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| Spence Rehabilitation Center |
| 9305 Calumet Ave. Suite C-1 |
| Munster, IN 46321 |
| Phone |
: (219) 513-2267 |
| Fax |
: (219) 836-1276 |
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What is chronic pain? |
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Chronic pain is pain that has been present longer than the |
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normal healing time. This pain has usually been around for |
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3 to 6 months. |
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What labs are useful when assessing chronic pain? |
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| 1. |
CBC: |
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Used to look for infection and anemia. |
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| 2. |
Urinalysis: |
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To look for kidney problems. |
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| 3. |
Urine and blood toxicology: |
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To look for evidence of drug use. |
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What imaging studies are used to assess chronic |
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pain? |
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| 1. |
X-ray or CT of the affected body part: |
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To look for fractures, infections, tumors, or |
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inflammatory diseases. |
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| 2. |
MRI of the affected body part: |
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Most sensitive imaging tool to look for soft tissue |
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problems resulting in pain. |
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How are medications used to control Chronic pain? |
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The ladder approach has been developed by the World |
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Health Organization. This approach provides physicians
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with guidelines on how to treat chronic pain effectively. |
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| 1. |
Nonopiate medications: |
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Are first tried such as Tylenol, NSAIDS, and Tramadol. |
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| 2. |
Adjuvant Medications: |
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Are started to enhance the effectiveness of pain |
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medications and control side effects. |
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| 3. |
Mild opiates: |
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Are started (ie. Tylenol #3, Vicodin, Darvocet, and |
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Norco) ± adjuvants, ± nonopioids. |
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| 4. |
Strong opioids: |
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Are started (ie. Fentanyl Patch, Morphine, Avinza) |
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Morphine ± adjuvants, ± nonopioids. |
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How are Opiates Started? |
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| 1. |
a short-acting (immediate-release) opiate is |
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started: |
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And slowly raised while the effectiveness and the side |
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effects are monitored. |
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| 2. |
The amount of short acting drug that was used in a |
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24-hour period is added up and converted to a |
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sustained release medication that is taken two or |
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three times a day around the clock. If the patient |
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experiences intermittant breakthrough pain, a short |
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acting as needed (prn) medication is also prescribed. |
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Why are Long acting opiates used? |
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Patients with Chronic, Constant Pain are usually placed on |
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a long acting Opiate Medication instead of an as needed |
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medication. Patients given medication this way are more |
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comfortable and use less medication overall. Short acting |
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prn medications are used for intermittent pain. |
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Why are adjuvant Pain medications Used? |
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Adjuvant medications are used to enhance pain control and |
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minimize side effects. Adjuvant medications can also treat |
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other symptoms that are usually associated with chronic |
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pain such as depression, insomnia, and anxiety. Adjuvant |
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medications are also better at treating nerve pain also |
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known as neuropathic pain. |
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| 1. |
Benzodiazepines: |
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Are used to manage anxiety. This class of medication |
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can be addictive, cause sedation, and depress |
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breathing. Clonazepam is especially useful for nerve |
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(aka. neuropathic) pain. |
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| 2. |
Antispasmodics: |
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Commonly prescribed medications include flexeril and |
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skelaxin. |
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| 3. |
Tricyclic Antidepressants: |
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Has been shown to improve pain control and treat |
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other symptoms such as depression, anxiety, and |
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insomnia. |
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a) |
An EKG is needed before started. |
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| 4. |
Anticonvulsants: |
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Are useful for lancinating (knifelike) pain. commonly |
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prescribed examples include neurontin, lyrica, valproic |
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acid, and phenytoin. |
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a) |
A complete blood count and baseline liver |
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function tests should be checked first. |
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What is Tolerance and How can Opiate Tolerance be |
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Minimized? |
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| 1. |
Patients who have been on opiate medications for a |
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long time may require a higher dose of medication |
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over time to maintain pain relief which is known as |
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Tolerance. |
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| 2. |
Sometimes tolerance can be minimized by switching |
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to a different type of opiate that works a little |
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different on the body. |
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What are common withdrawal symptoms that |
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patients can experience when stopping opiates? |
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When opiates are stopped suddenly, patients will likely |
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develop withdrawal symptoms. Common symptoms are |
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listed below: |
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| 1. |
Sweating |
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| 2. |
Rapid heart rate |
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| 3. |
High blood pressure |
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| 4. |
Irritability |
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| 5. |
Anxiety |
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What are some common side effects of opiates? |
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| 1. |
Nausea and vomiting |
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| 2. |
Constipation |
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| 3. |
Blood pressure instability |
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What is an opiate contract and why is it used? |
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The individual will be required to sign and agree to an |
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Opiate contract before starting the medication. The
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contract enforces the individual to comply with the |
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treatment plan prescribed by the doctor and minimize
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the likelihood of medication abuse. If the patient does
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not follow the contract, he or she may be taken off of
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the medication or even have to find another doctor. |
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| 1. |
The agreement enforces that prescriptions only be |
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prescribed by one physician and one designated |
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pharmacy. |
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| 2. |
The agreement usually specifies that the patient take |
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the medication only as prescribed. |
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| 3. |
By signing the agreement, the patients acknowledge |
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that they are responsible for their written prescription |
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medication, and that they refill their medications during |
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regular office hours. They also must plan ahead so as |
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not to run out of medication during weekends or |
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vacation periods. |
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What are some other Therapies commonly used to |
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treat chronic pain? |
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| 1. |
Physical Therapy: |
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Usually started with gentle range-of-motion and |
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stretching exercises progressing to strengthening. |
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| 2. |
Modalities: |
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Usually provided by the physical therapist. Some |
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common modalities are listed below: |
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| a) |
Hot packs: |
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To increase blood flow and relax tissues. |
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| b) |
Ultrasound: |
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Provides heat deep into the tissues. |
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| c) |
Transcutaneous Electrical Nerve Stimulation |
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(TENS): |
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An low electrical impulse is applied to the body |
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which blocks the pain impulses from going to |
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the brain. |
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| d) |
Traction: |
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The tissues are stretched in a controlled |
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environment. |
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| e) |
Myofascial release: |
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The soft tissues are mobilized. |
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| 3. |
Occupational Therapy: |
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To provide the patient with desensitization techniques |
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| 4. |
Recreational Therapy: |
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The individuals favorite activities are used to keep |
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them active. |
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| 5. |
Pain Psychology: |
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To assess and improve coping strategies. The |
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psychologist also teaches the individual relaxation |
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techniques and how to manage their stress. The |
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psychologist can also teach the individual biofeedback |
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techniques. |
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| 6. |
Vocational Therapy: |
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The individual’s work history, education, and |
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motivation level to return to work are assessed by |
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a counselor. Afterwards, therapies are provided to |
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condition the individual so that they may return to |
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reasonable employment. |
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What types of surgical procedures can be used to |
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treat chronic pain? |
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| 1. |
Nerve blocks: |
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An anesthetic and steroid can be used to target the |
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nerves that go to the painful part of the body. |
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| 2. |
Sympathetic blocks: |
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Including stellate ganglion and lumbar sympathetic |
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blocks are used. |
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| 3. |
Spinal cord stimulators: |
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To treat irritated nerves that have failed to respond |
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to other less invasive treatments. |
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| 4. |
Pain pumps: |
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A pump can be implanted in the spine that delivers |
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the opiate medication directly to the receptors which |
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reduces the overall opiate concentration needed in |
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the body. |
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