Course 3: Pain Assessment and Management: Role of the PT 1 Contact Hour
By: Keelan Enseki, MS, PT, OCS, SCS, ATC, CSCS Learning objectives After completing this course, the learner will be able to: Define pain according to the International Association for the Study of Pain. Identify the economic and personal impact of pain, as well as potential prescription drug abuse. Course overview Pain is a complex phenomenon. It can warn us that we are, or are attempting to go, beyond what is safe for our bodies. It can indicate a pathophysiology that requires medical attention; however, sometimes, pain can be an unreliable indicator of illness or injury. At other times, pain from common conditions, such as fibromyalgia or migraine headaches, may have no specific, identifiable physical pathology, but the patient can experience a significant degree of pain. Pain can be acute, or persistent/chronic, lasting for months or years and interfering with an individual’s life. Pain is experienced differently by each individual. The experience of pain and the way individuals react to it varies with culture, age, and co-existing medical or mental health conditions. Adding to the complexity of the pain phenomenon is the way individuals respond to the treatment of the pain. Persons
Examine the physiology, classifications, and characteristics of acute and chronic pain. Describe concepts and tools for pain assessment. Describe both pharmacological and non-pharmacological approaches to treating pain. with the same diagnosis may receive nearly identical treatment, but respond quite differently. This makes it especially important to assess pain carefully, and to develop an individualized plan of care for each patient. This educational course will present a brief overview of pain, including current terminology and different pain types. An overview of pain assessment and both pharmacological and non-pharmacological treatment will be presented, including general concepts of physical therapy treatment for chronic pain. This course will empower the physical therapy professional to understand the vital role they play in helping their patients to reclaim their lives. Resources for further reading will also be provided.
DEFINITION, CLASSIFICATIONS, AND TYPES OF PAIN
The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (IASP, 2017). Note that this definition refers not only to the physical sensation of pain, but also to the emotional experience of pain as well. Pain causes not only physical discomfort, but also takes a toll on the emotional well- being of the sufferer. The IASP also acknowledges that pain is associated with both actual damage and potential damage. The two most general classifications of pain are acute pain and chronic pain. Acute pain has a sudden onset, is associated with a specific event, such as trauma, and is of limited duration. Chronic pain can last for weeks, months, or years and though it can sometimes be linked to an underlying pathological process that is ongoing or degenerative, sometimes chronic pain exists in the absence of any identifiable tissue dysfunction. Table 1 summarizes some of the differences between acute and chronic pain. Table 1. Acute Verses Chronic Pain Acute Chronic • Time-limited. • Not an ongoing process. • Sudden onset. • Persists for weeks, months, or years. • Can be an ongoing process that lasts a lifetime. • Associated with a specific physical trauma or acute illness. • May be associated with an ongoing process that can be ongoing or degenerative in nature. • Generally, a signal that injury or illness is occurring. • Generally, an ongoing problem that may have no specific explanation. Note . From Elite Schools, 2018.
There are various types of pain. It is important for physical therapiststo be able to define the different types of pain and recognize the impact that each type has on physical and emotional well-being. Pain types include: ● Breakthrough pain : “ A sudden increase in pain that may occur in patients who already have chronic pain from cancer, arthritis, fibromyalgia, or other conditions. Breakthrough pain usually lasts for a short time. During breakthrough pain, the level of pain may be severe, but the type of pain and its location in the body are usually the same as the patient’s chronic pain”. (National Cancer Institute Dictionary of Cancer Terms, no date given) ● Neuropathic pain : “Pain caused by a lesion or disease of the somatosensory nervous system”. (IASP,2017) ● Nociceptive pain : “Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors”. (IASP, 2017) ● Nociplastic pain : “Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain”. (IASP, 2017) ● Referred pain : Referred pain occurs when a patient feels pain in one part of the body, but the pathology is elsewhere. An example of this type of pain is when the pain of angina, occurring as a result of coronary artery insufficiency, is felt in the jaw or the left shoulder instead of the chest. Another example is gall bladder disease, which can cause pain in the right shoulder or scapular area (Mosby, 2016). ● Somatic pain : A type of nociceptive pain that may also be referred to as skin pain, tissue pain, or muscle pain. The nerves that detect somatic pain are located in the skin and deep tissues (Jacques, 2018). It is usually easy to locate and is increased by movement or direct contact. ● Visceral pain : Another type of nociceptive pain that originates from internal organs, such as the bowel or gall bladder. It is described as dull and may be difficult to locate, as it is often diffuse in nature (Jacques, 2017).
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Book Code: PTNC1023
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