● FLACC scale : The FLACC scale is used for cognitively impaired individuals , or those unable to self-report (e.g. people with dementia or small children that cannot speak or point). It rates the pain level based on five criteria: ○ F ace (expressions, grimace, etc.). ○ L egs (kicking, restless, etc.). ○ A ctivity (moving, rigid, etc.). ○ C ry (moans, sobs, etc.). ○ C onsolability (relaxed, difficult to console, etc.). (D’Arcy, 2007; National Hospice and Palliative Care Organization, n.d.) Treatment for pain often involves a combination of pharmacological and non-pharmacological approaches. When developing a treatment plan, it is important to remember that all patients, regardless of age, should be treated with respect and dignity, and that all patients should play an active role in the management of their pain. Several important things to consider in pain treatment are that acknowledging pain is not a sign of weakness; it is an essential first step towards treating the pain.
When assessing pain, it is also important to keep in mind any cultural influences that may affect the pain experience. Cultural sensitivity is important to understanding a patient’s perception and his or her ability to deal with pain. However, it is important not to assume that all patients from a specific culture will behave in the same way. All patients should be treated as individuals and with respect (Galanti, 2016).
OVERVIEW OF TREATMENT
Pain is also not a normal part of aging; older patients need comprehensive pain management programs just as much as younger patients (Center for Medicines & Healthy Aging, 2018). The following sections will offer a brief overview of common medications for treating pain, followed by non-pharmacological approaches to treating chronic pain.
PAIN MEDICATION
3. Adjuvant analgesics : Medications originally used to treat conditions other than pain, but they may help relieve specific pain problems; examples include some antidepressants and anticonvulsants. 4. Other : Medications with no direct pain-relieving properties may also be prescribed as part of a pain management plan. These include medications to treat insomnia, anxiety, depression, and muscle spasms (ACPA, 2016). thinners or antiplatelet aggregation drugs (warfarin, clopidogrel) (ACPA, 2016). Acetaminophen is another common non-opioid analgesic that is available over the counter. Physical therapists should be alert for signs of liver failure in their patients taking acetaminophen, especially those with a history of liver problems. These signs and symptoms include jaundice, loss of appetite, fatigue, itching, pain in the upper right abdomen, and dark urine (Rxlist.com)
Four categories of pain relievers are commonly used to relieve pain: 1. Non-opioid analgesics : Aspirin, Non-steroidal anti- inflammatory drugs (NSAIDs), acetaminophen. 2. Opioids (also called narcotics) : Morphine, codeine, hydrocodone, oxycodone, and methadone are examples of opioid medicaitons. Tramadol and tapentadol are not true opioids, but they work similarly to opioids, and primarily on the same receptors. Non-opioid analgesics Non-steroidal anti-inflammatory druges (NSAIDs) are useful for treating mild to moderate pain. NSAIDs include drugs such as ibuprofen, aspirin, naproxen, and celecoxib. NSAIDs carry the risk of side effects (stomach ulcers, kidney failure), and patients who take higher doses of NSAIDs for extended periods are most at risk. NSAIDs have a thinning effect on the blood and should be used with caution or avoided in those patients on blood Opioids Opioids are morphine-like substances that occur naturally in the body (endorphins, enkephalins, dynorphins) or can be synthetic or semisynthetic (ACPA, 2016). Opioids act on four types of Adjuvant medications Adjuvant medications are medications not typically used for pain relief, but may be helpful in certain pain-causing conditions with or without the presence of a pain reliever. Adjuvant medications include antidepressants, anticonvulsants, and botulinum toxins.
receptors in various areas-from the cerebral cortex to the spinal cord and peripheral locations-thus offering incomparable analgesic effects (Mugabure Bujedo et al., 2015).
Evidence-Based Practice Alert! Discoveries of gender differences in pain perceptions and responses to treatment have led to new research directions on the experience and relief of pain. For example, medications called kappa-opioids provide effective relief from acute pain in women, yet increase pain in men (The National Institutes of Health, n.d.).
NON-MEDICATION TREATMENT OPTIONS
Most people with chronic pain incorporate both medication and non medication strategies into their treatment regimen. In 2016, the Center for Disease Control (CDC) released opioid prescription guidelines in response to the growing opioid epidemic. These guidelines stated that while opioid prescription is indicated in some situations such as cancer treatment, Physical therapy In response to the CDC’s guidelines and the opioid epidemic, the American Physical Therapy Association (APTA) launched the #ChoosePT campaign, with the goal of educating the public on
palliative care, and others, nonpharmacological approaches such as physical therapy and cognitive behavioral therapy are preferred for chronic pain, since the benefits and efficacy of these approaches outweigh the risks of opioid medications (Dowell et al., 2016). These approaches, along with nutritional considerations, will be discussed in this section.
the risks of opioids and the benefits of physical therapy over prescription pain medication (ChoosePT, n.d.). Though chronic pain can be challenging to treat, pain research, particularly in
EliteLearning.com/ Physical-Therapy
Book Code: PTNC1023
Page 64
Powered by FlippingBook