Pain Management Central

• One in five people with pain and a chronic disease also have depression. Antidepressants, particularly tricyclic antidepressents, can help reduce chronic pain.¹
• In 2017, the average opioid prescription rate was 58.7 prescriptions per 100 people. Certain counties had rates seven times that amount.²
• Over 80% of patients who have surgical procedures experience postoperative pain. Seventy-five percent of those with postoperative pain report the severity as moderate, severe or extreme.³
• Chronic pain is common in adolescents and children, with median prevalence rates varying from 11% to 38% depending on the underlying condition.⁴
• According to the CDC, opioid use has declined since 2010, but opioid-related deaths have risen. The recent spike has been largely attributed to illicit use of fentanyl, heroin and carfentanyl.⁵
• Complementary and alternative medicine, which encompasses all techniques outside of conventional medicine, are used by an estimated 38% of adults and 12% of children.⁶
• Nutrition can play a role in pain management, especially in regard to decreasing inflammation. Anti-inflammatory diets that are high in legumes, fruits, whole grains, fish and healthy oils have been shown to improve overall health and reduce inflammation.⁶
• Myofascial pain, among the most common types of pain, is caused by slight pressures on spinal nerve roots. The pressure result in nerve dysfunction, leading to hypersensitivity in the structures connected to the roots.⁶
• Alternating between heat and cold can be used to manage pain due to rheumatoid arthritis. Cold packs numb the pain throughout the affected area, while intense heat can help to relax affected muscles and joints.⁷
• Research shows that acupuncture, an approach in which practitioners stimulate specific points on the body by piercing the skin with needles, may be effective for treating back, neck and knee pain. However, evidence suggests that acupuncture’s effectiveness is largely related to psychological factors such as expectation and beliefs related to the treatment.⁸
• Pre-emptive analgesia is an increasingly popular form of preventative pain management that is used in patients undergoing orthopedic surgery. The treatment utilizes non-steroidal anti-inflammatory drugs, adrenergic agents and local anesthetics, as well as novel delivery of opioid medications.⁹
• Treatment with NSAIDs have resulted in positive effects among patients undergoing orthopedic surgery, including reduced edema and hypermetabolism at the surgical site, as well as a decreased postoperative stress response. However, NSAIDs cause a small decrease in renal blood flow.⁹
• Patients who require pain management following orthopedic surgery typically fall into one of two categories: elderly patients admitted for repair of a fracture or younger patients admitted for elective joint replacement.¹⁰
• Due to concerns surrounding opioid use, alternative approaches like medical hypnosis and acupuncture are becoming increasingly popular with orthopedic surgeons and their patients.¹¹

References

1. Cedars-Sinai Medical Center. Rheumatic pain management. Available at: https://www.cedars-sinai.org/programs/rheumatology/treatments/rheumatic-pain-mangement.html. Accessed July 19, 2019.
2. CDC. U.S. opioid prescribing rate maps. Available at: https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html. Accessed July 19, 2019.
3. Chou R, et al. J Pain. 2016; doi: 10.1016/j.jpain.2015.12.008.
4. Palermo TM, et al. J Pain. 2019; doi: 10.1016/j.jpain.2018.09.009.
5. Wardhan R, et al. F1000Res. 2017; doi: 10.12688/f1000research.12286.1
6. International Association for the Study of Pain. Integrative pain medicine: A holistic model of care. Available at: http://americanpainsociety.org/uploads/get-involved/iasp-clinical-update.pdf. Accessed July 22, 2019.
7. Rheumatoid Arthritis Support Network. RA pain: What is the best pain relief for rheumatoid arthritis? Available at: https://www.rheumatoidarthritis.org/living-with-ra/pain-management/. Accessed July 22, 2019.
8. NIH. Acupuncture: In depth. Available at: https://nccih.nih.gov/health/acupuncture/introduction. Accessed July 22, 2019.
9. Practical Pain Management. Treatment of acute pain in the orthopedic patient. Available at: https://www.practicalpainmanagement.com/treatments/pharmacological/treatment-acute-pain-orthopedic-patient. Accessed July 23, 2019.
10. ACP Hospitalist. Managing pain in orthopedic patients takes awareness, finesse. Available at: https://acphospitalist.org/archives/2008/05/pain.htm. Accessed July 23, 2019.
11. OrthoInfo. Managing pain with medications after orthopaedic surgery. Available at: https://orthoinfo.aaos.org/en/recovery/managing-pain-with-medications/. Accessed July 23, 2019.