ASSESSMENT MANAGEMENT OF CHRONIC PAIN · Aromatherapy Massage • Aromatherapy is the therapeutic...
Transcript of ASSESSMENT MANAGEMENT OF CHRONIC PAIN · Aromatherapy Massage • Aromatherapy is the therapeutic...
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Fiona MacPherson
Chronic Pain Nurse SpecialistNHS Lothian
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Chronic Pain is common
18.1% of people in Scotlandhave Chronic Pain
That is 1 in 5 people
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Chronic Pain
• ------is pain which has continued for at least 3 months and is unlikely to resolve spontaneously. Ref (IASP)
• “Pain is what the person says it is and hurts when they say it does----”
Ref (McCaffery and Beebe)
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Pain changes our brain functions
18
27
33
36
39
55
60
0 10 20 30 40 50 60 70
Poor appetite
Anxiety
Depression
Concentration difficulties
Drowsiness
Lack of energy
Difficulty sleeping
% patients with moderate to very severe discomfort due to symptoms (n=126)
Meyer-Rosberg K et al. Eur J Pain 2001; 5: 379–389.
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Chronic Pain Conditions
• Musculoskeletal Origin
• Neuropathy following Surgery
• Post-herpetic Neuralgia
• Osteoarthritis
• Rheumatoid Arthritis
• Peripheral Neuropathy
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Why measure pain & effects of pain ?
• Translates a subjective experience into an objective description
• Gives a baseline from where a plan of care can be devised
• Allows ongoing evaluation of the care and effectiveness of treatment interventions
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Assessment
Efficacy
Reassessment
History
Examination
Safety
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Pain Assessment
• Visual analogue scales (VAS)
No Pain Worst Pain
0 10
The patient is asked to mark a point on a line
that they feel best represents their pain
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Pain Assessment
• Verbal Rating Scale
No Pain Mild Moderate Severe Worst
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Pain Assessment
• Numerical Rating Scale
No Pain Worst Pain
0 1 2 3 4 5 6 7 8 9 10
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Management of Chronic Pain
• Drug Therapy
• Injections
• TENS
• Physiotherapy
• Acupuncture
• Relaxation & Distraction
• Aromatherapy massage
• Pain Management Programmes
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Drug Families
• Paracetamol
• NSAIDS
• Opioids
• Adjuvants– Tricyclics
– Anticonvulsants
– Others
Strong OpioidStrong Opioid±± NonNon--opioidopioid±± AdjuvantAdjuvant
Freedom from cancer painFreedom from cancer pain
Pain persisting or increasingPain persisting or increasing
Pain persisting or increasingPain persisting or increasing
12
3
NonNon--opioidopioid±± AdjuvantAdjuvant
Weak OpioidWeak Opioid±± NonNon--opioidopioid±± AdjuvantAdjuvant
PAIN
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Transcutaneous Electrical Nerve Stimulator (TENS)
• Application of an electrical current through the skin to stimulate the nervous system.
• Developed as a way of controlling pain through the ‘gate’ theory, where it is believed, selective stimulation of certain nerve fibres could block signals carrying pain impulses to the brain.
• Stimulation of Endogenous Opioids
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Benefits of TENS
• Viable alternative to multiple drug therapies
• Non-invasive
• Patient has control
• Cost effective
• Not a cure, but temporary analgesia
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Contraindications
• On demand pacemaker
• Pregnancy --- 1st trimester
• Over the anterior part of the neck
• Do not use whilst driving or operating heavy machinery
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Duration
• Never less than 30 minutes.
• Continuous stimulation may be given all day.
• Intermittent stimulation (Burst) usually 30-40 minutes 4-6 times a day.
• Can have a cumulative effect
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Evaluate
Good outcomes include:-• Being pain–free at rest• Reduced pain during movement• Increased mobility• Adequate sleep• Reduction of analgesia
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Acupuncture• According to traditional Chinese medicine, acupuncture promotes the flow of qi (life force energy),thereby balancing the human body system.
• Modern acupuncturists use traditional meridian points and also trigger points, which have no fixed locations and are found by eliciting tenderness at the site of most pain.
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Hypnotherapy
• When the patient is in a deeply relaxed state the practitioner gives therapeutic suggestions, which are aimed at influencing behaviour or relieving symptoms
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Aromatherapy Massage• Aromatherapy is the therapeutic use of essential oils in an attempt to restore a “balanced” state to body and mind.
• The most common application of aromatherapy is massage with essential oils.
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Effects of Aromatherapy Massage
• Promotes deep relaxation relieving both mental and physical fatigue
• Reduces muscular tension
• Stimulates the circulation
• Direct action on the limbic system the area which governs emotions
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Cognitive Behavioural Therapy
• Education• Coping Skills--relaxation & distraction• Mood modification--challenge negative thoughts
• Activity modification--pacing & goal setting
• Behaviour modification--involve family and friends
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Overactivity/ Rest Cycle
Weeks
Rest
Trying to catch up
Activity
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Pacing
Weeks
Activity
First baseline
overactivity
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Conclusion
• Addressing chronic pain need not involve costly, high-tech interventions but does require global education of health professionals, patients and their families to best apply available, generally low-cost yet effective therapies
(IASP 2004)
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Support Groups
• Pain Association: 0800 783 [email protected]
• Pain Concern: 01620 [email protected]
• www.paintoolkit.org