The focus in chronic pain assessment differs from the evaluation of acute pain, which assumes a specific underlying injury or disease that treatment will cure. Begin chronic pain assessment with the history and physical examination. Important components of the initial evaluation are summarized in Table 3 and are detailed below.
The prevalence of chronic pain in the US is difficult to estimate, but its impact is profound. Fifty to eighty million Americans experience daily pain symptoms. The cost of pain management is approximately $90 billion annually.
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Although not completely understood, the pathophysiology is thought to involve the following two mechanisms:
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Plan for treatment of reinjury or exacerbation during the subacute pain phase. Often subacute pain occurs with increase in activity before tissue is completely restored to health.
Older anticonvulsants such as carbamazepine and phenytoin have some efficacy for neuropathic pain, but are associated with frequent adverse effects, drug-drug interactions and potentially severe adverse reactions, such as granulocytopenia and hyponatremia.
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Failing urine drug screening tests. Some jobs require a negative urine drug screen, and employment may not be compatible with opioid therapy. Patient can be harmed financially and professionally if they screen positive for an opioid, even when prescribed and monitored by a clinician.
Consider methadone for its prolonged duration of effect, which is useful for longer term therapy and minimizes euphoria with low doses.
Transdermal fentanyl has a black box warning for opioid naïve patients. It should only be considered, even at low doses, for patients who are tolerant to opioids. Plasma levels of transdermal fentanyl are erratic and are influenced by Muscle Relax several factors, including patient temperature, ambient humidity and temperature, skin thickness, presence of adipose tissue, and location of patch.
Approximate percentage: establish the percentage of pain each pain generator is contributing to the overall clinical status.
The feeling of pain and the emotional, physical, and social impact of pain are interrelated, but can be separated for treatment purposes. Therefore, problems with functioning related to pain can be addressed even if pain is not targeted directly and remains unchanged.
If PRN medication is required ≥ 3×/day → inadequate analgesia likely; review the regular medication Additionally, concurrent treatment with adjuvant drugs