Chronic Pain Case Studies

Opioids are effective for the treatment of acute pain, such as pain following surgery. They have also been found to be important in palliative care (hospice) to help with the severe, chronic, disabling pain that may occur in some terminal conditions such as cancer. In many cases opioids are successful long-term care strategies for those with chronic cancer pain (CCP). There are not many alternatives for those with CCP like there are for those suffering acute or chronic non cancer pain (CNCP). In one study, conducted by Furlan et al. (2006), opioids were effective in the treatment of CNCP overall; they reduced pain and improved functional outcomes better than placebo. Strong opioids (oxycodone and morphine) were significantly superior, to naproxen and nortriptyline (respectively) for pain relief but not for functional outcomes. Unfortunately, Weak opioids (propoxyphene, tramadol and codeine) did not significantly outperform NSAIDs or TCAs for either pain relief or functional outcomes. Overall, if opioids are

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

This feature also enables the use of this technique into the postoperative period for analgesia, using lower concentrations of local anaesthetic drugs or in combination with different agents.

They also have to follow strict medical guidelines, anesthetists must take into account the patient’s current health medications they are currently taking, and type or surgery that is being done. During surgery, the anesthesiologist monitors the patient’s critical life signs to make sure there are no complications. Also, after the surgery, the patient remains being monitored as the anesthesia wears off. They must also assist with chronic and cancer related pain treatment, cardiac and respiratory, resuscitation, blood transfusions, and watch over nurse anesthesiologists. They are also responsible for recording the type and amount of drugs given, and the condition of the patient before, during, and after sedation. There are also different kinds of anesthesia. There are three main types of anesthesia known as: local, regional, and general. Local anesthesia is usually injected to numb a specific body part that requires minor surgery, for example, on a hand and foot. Regional anesthesia numbs an area of your body for surgery. You can be awake or you can be sedated. This is most used for spinal and epidural anesthesia when someone is giving childbirth or having prostate surgery. General anesthesia is when you are unconscious and fully unaware of anything.

Establish a convenient time with patient to talk about pain and its psychological and emotional effects.

Anesthetics are used to control a number of critical functions during surgery including inducing a balanced state of unconsciousness, managing the sensation of pain, causing temporary paralysis of skeletal muscle and slowing of the bodies autonomic responses thereby allowing the surgical team to complete increasingly long, difficult and invasive procedures with minimal discomfort to the patient and limited risk of post surgical

Patients undergoing general anesthesia were typically given one or a combination of the following agents: propofol, nitrous oxide, desflurane, halothane, isoflurane, and sevoflurane. Once the patients were intubated, they were placed in the prone position on a standard operating frame. When the general anesthetic course was complete, the anesthetic agents were discontinued and 100% O2 was administered via endotracheal intubation or ventilation mask. Patients were then extubated when appropriate and transported to the PACU. Patients were monitored by the PACU nursing staff until they were deemed awake, alert, and responsive, and stable before transfer to the floor. IV analgesia was also administered patients during their PACU stay, and patients were given a patient-controlled analgesia

Acetaminophen (Tylenol). The resident takes Tylenol around the clock (ATC) for pain which is within the recommended dose of 325-650 milligrams every

A prospective randomized, blinded clinical trial was performed by Schroer W.C. to evaluate the efficacy of liposomal bupivacaine for better pain control against bupivacaine HCL. Patients (n= 111) undergoing TKAs were randomized to receive liposomal bupivacaine vs bupivacaine HCL. 58 patients received 266mg (20cc) liposomal bupivacaine mixed with 75mg (30cc) 0.25% bupivacaine, and 53 patients received 150mg (60cc) 0.25% bupivacaine. A result of the study was generated by accessing visual analog pain (VAS) scores and narcotic use post-operatively. There were no VAS pain score differences between study group patients vs control group. As on POD1: 4.5/4.6 (P=0.73); POD2: 4.4/4.8 (P=0.27); and POD3: 3.5/3.7 (P=0.58). Narcotic use was similar during

Analgesic is another word for painkiller. Non-narcotic analgesics, such as acetaminophen, only work for mild pain relief. Acetaminophen is an anti-inflammatory analgesic which works peripherally (locally) to stop the production of Cyclooxygenase. Cyclooxygenase is an enzyme that converts arachidonic acid to prostaglandin, which results in pain and inflammation. Increasing the dosage does not increase the pain relief, but does increase the side effects - nausea, upper stomach pain, itching, loss of appetite, and in extreme cases, liver and kidney damage. However, because the pain relief would be no different in taking one or two Tylenol to six, and because it only works locally to relieve pain, there is no addictive quality to acetaminophen. Opioids also provide relief from pain, but are a narcotic. Narcotic analgesics - hydrocodone - are used to relieve moderate to severe pain, and work in the central nervous system to change the way the brain receives pain signals. The hydrocodone binds to opioid receptors in the central nervous system and gastrointestinal tract, and works centrally to change the way the user experiences pain, all while providing a sense of euphoria. Increasing the dosage increases pain relief and euphoria, while also increasing the side effects - nausea, vomiting, drowsiness, mood changes,

In adequate post-operative pain management and assessment postpones patient discharge and delays recovery affecting 24% of patients. As a result there are increased readmissions and prolonged length of stays in hospital, and also poor clinical outcomes for the patient.

Surgery causes predictable tissue damage leading to the expected outcome of postoperative pain (Eccleston, 2011). Despite clinical research and initiation of regulatory standards, postoperative pain management is still inadequate due to a variety of factors including diverse pharmacological options, negative attitudes towards opioids, and inadequate staff education (Grinstein-Cohen, Sarid, Attar, Pilpel, & Elhayany, 2009). Research findings indicate that adequate postoperative pain management occurs in only 25% of surgical patients (Wu & Raja, 2011). Inadequate pain control directly relates to increased lengths of stay and postoperative complications. For instance, Frost and Sullivan Company (2011) found an increased length of stay by greater than one day due to improper pain management. This increase becomes an issue when inpatient hospitalization averages $1,629 per day in the United States, not including procedures, testing, or medications (Oh, 2012). Inadequate pain control leads to tachycardia, hypertension, immunosuppression, and hyperglycemia. These may result in delayed healing and the risk of readmissions within 30 days, which can also result in increased overall hospital costs (Wu & Raja, 2011). The emotional distress of pain on both the patient and family further complicates healing by affecting behaviors and decisions (Linton & Shaw, 2011).

Larry, a 35-year-old truck driver complained about inflammation and pain in the flexor and pronator muscles of the forearm where the tendons originate on the medial epicondyle of the hummus (by the elbow joint). The pain is penetrating the forearm in his dominant hand which is making it very hard to work because he is finding it very difficult to shift gears. He was prescribed a non-steroid anti-inflammatory and put on light duty.

Ms. Kelly is a nondrinker, smokes five cigarettes per day and uses recreational grade cannabis for pain and sleep daily.

Pain is something that causes discomfort to one’s body, but pain is something that we call can interpret differently as well. Someone’s adherence to pain varies through culture, gender and self-values and sometimes the method that we may choose to treat or cope with them are different but may not be accepted by the laws and regulations of the government. For example in the Cannabis and Its Derivatives case scenario is presented about a 54 year old man who is a multiple sclerosis patient living in Ontario, that travels to Florida often and uses medical marijuana to cope with his pain. He states: “He visited Florida a few times, where he smoked cannabis, which helped tremendously to reduce the neuropathic pain and detach his mind from it. He