Chronic Pain Management – The Nurse’s Role In Pain Management & Care

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

chronic pain management
Retrieved from https://www.mdpi.com/2227-9067/7/10/179/htm on 1st April 2021

Biopsychological – Spiritual Model of Pain

chronic pain management
Retrieved from https://www.semanticscholar.org/paper/Does-the-biopsychosocial-spiritual-model-of-apply-A-Ghaferi-Bond/9fb3255334ca112f00e67ef106367285cebb3c99 on 1st April 2021

Chronic Pain Management Patient Journey:

  1. Consultation resulting in a referral
  2. Outpatient visit
  3. Consultant review
  4. 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
chronic pain management
Retrieved from https://www.researchgate.net/figure/New-adaptation-of-the-analgesic-ladder_fig2_258112804 on 1st April 2021
Retrieved from https://www.cfp.ca/content/56/6/514/tab-figures-data on 1st April 2021

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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