6.) Chronic Pain: Careful selection

From: Helen Dynda (olddad66@runestone.net)
Mon Aug 27 13:14:25 2001

6.) Careful selection Implantable therapies are not for everyone. For some patients, an implantable therapy is the last alternative before considering permanent ablative neurodestructive procedures. The ideal candidate for an implantable device is a patient who did not respond effectively with more conservative therapies and who achieves a significant amount of pain relief from a trial screening period with spinal cord stimulation or intraspinal opioids. Advanced pain treatment therapies are more likely to succeed in patients who don’t have serious drug dependence and have a strong desire to participate in treatment. A psychological evaluation, including both psychological testing and clinical interview, is essential for determining the patient’s chance for success with implantable therapy. Patients with drug abuse histories, those who obtain important secondary gains from their pain, and those with significant psychological problems are not good candidates for implantable therapies.

The intended outcomes of implantable therapy are improvement in the person’s ability to participate in activities of daily living, pain reduction, decreased use of oral medications, return to work, and improved quality of life. The advantages of implantable therapies are that they are cost-effective, nondestructive, and reversible. In general, the implantation procedure costs approximately what alternative therapy costs per year and produces better long-term results in appropriately selected patients. In one study, 50 percent of suitable patients receiving spinal cord stimulation experienced pain relief; 24 percent returned to work. The results for intrathecal morphine are even more impressive—80 percent of patients reported pain relief and 40 percent resumed work. Patient age, length of disability, occupational mobility, and activity levels are among the factors that predict the likelihood that a patient with chronic pain will return to work.

To stop the downward spiral of chronic pain, a partnership is needed between nurses, other healthcare professionals, and the patient and family. Nurses have many roles to play in managing chronic pain: educator, clinician, case manager, and consultant. Nurses are also often in a position to suggest a referral to a chronic pain treatment clinic for the patient whose pain has become a disabling problem. Chronic pain is a complex, multidimensional health problem. As part of an interdisciplinary management team in a variety of healthcare settings, nurses can use their knowledge of pain management to help patients improve their health status and enhance their quality of life.

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The above information is from:

[]] Chronic Pain: Stopping a Downward Spiral


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