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Pain Management

Pain management introduction

Washington State Pain Management Guidelines

Classification of Pain, Pain measurement/scoring

Barriers to adequate pain control

Pre-emptive, multimodal or balanced analgesia/pain management

Behavioral Therapy Aspects of Pain Management

Palliative or ‘End-of-life’ care/Cancer pain

Placebos
JCAHO standards

Diabetic peripheral neuropathy

Outpatient surgery pain management

Patient satisfaction

Pain Management Issues

Opioid contracts

Pain Rehabilitation Programs

Pain Clinics or Centers

Chronic/Persistent Pain Programs – coverage

Chronic/Persistent Pain Programs – Inpatient

Pain Rehabilitation, Outpatient

Outpatient Hospital Pain Rehabilitation Programs, Medicare NCD

Exit Criteria from chronic pain programs

Dental pain management – after hours care

Headaches

Pain Management in Long Term Care

Pain Management in the Emergency Department

Pain Management Notes


Pharmacologic Management of Pain

Initial oral mild to moderate pain management

Prescribing Guideline – California model guideline

Opioid therapy

Methadone

Cancer Pain Management

Topical NSAIDs for chronic musculoskeletal pain

Neuralgic/Neuropathic Pain

Pharmacologic Challenges for Sympathetically Maintained Pain

Continuous Epidural Analgesia for the treatment of Complex Regional Pain Syndrome (CRPS)/Reflex sympatheticDystrophy (RSD)
Cognitive Behavioral Therapy + Physical Therapy for Complex Regional Pain Syndromes
Cryoanalgesia and Cold Laser Therapy
Trigger Point Injections
Induced Lesions of Nerve Tracts, Medicare NCD
PCA by proxy – JCAHO sentinel alert


Pain management patient self-evaluation tools

Pharmacy tables - drugs, eqianalgesic calculations

Addiction

Diversion

Complementary and Alternative Medicine; Approaches to pain management

Acupuncture

Biofeedback

Bioelectromagnetic therapy

Guided imagery

Manual/massage therapies

Naturopathy

Relaxation therapy

Transcendental meditation

Resources - CAM

Legal issues related to pain management – California Medical Board policy statement and guideline

References/suggested reading by topic related to Pain Management

References/suggested reading by topic related to CAM

CAM web sites

Anesthesiology: Anesthesia services - General Coverage Policy; Office-based anesthesia; Dental Anesthesia; Safe sedation of children; Pain Management; Intrathecal/subarachnoid injections; Epidural injections for pain; Continuous epidural analgesia; Cryoanalgesia and Cold Laser (low-energy or low-level) Therapy for wound healing, pain therapy, and other disorders;

Facet Joint Injections/Median Branch Nerve Blocks; Facet Denervation, Facet Denervation: Neurotomy, Facet Rhizotomy, or Articular Rhizolysis; Facet Denervation: Percutaneous Radiofrequency; Paravertebral Nerve Blocks; Anesthesiology Notes.

Pain Management web sites

Consent and Agreement Forms for long-term controlled substance/opioid therapy

Informed Consents for Long-term Narcotic Use - example

Opioid Contract – UC Davis form


Resources - Pain Management
Pain Publications for Patients and Their Families
Palliative Care Leadership Centers
Model Policy for the Use of Controlled Substances for the Treatment of Pain. Federation of State Medical Boardsof the United States, Inc. 2004
Pain Management Provider Credentialing
Pain Management Notes
Part II Skeletal Muscular System Guidelines

· Knee

ü Arthroscopy, knee

ü Total Knee Replacement

ü Hyaluronidase, intra-articular injections for osteoarthritis, knee

ü Knee, general references

· Back and Neck Pain – Evaluation and Procedures

ü Low back pain (Acute, ‘slow to recover’)

ü Anti-depressant drug therapy for low back pain

ü Machines to test and treat low back pain

ü Algorithm for back pain evaluation

ü Chymopapain Chemonucleolysis

ü Endoscopic Anterior Spinal Surgery

ü Epidural injection of steroids for back pain

ü Facet Joint Injections/Nerve Blocks

ü Facet Denervation, Facet Neurotomy, Facet Rhizotomy, or Articular Rhizolysis

ü Hypertonic saline for the treatment of epidural adhesions, adhesive arachnoiditis, or failed back syndrome

ü Intradiscal electrothermal therapy (IDET)

ü Laminectomy

ü Magnets for the treatment of chronic low back pain

ü Meniscectomy

ü Microdiscectomy, Percutaneous Lumbar Discectomy

ü Percutaneous vertebroplasty

ü Spinal Instability – Pedicle screw fixation

ü Spinal stenosis

ü Trigger Point Injections

ü Cervical Pain, acute

ü Chiropractic Medicine

· Spinal manipulation under anesthesia

ü Bone stimulators, electric and low-intensity ultrasound

· Distraction osteosynthesis, Ilizarov method

· Olecranon bursa aspiration

· Total Hip Replacement (arthroplasty); Primary, excluding hip fracture;

· Injection, tendon sheath, ligament, or trigger points or ganglion cyst
· Arthrocentesis – Joints; Aspiration/Injection Ganglion Cyst
· Kyphoplasty – Medicare LMRP
· Ultrasound therapy for calcific tendinitis of the shoulder

· Fibromyalgia

· Rheumatology links

· Post-work Injury Evaluation and Work Hardening

· ‘Prehab’

Web Sites – Skeletal-Muscular System-related

References – General - for skeletal-muscular pain management