4.) Chronic Pain: Range of treatments

From: Helen Dynda (olddad66@runestone.net)
Mon Aug 27 13:14:17 2001

4.) Range of treatments Therapeutic modalities for pain can range from simple and noninvasive to surgical and irreversible. At peripheral pain sites, nonopioid analgesics, heat and cold application, and local anesthetics can alter the release of nociceptive substances and reduce muscle spasms. In the spinal cord, epidural analgesics, tricyclic antidepressants, neurosurgical procedures, and stimulation of large nerve fibers by direct electrical stimulation, massage, heat and cold application, and therapeutic touch can interfere with nerve impulse transmissions. In the brain stem, electrical stimulation, tricyclic antidepressants, opioid analgesics, and neurosurgical procedures can reduce or eliminate the transmission of pain impulses. In the cerebral cortex, cognitive techniques such as hypnosis, imagery, music therapy, relaxation, behavioral training, and opioid analgesics provide additional ways to control pain.

Pharmacological managementof chronic pain includes non-narcotic analgesics, narcotic analgesics, and psychotropic drugs. Oral medications start with nonsteroidal anti-inflammatory drugs (NSAIDs) and may progress to include muscle relaxants, antidepressants, and anticonvulsant drugs. NSAIDs such as aspirin, acetaminophen, ibuprofen, and indomethacin are widely available, have few serious side effects, and are effective in relieving pain associated with inflammation, such as musculoskeletal disorders. Narcotic analgesics range from weak to strong opioid drugs. Effective oral doses of oral narcotics range from 15 to 30 mg a day of morphine or its equivalent. Patients may develop tolerance and require increasing dosages. Systemically absorbed opiates can produce many undesirable gastrointestinal side effects such as constipation, nausea, and vomiting and also produce sedation that results in memory impairment, drowsiness, and impaired concentration. Other common side effects of opioid analgesics are fatigue, weakness, and central nervous system depression.

Older patients may have increased sensitivity to the analgesic effects of medications and may have more central nervous system side effects, such as confusion, dizziness, and drowsiness. Aging affects the absorption, detoxification, and excretion of medications, increasing toxicity risks and adverse reactions. Since the average older patient takes four to five medications daily, the adverse risks are increased. These problems underscore the need to consider nonpharmacological means of pain management in this age group.

Nerve blocks may be used to stop the transmission of pain impulses. For patients not responsive to any other form of treatment, a neuroablative procedure—which destroys nervous system tissues—may be considered to relieve intractable pain. Two examples of a neuroablative procedure are a rhizotomy—destruction of the sensory root of a spinal nerve—and a cordotomy—destruction of part of the spinal cord’s major sensory tract. Because their effects are irreversible, they are a last resort.

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The above information is from:

[]] Chronic Pain: Stopping a Downward Spiral


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