Pain Management and Fibromyalgia Overview

Pain & Sensory Perception

• Pain is defined as "whatever the experiencing person says it is, existing whenever they say it does" (International Pain Society, 2018).
• Pain is shaped by various factors, including the patient's expression and the impact of pain on their life.
• Psychological distress can lead to ineffective pain management or reliance on pharmacological methods.
• It's crucial to consider the patient holistically.

Main Types of Pain

• Nociceptive Somatic: Pain related to nociceptive activity in the skin (sharp, aching, throbbing).
• Nociceptive Visceral: Pain originating from organs/body cavities (gnawing, cramping, dull).
• Neuropathic: Pain caused by injury to central, peripheral, or autonomic nerves (burning, prickling, tingling, numbness).

Pain Transmission

• Pain originates in one or more body parts, but its perceived location may differ.
• Pain signals travel through nerves to the spinal cord.
• The brain processes these signals and interprets them as pain.
• Endorphins released by the brain can reduce pain.

Assessment

• Onset: When did the pain begin?
• Provocative/Palliative: Does pain worsen with movement? Does anything relieve it? Can any successful treatments be described?
• Quality: How does the pain feel? Describe the intensity, and type of pain.
• Region: Where is the pain located?
• Severity: Rate the pain on a scale of 0-10.
• Treatment/Timing: What treatments have worked in the past? Is the pain continuous or intermittent?
• Understanding: Patient history, and past experiences with pain.
• Values: Acceptable pain levels and patient goals of care.

Pain Rating Scales

• Facial expressions (grimacing, furrowed brow, etc.)
• Clenched jaw/teeth
• Grasping blankets
• Rigid body
• Unusual breathing patterns
• Agitation/irritability
• Moaning/calling out
• Not responding to voice/withdrawn
• Flinching to touch
• Guarding painful areas
• Kicking, restless legs, rocking

Fibromyalgia

• Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tender points.
• Patients often experience poor sleep, morning stiffness, irritable bowel syndrome, and anxiety.
• Women are 9 times more likely to be diagnosed than men.
• Ages 30-50 are commonly affected, and having a family history is a possible risk factor.
• The exact cause is unknown; however current understanding suggests alterations in neurotransmitter levels and central processing of nociceptive pain input.

Nerve Root Compression

• Normal Disc: Spinal cord, Neural foramen, Nerve Root, Nucleus pulposus, and Disc annulus.
• Degenerated Disc: Normal disc structures are damaged/deteriorated.
• Bulging Disc: The Nucleus pulposus is pushing into the annulus, but not breaking through the annulus fibrosis.
• Herniated Disc: The nucleus pulposus has broken through the annulus fibrosis.
• Radiculopathy: Pain, numbness, and weakness caused by nerve root compression in the spine.
• Symptoms: Pain, numbness, tingling, weakness, loss of reflexes, changes

Diagnosis

• Patient history and physical examination (muscle strength and reflexes, pain with movement)
• Imaging (X-ray, CT, MRI)
• Nerve conduction studies (measures nerve function)

The Spine

• Regions: Cervical, Thoracic, Lumbar, Sacrum and Coccyx

Cauda Equina Syndrome

• Emergency condition related to nerve root compression below the spinal cord.
• Symptoms: Impaired bladder and bowel control, sexual dysfunction, saddle anesthesia, and limb impairment.
• MRI required immediately.
• Surgical decompression needed within 48 hours to prevent permanent damage.

Palliative Pain Management

• Palliative care focuses on relieving pain and other distressing symptoms in patients facing life-threatening illness. It aims to maximize comfort and quality of life.
• It can be given alongside curative treatments.
• It does not hasten or postpone death but focuses on goals of pain control, avoiding prolonged suffering, a sense of control, easing family burden, making clear decisions and completing life tasks.
• Assessing the patient's physical, spiritual, emotional, and social needs is crucial.

Barriers to Palliative Care

• Lack of resources
• Lack of knowledge
• Provider bias
• Misunderstanding
• Restrictive eligibility criteria
• Reluctance

Palliative Assessment

• A comprehensive history is essential.
• A complete physical, psychological, social, and spiritual assessment.
• Appropriate investigations.

Basic Principles of Pain Management

• Delay in treatment should be avoided.
• Oral routes are generally preferred for medication.
• Analgesics should be used as per the need for regular pain relief.
• Breakthrough pain should be addressed.
• Educate patients on pain management and the use of pain scales.

WHO Pain Ladder

• A systematic approach to pain management.
• Provides guidance on appropriate pain medications based on pain severity.

Complications

• Peripheral Neuropathy: Nerve damage.
• Diabetic Foot: Foot complications when diabetes results in nerve damage.
• Guillain-Barre Syndrome (GBS): Rapidly progressing, potentially fatal, nerve condition.
• Trigeminal Neuralgia (TN): Uncommon, extremely painful facial pain.

Special Populations

• Addressing pain management for individuals with substance abuse disorders requires a dual diagnosis approach.

Peripheral Neuropathy

• Neuropathy affects one or more nerves (mononeuropathy or polyneuropathy).
• Symptoms depend on the type of nerve damaged.
• Symptoms can include muscle weakness, twitching, tremors, sensory dysfunction, and autonomic dysfunction.
• Common causes include autoimmune conditions (e.g., lupus), diabetes, infections, and certain medications.

Complications of Peripheral Neuropathy

• Burns and skin injury
• Falls
• Infection
• Heart and circulatory system problems
• Diabetic foot ulcers
• Gangrene

GBS:

• A rapidly progressing and potentially fatal nerve condition.
• Characterized by symmetrical ascending paralysis, loss of reflexes, and often triggered by infections (viral or bacterial)
• Requires constant monitoring of the respiratory system and may require mechanical ventilation.

Trigeminal Neuralgia

• A chronic painful condition.
• Characterized by severe electric shock-like facial pain outbreaks.
• Often starts as brief attacks (seconds to minutes).

Bell's Palsy

• An acute facial nerve disorder causing paralysis.
• Majority of patients recover in 3 weeks.
• It is often associated with emotional stress and trauma.

This quiz explores important concepts in pain management, specifically focusing on fibromyalgia and related treatment options. It covers various symptoms, psychological aspects, and specific demographic considerations related to fibromyalgia patients. Learn about underlying conditions and treatment strategies that can aid in managing pain effectively.