pain intervention in modern practice - kees besse
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CONCLUSION: - Assessment and treatment of chronic pain is a multidisciplinary task - Anesthesiologists/pain specialist are the preferred coordinatorsTRANSCRIPT
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Pain Intervention in Modern Practice
Kees Besse, anesthesiologist, FIPP
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Campus Dekkerswald Nijmegen
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IASP definition of pain
An unpleasant sensory and emotional experienceassociated with actual or potential tissue damage, ordescribed in terms of such damage.
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Nociception
Activation of sensory transduction in nerves by thermal, mechanical or chemical energy impinging on specializednerve endings. The nerve(s) involved conveysinformation about tissue damage to the central nervoussystem.
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Pain transmission
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Neuropathic pain
Pain arising as a direct consequence of a lesion ordisease affecting the somatosensory system.
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Multidimensional Pain neuromatrix:
Melzack R MD Consult 2003
Input in body neuromatrix of:
Cognitive brain sites
Sensorial conduction system
Emotional systems
Output towards brain site responsible for:
Pain perception
Action programming
Stress-related programms
C
S
E
time timeModified Loeser
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Pain assessment at intake
• Pain assessment is the responsibility of doctors, nurses and patients
• Careful history and physical examination
• Use of Numeric Rating Scale (NRS) on every visit at the outpatient department
• Use of the Brief Pain Inventory (BPI)
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Diagnosis
•Established: treatment proposition
•Preliminary: multidisciplinary assessment
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Multidisciplinary assessment
•Pain nurse: social assessment, medication
•Pain psychologist: psychological assessment
•Pain physiotherapist: pain related physical examination
•Pain specialist: coordination
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Treatment targets
•Pain reduction
•Rehabilitation
•Resocialisation
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Painreduction
•Medication
•Nerve blocks
•Neurostimulation
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Nerve blocks
•Diagnostic
•Therapeutic
•Pulsed radiofrequency
•Thermal radiofrequency
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Nerve block performance
•Meticulous explanation to the patient of nerve block goal
•Explanation of expected effects and side effects
•Written informed consent
•Block supported by fluoroscopy or echo guided
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Neurostimulation
•Transcutaneous Electrical Nerve Stimulation (TENS)
•Dorsal column stimulation
•Motor cortex stimultion
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Spinal cord stimulation
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Non anesthesiologic pain treatment
•Cognitive behavioural therapy (psychologist)
•Rehabilitation center
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Conclusion
•Assessment and treatment of chronic pain is a
multidisciplinary task
•Anesthesiologists/pain specialist are the preferred
coordinators