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Chronic pain normal features
- pain present for extended period of time
- manageable
- should be able to participate in ADLs
- social supports in place
- financial and psychological supports in place
Other possible chronic pain features
- fear/anxiety/depression
- isolation
- limited mobility
- family distressed
- decreased quality of life
- hard time completing tasks
- increased fatigue
,Normal neuropathic pain
- increased or decreased sensation over affected area
- inspect skin and tissue for colour/warmth/deformity/masses
- increased pain during night
Other possible neuropathic pain findings
- lesions/open wounds/tissue damage
- changes in hair distribution
- temperature
- coccyx wound
Endocrine/metabolic consequences of unrelieved pain
Altered release of hormones (Impacts every body
system) CM: weight loss, fever, increased RR and HR,
shock
How is pain intensity assessed?
- simple descriptive pain intensity scale
- 0-10 numeric pain intensity scale
- visual analogue scale
- face assessment tool
,FLACC Paim assessment for infants and toddlers
Facial expressions
Leg movement
Activity
Crying
Consolability
Hierarchy of pain assessment?
Attempt-consider-observe-evaluate-conduct
PT related barriers to adequate pain management
Fear of addiction or tolerance
Concerns about adverse effects
Fear of injects
Forgetting to take meds
Meds not working/doesn't want to bother healthcare team
4 steps of pain?
Transduction, transmission, perception, modulation
, What is modulation?
Neurons from the brain stem release neurotransmitters that block pain receptors
ending impulse (endrogenous opiods)
Analgesic ladder for pain management
1. Non-opiods +/- adjuvants (mild pain, 1-3)
2. Moderate opiods +/- non-opiods, +/- adjuvants (mild-mod pain, 4-6)
3. Strong opiods +/- non-opiods, +/- adjuvant (mod-severe pain 7-10)
Freedom from pain goal?
We can't always get pain to zero but we want to get as close as possible
WHO step ladder
1 mild (pain 1-3), 2 moderate (pain 4-6), 3 severe (pain 7-10)
WHO step 1 drugs
ASA, acetaminophen, NSAIDs +/- adjuvants
WHO step 2 drugs
A/codeine, A/hydrocodone, A/oxycodone, A/dihydrocodeine, Tramadol +/-
adjuvants