Our biggest news this week is that our conference application has gone live. Get your free conference app here. This significantly adds value to our registrants and our sponsors as well as all people interested in the topic of an integrative approach to pain evaluation and management: solutions to the opioid crisis. Registrants can communicate with each other, upload papers, arrange meetups, participate in a photo contest, and much much more. Registration is of course now open and we encourage people to register early. Get more conference information here. Register now For those organizations that can afford to become sponsors we strongly encourage it because it helps the cause of good decision making in this sphere of pain evaluation and management. Explore sponsorship opportunities here. Up to 50% of patients seeking primary care do so for chronic pain. Treatment is generally broken up into six categories including pharmacologic, physical medicine, behavioral, neuromodulation, interventional, and surgical. It is often best to combine modalities and medication should typically not be the only modality used. Education and reassurance are extremely important as is the setting of reasonable expectations. A 30% decrease in pain is typically achievable; that may significantly increase the patient's quality of life. Join the ACHT now
Non-opioid analgesics include aspirin and Tylenol as well as non-steroidal anti-inflammatory drugs and cox-2 inhibitors. Other medications include opioids, antidepressants, muscle relaxants, anticonvulsants, topical pain medicine, NMDA receptor antagonists (e.g. ketamine), and Tramadol.
Depression and chronic pain often exist together in which case both needed to be treated.
The World Health Organization has an analgesic ladder to treat cancer pain and some have applied these principles to the management of pain not associated with cancer. Accurate diagnosis of the etiology of the pain facilitates treatment. Treatment algorithms are often based on expert opinion rather than high level evidence. Topical analgesia may be of some help. Non-pharmacologic treatments such as physical therapy, acupuncture, spirituality, guided imagery, chiropractic manipulation, and massage as well as behavioral therapy and psychotherapy may be useful. Other therapies include biofeedback, exercise, ultrasonic therapy, and electrical neuromodulation such as TENS. Application of heat and cold may play a role as can nerve blocks, epidural injection of steroids, trigger point injections, and botulinum toxin injections. Spinal cord stimulation can be used for chronic neuropathic pain. Nociceptive pain is the most frequent pain type. It occurs when the nociceptive nerve fibers are incited by insults like stubbing ones toe. Nociceptive pain typically develops in response to a specific injury and tends to be self limited. For example, nociceptive pain from an ankle fracture resolves as the fracture heals. Inflammation in the viscera (e.g. appendicitis) is autonomic and poorly localized. Once the abdominal wall gets inflamed, the pain is somatic and well localized. Hence, the typical presentation of appendicitis with generalized abdominal pain migrating to the right lower abdominal quadrant. Neuropathic pain is intrinsic to the nervous system.