chronic pain management
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chronic pain management

Read and learn more about chronic pain management. For more, visit the Chronic Pain website ChronicPainFAQ.org

Q: Are there any nurse practitioners currently working in a chronic pain management unit/setting?
I am looking for any SOP’s (standard operating proceedures), clinical pathways, terms of reference, best practice guidelines or job descriptions for a nurse practitioner in a chronic pain management setting. We have recently established a new NP position at the PMU (chronic pain management unit) within our hospital and would like further guidance as to the role/job description etc. Appreciate input.

A: Hi, I found your question very interesting. I too am looking for SOP’s for np’s r/t chronic pain management. I work in a rural family practice and work with many clients with chronic pain, no insurance and not much within 30 miles to refer to. today alone I saw 3 chronic painers and spoke w/ 2 more via phone. Have you found any info? I am even interested in training for NP’s Thanks

Q: Chronic Pain Sufferers: What Pain Management Techniques do you use?
What is your medical condition that causes chronic pain for you?

What pain management techniques do you use for your chronic condition/pains?

A: Arthritis (wrists, thumbs)
Spinal Stenosis (narrowing of spinal canal)
Lumbar disintegration (disintegrating disks)

I use 800mg Ibuprofen as needed for daily pain.
On occasion I’ll use LorTab (hydrocodone) for emergent pain and to aid sleep on nights when it just won’t let me be. I have legal scripts for these from my physician.

But, mostly, I have developed a high pain tolerance, and prefer not to use drugs unless absolutely needed.

I also have several physical therapy excersizes that help strengthen areas to releive the cause of pain, rather than treating only the symptoms.

If you block the pain altogether, you run the risk of ignoring it and doing more damage. This can lead to even more pain in the long run. Pain is a signal that something is wrong. If you can treat what’s wrong, the symptoms will go away with the condition.

Q: I need info on comping with chronic pain management?
mentally and physically by those who have degenerative cervical/neck vertebrae conditions. I have been told an operation is no guarantee I will be pain free. I had a fusion 3 years ago and really thought that would be the end of my problems. I am anxious to hear from others who are going or have been going, through the same problems.

A: I am facing fusion surgery for spondylolistesis (slipped vertebra, L5/S1) next week. This is my low back, but I have experience with pain management clinics/doctors. The neurosurgeon seemed very confident that it will help. I sure hope so, because I need to get myself back to work!
It is tough dealing with chronic pain. It can make daily activities that most take for granted an ordeal for those with back and neck pain. Pain management clinics perform procedures and prescribe medications to help with pain. There are people out there with chronic pain that have exhausted all of their options, and pain management regimen is their only remaining option. If your insurance approves it, you can go to pain management and still see your neurosurgeon. You can coordinate your care between the two physicians. Many people do this, including myself.
There are also methods to help cope with pain. Some people use breathing exercises, meditation and bio-feedback as a drug-free (or reduced meds) way to help with chronic pain. This could be method to help you use less of your pain medication. Always ask your doctor for advice.
Many people don’t understand the nature of back/neck pain, unless they have experienced it themselves. They are unaware that there is pain at the site of the problem/injury, traveling nerve pain, and resulting muscle spasms to the point that one cannot even move without pain.
Talk to your doctors about different options to help you get back on your feet. A pain management physician (board certified in anestesiology and pain management) might be an option for you.
Good luck, and feel better.

Q: Can anyone recommend a chronic pain management clinic in the houston , tx area?

A: You need to get your family doctor to refer you to one in your area. Hope this helped

Q: is there any online courses in chronic pain management offered for anaesthetists?

A: As I know, this site has top listing of such college courses online – education.mypressonline.com

Q: What’s new in non-narcotic chronic back pain management?
My husband’s had a spinal fusion and a spinal cord stimulator (wonderful device) implanted but he still have pain in his lumbar. He’s had chiropracty, osteopathy, electrofied acupuncture, watsu, every drug you can think of, physical therapy, trans-cutaneous nerve stimulation, pain relief patches (lido and fentynyl), electronic muscle stimulation, pool therapy, nitro paste, and I’m sure I missed a few. What are you all doing for your chronis back pain?

A: A pain management specialist can inject a steroidal solution into the region that’s painful — often this will last for months — it helps to lessen inflamation and pain on the nerves. You’ll probably have to ask for a referral or call the hospital to make an appointment — there aren’t a huge number of pain management anesthesiologists in private practice.

