Pain Management

Fibromyalgia Pain Management

2008-11-17T10:32:00.000-08:00

One of the most obvious symptoms of fibromyalgia syndrome is that relentless nerve and muscle pain. Most fibromyalgia sufferers experience chronic and widespread pain that can get worse when they are exposed to certain aggravating factors. Treatment of this chronic pain is essential in order to improve muscle strength, range of motion, and overall quality of life. Unfortunately, treating fibromyalgia pain isn?t always easy. A pain specialist can help to diagnose the cause of your pain and provide you with a comprehensive treatment program thereby reducing your pain symptoms.
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What is a Pain Specialist?A pain specialist is a medical doctor who has expertise in the diagnosis, management, and treatment of both acute and chronic pain. Pain management specialists offer a variety of treatment services, and may design treatment programs that incorporate medical, psychological, and behavioral therapies. Pain specialists usually work out of private pain treatment centers or pain treatment centers affiliated with hospitals or university medical centers.
Qualifications of a Pain SpecialistPain specialists are typically practicing medical doctors who already have experience in a particular area of medicine, such as neurology, physiatry, anesthesiology, or orthopedics. This means that pain specialists have undergone years of training in basic medical practice and in specialized fields of medicine.
In order to become a pain specialist, doctors must spend at least one year completing intense training in the field of pain management. They must then complete a rigorous exam before becoming certified by the American Board of Anesthesiology or the American Board of Pain Medicine.
What Can a Pain Specialist Treat?Pain specialists can treat a wide variety of painful injuries and illnesses. They often treat acute pain that occurs after an injury or surgery, but most pain doctors specialize in the treatment of chronic pain. Some conditions that a pain specialist might treat include:
back pain
neck pain
arm and leg pain
spinal stenosis
nerve damage
cancer pain
neurological pain
How Can a Pain Specialist Help Fibromyalgia?Fibromyalgia is a very difficult illness to treat, particularly because so few health care practitioners are familiar with its symptoms. Pain specialists are particularly helpful for fibromyalgia sufferers because they are very familiar with the different aspects of the disease. This makes it easier for them to locate and treat sources of pain.
Pain specialists are also more familiar with and have easier access to a wide range of treatment therapies, including opioids. Unlike primary physicians, pain specialists are more willing to aggressively treat pain in order to provide you with relief. Pain specialists are also able to take on a leadership role when it comes to treating you fibromyalgia.
Your pain specialist will likely correspond with your other treatment providers in order to keep them up to date and on track with your treatment regimen.
What Tests Will a Pain Specialist Perform?In order to diagnose the source and cause of your pain, a pain specialist will likely perform a number of different tests including:
MRI (magnetic resonance imaging)
skin temperature monitoring
muscle and nerve x-rays and imaging
These tests can help pinpoint areas of pain and may help to identify areas where muscles or nerves are operating abnormally.
What To Expect When you See a Pain SpecialistIf you decide to see a pain specialist for your fibromyalgia pain, you may be a little nervous. Don?t worry though. The appointment will be much like your typical health care appointments, only in much greater depth.
Your pain specialist will begin by taking a detailed medical history. This will include any illnesses or pain that you may have experienced prior to your fibromyalgia. Your pain specialist will also ask you some specific questions about your pain. Common questions include:
What does your pain feel like?
Where is your pain located?
How long does your pain last?
What makes your pain better? What worsens your pain?
Your pain specialist will also perform a physical exam and may run some diagnostic tests in order to come up with a treatment regime. Pain management specialists usually offer comprehensive treatment programs, which can include a combination of medications, physical therapy, and psychological therapy. Typical treatments include:
nerve blocks
Transcutaneous electrical nerve stimulation (TENS)
physical therapy and massage
depression treatment
Finding a Pain SpecialistIf you are interested in seeing a pain specialist, you will need to get a referral from your primary health care provider. He will be able to recommend a pain specialist in your area. If you can?t find a pain specialist, speak to the anesthesiology department of your local hospital or contact your local governing board.

