Thank you for the presentation on pain management. A multidisciplinary approach utilizing both pharmacological and non-pharmacological therapies can help address different types of acute and chronic pain.

1. Cancer Treatment Centers of America ®
Midwestern Regional Medical Center
Pain Management Service
Presented by: Dr. Rahman
Date: 5/10/2012 – Thursday
www.cancercenter.com

2. Pain
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3. Objectives
To describe the history of pain.
To describe what pain is.
To explain the types of pain.
To give examples of the types of pain.
• Open Discussion – Okay to ask questions during the lecture.
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4. History of Pain
• Ancient Greeks times:
– Aristotle (384 B.C. – 322 B.C.)
Pain due to evil spirits who entered the
body during injury.
– Hippocrates (460 B.C. – 370 B.C.)
Pain due to an imbalance in the
vitals fluids of the body.
Pain was not well understood and was believed to originate outside
the body. As a punishment from God.
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5. What is Pain?
• In the past, pain defined as “whatever the experiencing person says
it is, existing whenever s/he says it does.”
• Stresses that pain is a subjective experience
• The patient not the clinician is the authority
• Patient’s self report is the most reliable indicator of pain
• Emphasizes that pain is a complex experience with multiple
dimensions
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6. International Association for the Study of Pain 1979
Pain defined as:
“An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage.”
Emphasizes that pain is a complex experience
with multiple dimensions
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7. Types of Pain : Time vs Location
• Acute vs Chronic
• Nociceptive (S&M) vs Neuropathic
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8. Acute Pain
• Trauma
• Surgery
• Infection
• Burns
• Appendicitis
• Inflammatory
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9. Chronic
• Pancreatitis
• Diabetic Peripheral Neuropathy
• Osteoarthritis
• Headache
• Fibromyalgia
• Phantom Pain
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10. Nociceptive
• Osteoarthritis
• Rheumatoid Arthritis
• Muscle Injury
• Inflammation
• Neoplasm
• Degenerative Disc Disease
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11. Neuropathic
• Diabetic Peripheral Neuropathy
• Stroke Pain
• Post Herpetic Neuralgia
• Complex Regional Pain Syndrome
• Multiple Sclerosis
• Neoplasm
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13. The 5th Vital Sign
• Vitals Signs:
– Temperature
– Pulse
– Respiratory Rate
– Blood Pressure
– Pain Score
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14. Types of Pain
 Low Back Pain
 Headaches & Migraines
 Myofascial Pain
 Cancer Pain (Head, Neck, Chest, Abdomen, Pelvis, Extremities, etc.)
 Complex Regional Pain Syndrome (RSD)
 Musculoskeletal Disorders
 Sciatica
 Post Surgical Pain
 Neuropathic Pain Syndromes e.g. Diabetic Neuropathy
 Abdominal and Pelvic Pain
 Spine Pain
 Post-Herpetic Neuralgia

15. • Here are the kinds of pain
blocks the pain service can offer
Caudal, Lumbar, Thoracic, and Cervical Epidural Steroid blocks
Patient-Controlled Analgesia (PCA) pumps
Patient-Controlled Epidural (PCEA) pumps
Trigger point injections
Blocks of Somatic and Visceral Cancer Pain Syndromes
Facet Joint Injections
Minor and Major Joint and Bursa injections
Peripheral and Central Somatic Nerve and Plexus Blocks
Tunneled catheter placements for various nerve sheaths
Radiofrequency ablative procedures
Intraspinal catheters for intrathecal opioid trials and implanted infusion devices
Spinal cord/Dorsal Column Stimulators
Discography
Ultrasound-Guided Procedures
Anatomical Landmark Guided Procedures

16. Pain Assessment
• Pain History
• Pain Physical Exam
• Labs/Imaging Studies
• Pain Diagnosis
• Pain Plan
• Then Follow-up Evaluation
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17. Pain Assessment
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18. Spinal Pain Generators

20. Multi-Disciplinary Care

21. MRI

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23. Potential Pain Therapies
• A. Nonpharmacologic
• B. Pharmacologic
• C. Interventional
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24. Nonpharmacologic
• Acupuncture
• Biofeedback
• Chiropractic Care
• Massage
• Physical Therapy
• TENS unit
• Cognitive Behavioral Therapy
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25. Pharmacologic
• Topical Agents
• NSAIDS
• Oral/IV steriod
• Opioids
• Antidepressants
• Anticonvulsants
• Infusions
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26. Interventional
• Trigger Point Injections
• Medial Branch Block
• Epidural Steroid
• Intradiscal Therapy
• Laminectomy/Fusion
• Vertobroplasty
• Discectomy
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27. Interlaminar approach

28. Transforaminal approach

29. OA

30. Anterior Approach

31. Greater Trochanter Injection

32. Shoulder/Bursa Injections

33. Elbow Bursa Injections

34. FJI

35. Retrobulbar Block

36. Stellate Ganglion Block

37. Sacrum Injections

38. SCS

39. ITP

40. TPI

41. Lower Cranial Nerve Blocks

46. Conclusion
• A good history is crucial in helping you develop
a Differential Diagnosis
• The physical exam maneuvers we use can help
us to rule out some cause and in some cases
rule in others
• Although radiology has become standard, it is
no substitute for the clinical exam

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