Easing Your Patients’ Pain

RAISING PAIN AWARENESSRAISING PAIN AWARENESS

Easing YourEasing YourPatients’ Patients’ Pain Pain An overview of pain, An overview of pain, treatment options, and the treatment options, and the physicians who specialize in physicians who specialize in treating paintreating pain


ANS has partnered with the National Pain Foundation (NPF), a non-profit organization founded to advance functional recovery of pain patients, to create this educational presentation.


3 out of 4 Americans have experienced chronic or recurring pain or have a family member who has experienced such pain.1

Almost 62% of pain sufferers have had their pain for a year or more.1

A majority of adults (57%) have experienced chronic or recurring pain, including 54% of adults aged 18–34.1

Long-term pain affects most of your patients.


Topics included in this presentation Recognition of pain as a major health issue

in the United States Pain management as a medical specialty Advanced treatments for pain Referrals to interventional pain physicians


Pain in the United States


Types and definitions of pain Acute Pain

Accompanies tissue injury or pathologyComes on quickly but lasts a short timeVaries in severity and intensity

Chronic PainContinues a month or more beyond usual recovery periodGoes on for months or years due to a chronic conditionDifficult to define onset


Types and definitions of pain

Nociceptive PainCaused by irritation to special nerve endings (nociceptors)Can be dull or sharpCan be mild or severe

Neuropathic PainCaused by a malfunction of the nervous systemResult of injury, disease, or traumaCan be sharp, intense, and constantCan be dull, aching, and throbbing


Millions of Americans suffer with pain…

50 million Americans are partially or totally

disabled by chronic pain.2 9 out of 10 Americans (aged 18 and older)

suffer with pain at least once a month.2

77% of pain patients strongly agree that new options are needed to treat their pain7

50% of Americans (aged 65 and older) suffer with pain on a daily basis.2


…and chronic pain is a costly problem. 36 million per year miss work due to pain.2

Pain costs almost $100 billion annually.3

Pain results in over 50 million lost workdays.3

50% of chronic pain patients have lost a job due to their illness7

Workers lose an average of 4.6 hours per week of productive time due to a pain condition.4


Lower Back Pain

40%

Osteoarthritis

HeadachesMigraines

Fibromyalgia

75%

26%

26%

Chronic pain is associated with many conditions.5

12%


Pain management asa medical specialty


Interventional pain management medicine Growing as a new specialty

Includes evaluation and treatment of acute and/or chronic pain

Requires that pain physicians receive at least one year of training in pain management post medical degree

Requires knowledge of all of chronic pain therapy options


Pain assessment process

Physicians should address Types of pain Distribution of pain Patient’s current pain state Effects of patient’s current treatment Appropriate tools available for pain

evaluation


Treatment steps to consider Focus early treatment on quickly

reversing the problem. Identify the best methods of treatment. Define distinct goals for the patient.

Pain reduction Improved function Enhanced quality of life


Physicians who often specialize in pain management

Anesthesiologist Neurosurgeon Neurologist Orthopedic

surgeon Physiatrist

(PM&R) Rheumatologist

Other pain practitioners

Acupuncturist Chiropractor Physical therapist Psychiatrist,

psychologist, or professional counselor


Challenges facing pain physicians Managing the patient’s pain when a cure

does not exist Identifying ways to manage pain by

using a chronic pain treatment continuum


MedicationsPhysical therapyCounseling

Treatments early in the continuum

This presentation will focus on the more advanced treatments used by pain physicians.


Advanced treatments for pain


Advanced treatments: Injections

Nerve blocks—An injection of local anesthetic and/or steroids that is applied directly to the nerve that serves an area of pain



Epidural steroid injections—An injection of steroids into the epidural space to alleviate chronic pain in the low back or leg



Facet joint injections—An injection procedure used to block or decrease pain that originates in the spinal facet joints


Advanced treatments: Medical devices

Neurostimulators—Implantable devices that use low-level electrical impulses to interfere with the transmission of pain signals to the brain


An overview of neuromodulation

A system typically consist of three components designed to work together Leads—very thin cables that

deliver electrical impulses to nerves near the spinal cord

Generator—the part of the system that sends electrical energy through the lead

Controller—the device that determines the level of stimulation


SCS patient selection process

Correctly diagnosed Failed lower-level therapies Successfully passed psychological

evaluation Patient is motivated Patient is educated


SCS trial overview

Leads are implanted in the epidural space An external power source is used to evaluate

Pain relief Paresthesia coverage Power requirements Programming needs System requirements

Patients can use the programmer to control stimulation to cover their pain areas


Why use spinal cord stimulation (SCS)? Effective pain management method Minimally invasive procedure that can be

reversed Possible reduction or elimination of pain

medications International recognition and use


Advanced treatments: Medications

Systemic opioids—Narcotics are used for patients with severe chronic pain who have not responded to more conservative therapies and for whom surgery has failed or is not an option.