Introduction to pain management

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Pain management can be simple or complex, depending on the cause of the pain. An example of pain that is typically less complex would be nerve root irritation from a herniated disc with pain radiating down the leg. This condition can often be alleviated with an epidural steroid injection and physical therapy. Sometimes, however, the pain does not go away. This can require a wide variety of skills and techniques to treat the pain. These skills and techniques include:
Interventional procedures
Medication management
Physical therapy or chiropractic therapy
Psychological counseling and support
Acupuncture and other alternative therapies; and
Referral to other medical specialists
All of these skills and services are necessary because pain can involve many aspects of a person's daily life.

How is pain treatment guided?
The treatment of pain is guided by the history of the pain, its intensity, duration, aggravating and relieving conditions, and structures involved in causing the pain. In order for a structure to cause pain, it must have a nerve supply, be susceptible to injury, and stimulation of the structure should cause pain. The concept behind most interventional procedures for treating pain is that there is a specific structure in the body with nerves of sensation that is generating the pain. Pain management has a role in identifying the precise source of the problem and isolating the optimal treatment.
Fluoroscopy is an X-ray guided viewing method. Fluoroscopy is often used to assist the doctor in precisely locating the injection so that the medication reaches the appropriate spot and only the appropriate spot.

Provided by http://www.medicinenet.com/pain_management/article.htm

Pharmacologic Management of Pain: NSAIDs to Opioids

2008-11-17T10:26:00.000-08:00

Statement of NeedMany physicians are reluctant and apprehensive about prescribing opioids for their chronic pain patients. This is largely due to real or perceived legal barriers that limit effective chronic pain management and concerns regarding misuse, abuse and diversion of opioids. The purpose of this activity is to provide participants with information to develop and manage the best pharmacologic treatment options for their patients with chronic pain.Intended AudienceThis program is intended for physicians, nurses, pharmacists, nurse practitioners and other associated healthcare professionals who care for patients experiencing acute or chronic pain.Learning ObjectivesUpon completion of this activity, the participant should be able to:
Evaluate the pain condition and develop the best pharmacologic treatment options for their chronic pain patients.
Apply principles of rational polypharmacy to better manage chronic pain.
Assess benefits and controversy of prescribing NSAIDs for the management of chronic pain
Assess benefits and risks in prescribing opioids for chronic pain.
Accreditation Statement:The Dannemiller Memorial Educational Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. PhysiciansThe Dannemiller Memorial Educational Foundation designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s).TM Each physician should claim only those credits that he/she actually spent in the activity. Nurse PractitionersThis program has been approved for 1.5 contact hours (which includes 1.5 Pharmacology hours) of continuing education by the American Academy of Nurse Practitioners. Program ID 0807328. Registered NursesThe Dannemiller Memorial Educational Foundation is a provider approved by the California Board of Registered Nursing, Provider Number 4229 for 1.8 contact hours. RNs outside California must verify with their licensing agency for approval of this course. Pharmacy Purdue University School of Pharmacy and Pharmaceutical Sciences is accredited by the Accreditation Council on Pharmacy Education as a provider of continuing pharmaceutical education. This program is a continuing education activity of Purdue University, an equal access/equal opportunity institution. Universal Program Number (UPN): 018-999-08-113-H01-P, 1.50 Contact hours ( 0.15 CEU)Release Date: 11/07/2008 Expiration Date: 11/30/2010Method of participation:The activity should take approximately 1.5 hours to complete. The participant should, in order, read the objectives and other introductory CME information, review the slides and listen to the accompanying audio, complete the registration form, post-test, and evaluation form. To access the registration form and post-test, click on the prompt on the final slide in the presentation. To receive credit for this activity, follow the instructions provided on the post-test. This credit is valid through November 30, 2010. No credit will be given after this date. There is no fee associated with this CME activity. In the event you are unable to print the certificate, please submit the post-test and then e-mail editor@dannemiller.com; a certificate will be mailed within 2 weeks. DisclosuresIn accordance with the Accreditation Council for Continuing Medical Education (ACCME), the Dannemiller Memorial Educational Foundation requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest. Accordingly,Bill H. McCarberg serves on the Speakers Bureau for Endo Pharmaceuticals. Eli Lilly and Company, Pfizer. Inc., Merck &Co. Inc. Alpharma Inc. King Pharmaceuticals. Inc. Cephalon, Inc and Pricara. The Dannemiller Memorial Educational Foundation staff that was involved in the development of this activity has no financial relationships with any commercial interests that are relevant to this activity. To resolve identified conflicts of interest, the educational content was fully reviewed by a physician member of the Dannemiller Clinical Content Review Committee who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence based and commercially balanced. Off-label statementThis educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program. DisclaimerThe contents and views presented in this educational activity are those of the authors and do not necessarily reflect those of the Dannemiller Memorial Educational Foundation or Alpharma INC. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity. For questions regarding the content of this activity and technical assistance, contact Dannemiller Memorial Educational Foundation, accredited provider for this CME activity, at editor@dannemiller.com.

