murat Karkucak, MD, ProvidenceSpokane, ShimSpine, Abbott, UC San Diego Health, Pain Doctor, Mayfield Brain and Spine and Medtronic Neuromodulation for Healthcare Professionals.
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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