Cryoanalgesia—Applying extreme cold to nerves to disrupt their ability to transmit pain

RF lesioning—Applying radio-frequency generated heat to nerves to disrupt pain transmission

IntraDiscal Electrothermal Therapy (IDET)—Applying heat to seal cracks and fissures in a dehydrated disc

Advanced treatments: Ablative procedures


Advanced treatments: Medical devicesImplantable drug pumps—Devices that deliver medications directly to the cerebrospinal fluid in the intrathecal space surrounding the spinal cord


Advanced treatments: Surgery

Neuroablation—Surgery that permanently blocks chronic pain by destroying nerves and tissues near the source of pain


Referring patients to pain physicians


Pain patients often need specialized care. Pain accounts for 80% of all physician visits.2

Only 48% of pain patients felt they were getting enough information on the most effective ways to manage chronic pain.7

86% of chronic pain sufferers report an inability to sleep well.7

60% of pain patients experience breakthrough pain one or more times daily.7


Pain patients often need specialized care. 14% of pain sufferers say that they are satisfied with their current medications.7

22% of chronic pain patients have changed physicians 3 or more times.6

The main reasons for changing physicians have to do with the physicians’ attitudes, knowledge, and abilities.6


Pain physicians can help patients with Chronic back, neck, and shoulder pain

Chronic headaches and migraines Chronic trunk and limb pain Repetitive motion pain Arthritis Fibromyalgia Complex regional pain Cancer pain


Other criteria for referring patients to pain specialists Multiple symptoms or sources of pain Unresponsive to conservative therapies Deteriorated functional status Uncomfortable prescribing or monitoring

opioid treatment


Choosing a pain physician for referrals Verify that the physician is certified by, or a

memberof, a pain-related professional organization: American Academy of Pain Medicine

(AAPM) American Board of Pain Medicine (ABPM)

Subspecialty certifications American Board of Anesthesiology (ABA) American Board of Physical Medicine &

Rehabilitation (ABPMR) American Board of Psychiatry & Neurology

(ABPN)


Benefits of referring patients to pain physicians Better outcomes for patients

Enhances effectiveness of primary care treatment plans

Improves patient/physician relationships


Conclusions

The wide range of treatments available today allows a patient to receive effective pain relief quickly.

Cooperation between primary care physicians and pain management specialists ensures that patients receive appropriate treatments for their pain.

An increased understanding of pain helps physicians improve the quality of life for chronic pain patients.

Physicians have the power to change the course of their patients’ lives.


For additional educationaland support information,

please visitwww.ans-medical.com

orwww.NationalPainFoundation.org


References 1. Americans Talk about Pain, conducted by Peter D. Hart

Research Associates for Research!America, August 2003.2. Pain in America: A Research Report, conducted by the

Gallup Organization for Merck, June 1999.3. Voices of Chronic Pain, survey released by the American

Pain Foundation for Endo Pharmaceutical, June 2006.4. Stewart, W.F., J.A. Ricci, E. Chee, D. Morganstein, & R.

Lipton. “Lost Productive Time and Cost Due to Common Pain Conditions in the U.S. Workforce.” Journal of the American Medical Association, Vol. 290, No. 18, 2003, p. 2443-2454.

5. National Pain Survey, conducted by Louis Harris and Associates for Ortho-McNeil, 1999.


References6. Chronic Pain in America: Roadblocks to Relief, conducted

by Roper Starch Worldwide Inc. for the American Pain Society, the American Academy of Pain Medicine, and Janssen Pharmaceutica, January 1999.

7. Voices of Chronic Pain, conducted by American Pain Foundation, May 2006.

• “JCAHO Focuses on Pain Management,” Joint Commission on Accreditation of Healthcare Organizations, http://www.jcaho.org/news+room/health+care+issues/jcaho+ focuses+on+pain+management.htm.

• Stamatos, J., Painbuster: A Breakthrough 4-Step Program for Ending Chronic Pain, First Edition, New York, NY: Henry Holt & Company, LLC, 2001.

Easing Your Patients’ Pain

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