Pain Management: Pain Basics

2008-11-17T09:43:00.000-08:00

Everyone experiences pain at one point or another. It often is an indication that something is wrong.
Each individual is the best judge of his or her own pain. Feelings of pain can range from mild and occasional to severe and constant.
What Is Acute Pain?
Acute pain begins suddenly and is usually sharp in quality. It serves as a warning of disease or a threat to the body. Acute pain may be caused by many events or circumstances, including:
Surgery
Broken bones
Dental work
Burns or cuts
Labor and childbirth
Acute pain may be mild and last just a moment, or it may be severe and last for weeks or months. In most cases, acute pain does not last longer than six months and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, may lead to chronic pain.
What Is Chronic Pain?
Chronic pain persists despite the fact that an injury has healed. Pain signals remain active in the nervous system for weeks, months, or years. Physical effects include tense muscles, limited mobility, a lack of energy, and changes in appetite. Emotional effects include depression, anger, anxiety, and fear of re-injury. Such a fear may hinder a person's ability to return to normal work or leisure activities. Common chronic pain complaints include:
Headache
Low back pain
Cancer pain
Arthritis pain
Neurogenic pain (pain resulting from damage to nerves)
Psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside)
Chronic pain may have originated with an initial trauma/injury or infection, or there may be an ongoing cause of pain. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage.
How Is Pain Treated?
Depending upon its severity, pain may be treated in a number of ways. Symptomatic options for the treatment of pain may include one or more of the following:
Drug treatments such as non-prescription medications like Aleve, Motrin and Tylenol or stronger medications such as morphine, codeine or anesthesia.
Nerve blocks (the blocking of a group of nerves with local anesthetics)
Alternative treatments such as acupuncture, relaxation and biofeedback
Electrical stimulation
Physical therapy
Surgery
Psychological counseling
Behavior modification
Some pain medicines are more effective in fighting pain when they are combined with other methods of treatment. You may need to try various methods to maintain maximum pain relief.
Reviewed by the doctors at The Cleveland Clinic Neuroscience Center.
Information provided by WebMD
http://www.webmd.com/pain-management/guide/pain-basics

Spinal Manipulation for Low-Back Pain

2008-11-17T09:01:00.000-08:00

Low-back pain is a common condition that can be difficult to treat. Spinal is among the treatment options used by people with low-back pain in attempts to relieve pain and improve functioning. It is performed by chiropractors and other health care professionals such as physical therapists, osteopaths, and some conventional medical doctors. This fact sheet summarizes the current scientific knowledge about the effects of spinal manipulation on low-back pain.
http://nccam.nih.gov/health/pain/spinemanipulation.htm