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Pain Management |
| Pain management is a multidisciplinary approach of medicine intended to improve the quality of life for the patient who otherwise is limited by sufferings caused by pain. The analysis of pain and its origin is critical in the entire course of pain management. The specialty of pain is mainly comprised of a team from various sections of medicine such as Physicians, anesthesiologists, psychiatrists, physiotherapists, occupational therapists and nurses. |
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| The typical approach followed in pain management would be as follows. |
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| Diagnosis of pain – identifying the reason for pain is the first step towards relieving the pain for the patient. Once the underlying pathology is treated then the pain is relieved for the patient. This process of identifying the underlying pathology can be achieved by the following standard method |
| Patient interview - |
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Pain history details such as development and timing, intensity, character, associated symptoms, aggravating and relieving factors, previous treatment etc. |
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Medical history details such as Review of systems, past medical history, past surgical history will provide the clinician with valuable inputs which may directly or indirectly be related to the present condition of the patient. |
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It also provides the information on present condition which is either sequel to the chronic condition present in the past or not. |
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Drug history is as important as any other because it gives the information of what drugs the patient has taken to help the pain and what effect those drugs had in relieving the pain. |
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Social history element such as personal history, family history and occupational history will give the clinician an indication about the patient life style, psychological factors, habits, genetic profile etc, which might directly or indirectly have an significance on the present condition |
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| Patient examination - |
| Physical examination generally follows the history recording. This is the step in which the clinician identifies the signs of the diseases, the clinician correlates the symptoms given by the patient while he does the physical examination. The clinician will do elaborate physical examination of the entire body to understand and assess the impact leading to the present condition of the patient, as well as to assess the risk factors for any procedures being considered for pain management. |
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| Even though the examination encompasses the entire body, for the pain practice the most relevant of physical examination would be musculoskeletal and neurological examination. |
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| The physical examination would consist of general examination such as constitutional factors, mental status examination etc. Followed by the systemic examination for various systems such as cardiovascular, respiratory, musculoskeletal examination (ROM, Muscle strength, muscle tone) neurological examination (dermatome examination, deep tendon reflexes) etc. |
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| Diagnostic imaging - |
| Diagnostic imaging plays an important role in understanding pathophysiology and mechanism of pain. The clinician will use these techniques in diagnosing the pain. There are various diagnostic imaging techniques for the clinician to choose from based on the patient need. The various imaging techniques are, |
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X-ray |
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Fluoroscopy |
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Computed tomography |
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Magnetic resonance imaging |
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Myelography |
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Bone scan and nuclear medicine |
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Discography |
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Positron-emission tomography |
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| Once the clinician arrives at a diagnosis for the pain, he has array of treatment options to choose from. The main criteria for the clinician would be to relieve the pain for the patient and restore the normal activity that patient would do on day to day basis. |
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| Treatment plan - |
The clinician follows the treatment in the following order: |
| Pharmacological Approach would be, use of medicine to relieve the pain such as: |
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Non steroidal anti-inflammatory drugs (NSAID's) |
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Opiods |
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Adjuvant treatments such as corticosteroids, antispasmodics, etc. |
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Psychopharmacology drugs such as antidepressants, anxiolytics etc, predominantly for the reason there can be psychiatric diagnosis associated with the chronic pain |
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| Therapeutic procedures in pain management have known to give good amount of relief for the patient. The predominant procedures are : |
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Peripheral nerve blocks |
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Central nerve blocks |
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Epidural injections |
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Facet joint blocks |
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Sacroiliac joint block |
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Trigger point injections |
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| Interventional treatment for chronic pain, these procedures are more invasive than the nerve block procedures. These procedures are reversible, it's shown to reduce pain and suffering in patients to a large extent and reduce the intake of oral medication. The procedure can be: |
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Spinal cord stimulation for chronic pain |
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Chronic intrathecal therapy for cancer and nonmalignant pain |
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Discography |
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Intradiscal electro thermal therapy |
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Vertebroplasty |
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| Psychosocial and behavioral approach meant to make the patient to cope with anxiety, depression and fear associated with chronic pain |
| Physical therapy, to improve the functionality and prevent disability there by providing the patient his or her independence to perform activities of daily living. |
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| Author: Dr. Kumar |
| Designation: Business Analyst |
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