Q: need referrals for a compassionate chronic pain management doctor?
kind pain managment doctors in philadelphia, pa

A: I’m not sure you really want to manage it do you? Why would you want to live with the pain when you can get rid of it? I know it’s possible for after living with my pain for over 30 years I did get rid of mine but it wasn’t because of the medical world. If I had stayed with only them I’d still be in pain. They seem to feel that living with pain is alright but then again it isn’t them who are feeling the pain. If you want more information contact me and I’ll get you the information on how to release your muscles to get rid of the pain. Just have to know where the pain is to get you what you need.

Q: Chronic, level 8 pain management until I get an appt?
I have ruptured discs compressing my sciatic nerve root. Have just moved and waiting to see specialist. The Dr. Gave me something totally inadaquate and don’t want to look like a drug seeker. Are there any powerful alternatives to treat my pain?

A: I think it is a shame that people with chronic pain have to suffer because they are looked upon as drug seekers by Doctors.

You have a diagnose that warrants stronger medication, I would call the doctor and tell him you have tried the meds but they are not helping, ask him for something stronger. If you have insurance I would go to the ER and tell them what the Doc prescribed but no relief, bring your MRI/CT’s and ask for help.

There is a bill going through now that is in support of chronic pain sufferers and Medical profession needs to recognize and treat appropriately. I hope you are seeing a Neurologist, they can write scripts for narcotics without being questioned, regular MD’s go under scrutiny if they write a lot of narcotic scripts so they are very leary.

Q: self-hynosis for weight loss and/or chronic pain management?
i asking if anyone has done this by using a library book on the subject and been successful. no medical coverage so can not afford a regular hypnotist any success? thank you ahead of time

A: No I have never used that but I am trying a chiropractor and its workin wonders. I never knew that a chiropractor can help with so many different things out besides your back and bones. The one I go to helps weight loss, asthma, migrain head-aches, and so many other things. She also treat children for their childhood problems such as weight again, ADHD, ADD, asthma, and ect.

Q: Is there a good doctor or Pain Center in MS that specializes in the treatment and management of chronic pain?

A: The University of Iowa has a great pain team.

Q: chronic pain management and best new medications?
I have lumbar spinal cord arachnoiditis, the result of failed back surgery and the aging process. I have been through some hell the last few days after discontinuing methadone. I was told it was effective. Unfortunately, I was not told it is one, mean drug to discontinue. I was just tired of feeling like a criminal when I had my prescription filled. I feel like a truck rolled over me. I was only taking 10 mg. a day… I tried my best not to go up on the dosage, and I succeeded. I never got total pain relief and now I am paying a heavy price. Any information on some newer, effective medications or therapies would be appreciated. Right now I am taking Neurontin. Tramadol did nothing for me and hydrocodone works for a short while but I am looking for a better long term solution. I have a great life in front of me…. I want to live it without all the pain I have right now.

A: For chronic pain, such as the pain seen in failed spinal surgery syndrome (FSSS), the best choices are methadone, Kadian, Oxycontin and Duragesic patches, with a short acting medication for break through pain. Part of the issue is that with all chronic narcotics your body will habituate and become accustomed to the dose. Regardless of which medication you take the dose will eventually need to be increased. All of these medications are schedule II controlled substances, and the actions of the pharmacist will be the same regardless of which one you are taking.

Any pharmacist who has any knowledge of his pain medications knows that the 10 mg methadone tablets are commonly used in pain management, and are different from the 40 mg methadone wafers which are the mainstay of addiction clinics until they are tapering the patient off.

Yes methadone has a long half-life which causes a long withdrawal period when stopping the medication. But as an FSSS patient it is probable that you will be on the medication for the long term, unless you are planning futher surgeries.

The methadone is the most stable of the long acting narcotics, and from a cost benefit basis is the best medication, if you do not have excellent pharmacy benefits in your insurance. A comparison of the usual methadone patient taking $60 mer mont in methadone will see approximately $400 a month in Oxycontin and $600-800 a month for Duragesic or Kadian.

Short acting narcotics are more psychologically addicting and more dangerous, because they don’t control the pain so the patients over take the medications.

DIscuss the long term options with your physician, and be reasonable when the suggestion of small increases in dose are recommended.

Incidentally, methadone will provide more pain control, with the least mental deficit of all of the pain medications available.

