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Clinical Focus Disease Management The Pratfalls of Pain
Clinical Focus Disease Management The Pratfalls of Pain
| The Pratfalls of Pain |
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| Written by JON D. MILLS, PT |
| Wednesday, 01 October 2008 07:00 |
THE ELEMENTS OF PAIN, THE THREAT OF ADDICTIONPain is the body’s way of alerting you that there is some underlying dysfunction, be it injury or illness, that needs to be corrected.There are different types of pain — chronic and acute — and a variety of ways to overcome its aches and tender spots, some courses that, like medicine, can become addictive.The perception of pain varies among individuals and in severe cases it can have an exceedingly negative impact on quality of life. Proper management of pain will ensure faster recovery times and allow an individual to maintain a higher quality of life.There are several factors that can influence pain perception and slow recovery times. Ethnic and cultural values can be a powerful dynamic. Depending on one’s beliefs, for example, high pain tolerance may be a sign of strength, while others may consider pain a punishment for wrongdoing.The perception that adults do not cry is prevalent, but it is an activity which, at its core, is a normal reaction to pain. Anxiety and stress highly influence pain perception. A person might have fear of hospitals, fear of drug interactions or non-reactions, or fear that the problem could be worse than it actually is — all of which can lead to high anxiety levels that ramp up the nervous system and keep the perception of pain high. Fatigue slows the body’s ability to heal and can lead to depression, which pain by itself can cause. Depression, in its turn, can feed anxiety and stress. A close consideration of all of the above factors is vital when it comes to pain management. Understanding what type of pain the individual has is also important in determining the course of treatment. Pain itself is the communication between the peripheral nervous system (PNS) and the central nervous system (CNS) that identifies injury or the potential for injury. Pain can be categorized at three levels:
Drug Management: A Slippery SlopePain management starts with over-the-counter or prescription medications. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are the starting point for mild pain. They are often accompanied by the use of less potent opiate drugs (morphine or codeine) for mild to moderate pain. More severe pain is treated with stronger opiate drugs and often with higher dosing. Antidepressants and anticonvulsant drugs also are used in pain management, usually when there is nerve damage involved.Addiction to prescription pain medication is becoming a larger problem because of the way these drugs react with an individual’s body.They can lead to physical or mental dependency. Drug tolerance, which is the ability to adapt to a drug, tends to drop the longer a medicine is used, potentially leading to higher dosages to achieve desired effects. Drug dependence occurs when drug tolerance goes up and the body needs the medicine to function. Addiction occurs when the drug is needed to satisfy physical, emotional or psychological needs. Addictive behaviors include lying, hiding pills, excessive emergency room visits and what is known as “doctor shopping” to get more prescriptions. As addiction grows, criminal activity can become more common, according to recent studies.These behaviors are usually abnormal to the individual’s history of behavior. Treatment Options and a Case StudyGetting pain patients to take an active role in their care is highly beneficial. Performing relaxation techniques or using biofeedback can help reduce stress and anxiety. Exercise is important to help release endorphins, the body’s natural pain killers. Adjunctive modalities and hands-oncare provided during physical therapy are also effective procedures.Electrical stimulation has been used for years to treat pain by interrupting the pain stimulus to the CNS. A newer form of electrical stimulation — interactive electrical stimulation — has allowed physical therapists to progress pain patients into more functional activities faster, with longer relief and less dependency on pain medicines. One such device is the Interx, a product of the Neuro Resource Group, which is a handheld unit with electrodes built in that allows the therapist to scan the body and identify optimal treatment points.The treatment is specific and customized to the individual and activates numerous pain-relieving mechanisms, increasing effectiveness of the overall treatment. The interactive unit communicates with the body through the skin and gives the therapist feedback in the form of skin friction, with high drag points being areas of concern.The unit allows the therapist to achieve dynamic treatment with a set of flexible array pads that are attached to the body part, and then active exercise, strengthening and PROM can be done while the unit gives feedback using a frequency cycle controlling pain. Use of the Interx unit has been highly beneficial in getting a return of functional status and decreasing pain.Treatment for fibromyalgia, reflex sympathetic dystrophy, orthopedic conditions, cervical and lower-back pain syndromes, plantar fasciitis, neuromas and neuropathy pain have been successful.The unit has been used dynamically to return full shoulder ROM postoperatively on the first day of treatment with pain levels dropping from eight out of 10 to one out of 10 during a 15-minute usage. One such case found the use of the flexible array pads to be beneficial in removing pain from a total knee patient while doing stairs, her only deficit after three months of therapy elsewhere, in one session lasting 10 minutes. The array pads are used frequently on lowerback pain patients during strengthening and stabilization exercises, allowing them to get through a 30- to 60-minute program with better tolerance and then sticking with the therapy program versus complaining that the exercises hurt too much and then either self discharging or having chronic scheduling issues. Being aware of how a patient responds to pain management is critical for success. It is important that the team approach with doctors, case managers and therapists is used and that open lines of communication are maintained. |