Case study summary Zain’s case highlighted how numeric scales may facilitate quantitative progress monitoring in pain therapy. In parts, it also highlighted how pain care teams should conduct a comprehensive assessment of lifestyle, pain complications report, and supplementary care plans (non-drug care) in cases resulting from severe pain impairments. Self-Assessment Quiz Question #11 Which of the following is considered Zain’s biggest risk factor
This new role significantly influenced his style of play. However, 6 months after the first incident, Zain sustained another injury to the back causing him to limp off the field of play. About 2 weeks later, he was diagnosed with fibromyalgia, chronic back pain, and hypertension. Physical examination and vitals Zain reported primary pains radiating from the neck to the lower back. A pain assessment was consulted to fully understand the level of sensation he had and the severity over different locations and ranges of movement. He self-reported his pains on a 10-point scale by life impacts starting from muscle and skeletal pains to soft tissue pains. The Fluminense medical team documented his report as follows: ● Upper back pains: life impact rank 8 out of 10. A year before the first incidence, he had experienced radiating upper back pain and was relieved by opioids. ● Bilateral hip pains: life impact rank 7 out of 10. ● Lumbar pains: life rank of 8.5 out of 10. ● Radiological examinations suggest progressive degeneration of the sacroiliac joints and a moderate multilevel fate arthropathy. On lumber epidural, the pain was significantly reduced, and Lidocaine patches also helped. ● Shifting musculoskeletal pains: life impact of 8 out of 10 with pain sensations radiating from the gluteals to the deltoids. Pain complication report On further questioning, the medical team identified some lifestyle problems that might have negatively impacted Zain’s fibromyalgia and his road to recovery: ● Smoking: Zain’s smoking habit is well known. Over the past 2 years, he had reportedly consumed tobacco at levels more than the average Norway smoker. ● Insomnia: with a poor sleep habit, Zain has developed insomnia for ‘the longest of times he could remember.” ● Sedentary lifestyle: With the exemption of his rugby career, Zain lived a largely sedentary lifestyle, rarely going out and walking less than 5,000 steps on most days. Therapy Zain admitted to having had poor adherence to medication over the past 6 months. His current medications plans: ● Pregabalin. ● Meclizine. ● Buprenorphine/Naloxone. ● Metoprolol. ● Hydrochlorothiazide. ● Supplements include melatonin, cholecalciferol, and levomefolic acid. Supplementary therapy plans The care team agreed that addressing Zain’s sedentary lifestyle could potentially improve his chances of a fast recovery. To this end, the team explored relaxation, yoga, and outdoor virtual reality experiences to primarily improve his movement range. Over the next 7 months of therapy, he is expected to walk an average of 8 thousand steps per day with a stepwise increase in daily target steps over the next 3 months.
for his pain condition? a. Poor sleep habits. b. Zero history of illicit drug use. c. Zain’s ”bull-them-all” runs. d. Zain’s use of Supplements.
Self-Assessment Quiz Question #12 Which of the following was Zain’s primary diagnosis?
a. Lung cancer. b. Nerve pains. c. Obesity. d. Fibromyalgia.
Self-Assessment Quiz Question #13 In this case, study, which of the following is true about the use of Lidocaine patches? a. It is indicated for the cure of fibromyalgia.
b. It affected sustained pain relief. c. It is unnecessary in this scenario. d. It is contraindicated in athletes.
Self-Assessment Quiz Question #14 As used in this case study, which of the following is true about Pregabalin? a. It is indicated for the cure of skeletal degeneration.
b. It is indicated for neuropathic pain. c. It is unnecessary in this scenario. d. It is contraindicated in athletes.
Self-Assessment Quiz Question #15 As used in this case study, which of the following is true about the supplement melatonin? a. It is contraindicated in athletes with fibromyalgia. b. It enhances the effect of Lidocaine. c. It is prescribed to correct Zain’s insomnia. d. It is unnecessary in this scenario.
CONSIDERATIONS IN PAIN ASSESSMENT AND MEASUREMENT
Assessment of pain can be a simple task when dealing with acute pain and pain as a symptom of trauma or disease. Assessment of the location and intensity of the pain often suffices in clinical practice. However, other important aspects of acute pain, in addition to pain intensity at rest, need to be defined and measured when clinical trials of acute pain treatment are planned. If not, meaningless data and false conclusions may result. Assessment of long-lasting pain and the effect of treatment is more challenging, both in patients suffering pain from nonmalignant causes and in patients with cancer pain. Numerous instruments have been developed for diverse types and
subtypes of chronic pain conditions to assess qualitative aspects of chronic pain and its impact on function. The extensive list of published instruments indicates that pain assessment continues to be a challenge. Because pain is such a subjective, personal, and private experience, assessing pain in patients with whom we cannot communicate well is difficult, most of all in patients suffering from cognitive impairment and dementia. The visual analog scale (VAS) and numeric rating scale (NRS) are most commonly used to assess the present intensity of acute pain. They are reliable, valid, sensitive to change, and easy to administer for the measurement of the severity of pain. The NRS, using an 11-point scale (0—’no pain’ to 10—’worst pain’, or ‘pain as bad as it could be”), is often preferred due to
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