In addition to working with pain patients, I was on pain medications for 5 years (before I started in this field) for an injury I sustained while on active duty in the military. I understand the concerns, but there are always problems with any pain control method. You need to find the method that gives you the best pain control, without significantly decreasing your quality of life.

Neurontin will control the neuropathic symptoms in your limbs but not the nociopathic pain in your back. I given the limited information you have presented I probably would not have expected tramadol to have been effective.

I hope all gets better for you soon.

Q: Thorasic, chronic, back pain management, is there such a thing without meds?

A: Meds do help: muscle relaxants, anti-inflammatories, pain killers all have a role. Remember that back pain is a symptom, not the problem. A chiropractor, physical therapist, acupuncturist, can all help back pain, each from a different perspective using manipulation or physical modalities or special points in your body. If you really want to effectively manage it, you need to figure out what is causing the back pain. As for do-it-yourself back pain management, you need to identify causes. Common causes of thoracic spine pain include: muscle spasms of the muscles just to each side of the spine oftentimes from over-exertion, muscle or disc problems following an auto accident or fall of some type, poor posture while playing video games, a bad chair at work. Other things that might be involved are muscle imbalance twisting the spine, mis-alignment of the spine, nutritional deficiencies such as calcium or a vitamin. Below are a couple websites from reliable places that have lots more information.

Q: Chronic pain management?
Other than drugs – what do you do to deal with it?

I remind myself of ways that I’m lucky or blessed, and I try to keep my mind occupied on other things – boys, usually ;) And foot baths! My feet aren’t hurting or anything, but it’s just really comforting for some reason.

Any other suggestions? Things you think about? Breathing exercises?
Oops – I guess I should have said, I have no problem with pain meds at all!!! I meant, on top of them, what do you do. But thanks!

A: Great question – I wish you had included more information about the specific pain. Here are some ideas – a TENS unit has been very helpful in removing pain from different parts of my body.

I also have a circular heating pad that vibrates around my neck and that has been very helpful for neck pain. Hot baths to soak your feet and hands in have been helpful and the most recent non-drug pain management technique is Radio Frequency Ablation – that is where they put a probe (in my case) along the nerves coming out of the spinal column (The procedure is slightly painful) and they burn the nerves slightly with a radio frequency and that process stops the pain from going up the nerve for 3 months to 3 years.

The power of positive thinking is extremely helpful – You are correct to remind yourself how lucky you are when you see folks who are much worse off than yourself.

Q: what are the use of narcotics in the management of chronic pain?

A: Narcotics can be very effective in managing chronic pain that is either resistant to other treatment methods or is not curable via surgery or physical therapy. There is a place for them in a comprehensive pain management plan and are relatively safe if taken exactly as prescribed and while under the care of a pain management doctor. There are side effects such as nausea and constipation, and there is always the risk of addiction as the result of abusing the medications. But there is a difference between addiction, which is the mental need for the drugs to feel high, and dependence, which is the body’s reliance on the substance after prolonged, appropriate use. But, when you are ready to come off the medication, the same doctor that put you on them can safely taper them down for you so that you do not feel withdrawals.

Q: Help about pain management, chronic knee pain?
I am a very active 24 year old, in Army, play softball and workout once a day. In may I was diagnosed with Chondrolmalcia, stress fractures, and arthritus in my right knee. The surgeon said “i am to young to get knee replacement, come back in 15-20 years, if something hurts dont do it.” Well thats fine but I have been in pain every day, I stand for to long it hurts, sit for 15 minutes it hurts, walk to much hurts, I am constantly icing my knee and other things to try to live a some what normal life. I refuse to not do anything and curl up in a ball and roll over! I have taken alot of meds, ranging from darvoset, naproxen, tylenyol 3, Vicodin, Indomethacin, Tramadol, and percoset. In the last week i have seen two doctors trying to refill the percoset(it works), he asks me this morning, “do i think that i am getting addicted,” and i say no you give me a 10day presciption and i return 15-20 days for a refill. I take 2 a day and you prescribe 3-4 per day!what is my next step?i need advice!

A: It works, but you should probably consider talking to a pain management professional about switching medication.

Percoset is normally meant to be a stop-gap measure to allow you to function until a more permanent pain solution can be found. Soon you will start noticing that the longer you are taking the percoset, the more they will ‘resist’, and eventually you may not be able to refill it, you will not have any other options for days, and that will be excruciating.

Best to call a PMP and find a more permanent solution before this happens.

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