CHRONIC PAIN: SELF-TEST
1. When assessing the pain patients mental status and affective response to their pain, What questions can be asked and what signs looked for?
A. General mood, suicidal ideation, whether or not they are sleeping well and if they have difficulty getting to sleep or are awakening early. Waddels non-organic signs for low back pain and pain behaviors are important signs of the affective nature of pain.
2. Which antidepressants can be monitored with blood levels to assess if they are within therapeutic range for depression therapy?
A. Amitriptilyine, nortriptyline
3. What are trigger points and how can they be treated?
A. Localized areas of muscle spasm, which cause pain often in a distal site, when palpated. Treatment may involve, massage, stretching, range of movement exercises, spray and stretch techniques and injections with local anesthetics or even dry needling. Education on posture and correct arrangement of work site can decrease the recurrence of trigger points.
4. How effective is TENS in chronic pain conditions?
A. TENS initially helps 60% of patients with chronic pain. Unfortunately it's efficacy decreases over time. If TENS is still helping after 2-3 months rental, purchasing a unit should be recommended. It is likely that TENS will continue to be effective after this time.
5. If one opioid does not relieve a patients chronic pain is it worth increasing the dose or changing they type of opioid?
A. YES to both. If there are no significant side effects or drowsiness, mental clouding, dizziness or sexual dysfunction the opioid should be increased to see if the pain is opioid responsive. If one opioid does not work a different type of opioid may be very effective, possibly due to different opioid receptor affinities.
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