Facilitating patients in their goals to wellness can be stressful. I know. I have found many tools to help me cope with stress, all of which I have shared on my website and on the Blog section (2019/Aug/20). First rule in a crisis – start with yourself before you can help others. Another helpful link to Fight Burnout. If you have any suggestions, please help build and improve this website by adding your thoughts to the comment section found on each page. Thank you for helping families and communites cope with chronic pain.
Forms are a great way to initiate management of Chronic pain.
Forms relating to Pain
Managing chronic pain is an opportunity to manage far more . . .
There are many ways to assess trauma – copy and paste this address for an easy form to print in your office.
Click to access 20ACE%20Score.pdf
Or have your patients visit this site: https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences
Chronic pain management is a complex problem and there are risks to undertreating pain, as well as opioid use. Below and article on the legal and ethical implications of pain management.
https://www.ncbi.nlm.nih.gov/pubmed/29957968
There are many health professionals who can form part of a multidisciplinary approach to pain management.
Article in BCMJ on Resources in BC and Chronic pain Management.
(unfortunately you will have to copy and paste to view)
https://bcmj.org/special-feature/resources-bc-health-care-providers-and-people-living-chronic-pain
There are also physicians dedicated to chronic pain. Here is a great website with helpful tips in managing complex pain and links to articles on managing pain. http://painmuse.org
There are many resources available to physicians and doctors to make this approach possible.
Consider referral to Pain BC
Referral to Self-Management BC
For improvement of mental health: Mental Health Improvement Canada
Specialized Clinics can offer invasive pain procedures like epidurals and other steroid infiltrations. These procedures can be used to assess whether more invasive treatment is warranted.
Cariboo: Cariboo Memorial Hospital
British Columbia: BC interventional Services
Great link to an article on Buprenorphine https://www.wired.com/2005/04/bupe/
Another article with important information – there are some inaccuracies with regard prescribing practise – in Canada – Buprenorphine is prescribed as other opioids on a special prescription. There are certain rules. It is used only off-label for pain – do your research. https://edsinfo.wordpress.com/2018/08/02/what-makes-buprenorphine-risky-for-pain-patients/
People with chronic pain have a hard time understanding the cause of their suffering. When the cause of chronic pain is not obvious, explaining pain is hard.
Healthcare providers may be too busy to provide the time necessary to explain pain. There are many theories as to the causes of widespread pain:
1. Neuroplasticity and the development of central and peripheral sensitization [1]
2. Nerve hormone changes (Neuro-endocrine) changes; 3. Anxiety 4. Small fibre polyneuropathy [2]
Small-fiber polyneuropathy (2)
Development of myofascial trigger points (MTP)2
Decreased anti-nocioceptive substances (3)
Increased production of toxic metabolites with exercise (2)
Sleep disorders (3)
Genetic transmission; mechanical traumas; conditions which include autoimmune
disorders, celiac disease and cerebral palsy; and toxins, like alcohol, excess glucose, drugs and
infectious agents.
Once a serious disease has been excluded, healthcare providers can use available resources to
relieve the heavy load of managing all aspects of chronic pain. Referring patients to allied health
professionals and self-management programs will improve patients’ self-efficacy and lead to
long term improved chronic pain.
People living in pain can find it hard to describe the intensity of their pain and how much it
affects their lives. There are many forms available that make such assessments easier. Families
or friends can help those who are too tired or overwhelmed to complete the forms and in doing
these tasks, the support system for the person in pain is often improved.
Physicians play a vital role in the pain management team. They can assess readiness for
change and once patients feel able, can help them navigate the programs and provide support and guidance as they travel through their pain journey.
Pain may require medications, even opioids. Although opioids come with inherent risks, there
are safer options which can drastically alter the quality of a person’s life.
In B.C. the RACE line is a fast and convenient way to consult a specialist pain physician. Physicians can bill for the time spent consulting these specialists. These specialists can assist with the management of the more complex, at risk individuals.
The opioid crisis is only one of many reasons to join the battle against chronic pain, but it is an
important one. It is only by effectively managing people who endure chronic pain that we can
truly assess what role we physicians play in preventing opioid overdoses and deaths.
Join the battle against chronic pain.
Please send any comments your feel necessary or provide feedback in the Community of Pain
Blog area.
Thank you valued member of the Battle against Chronic Pain.
References
1. Staud Roland, Peripheral Pain Mechanisms in Chronic Widespread Pain, Best Practice Res in
Clin Rheumatology, 2011, April; 25(2):155-164.
2. Oaklander AL, Herzog, ZD, Downs HM; Objective evidence that small-fibre polyneuropathy
underlies some illnesses currently labelled as fibromyalgia. Pain 2016, Nov; 157(11) 2493-
2503.
3. Bellato E, Marinin E, Castoldi F, et al. Fibromyalgia Syndrome: Etiology, Pathogenesis,
Diagnosis, and Treatment. Pain Res Treat. 2012; 2012:426130. Published online 2012 Nov 4.
Doj: 10.1155/2012/426130
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Post Traumatic Stress Disorder 