Pain Management - Guidelines and Clinical Issues

Contents List

Part I Pain Evaluation and Management

	Pain management introduction
	Washington State Pain Management Guidelines
	Classification of Pain, Pain measurement/scoring
	Barriers to adequate pain control
	Pre-emptive, multimodal or balanced analgesia/pain management
	Behavioral Therapy Aspects of Pain Management
	Palliative or ‘End-of-life’ care/Cancer pain
	Placebo use
	JCAHO standards
	Diabetic peripheral neuropathy
	Surgical pain management - Conscious sedation (P & P); Post-op wound irrigation with local anesthetics; Opioid-related adverse events in surgical patients: increased LOS
	Patient satisfaction
	Pain Management Issues
	Opioid contracts
	Pain Rehabilitation Programs
	Pain Clinics or Centers
	Chronic/Persistent Pain Programs – coverage
	Chronic/Persistent Pain Programs – Inpatient
	Pain Rehabilitation, Outpatient
	Outpatient Hospital Pain Rehabilitation Programs, Medicare NCD
	Exit Criteria from chronic pain programs
	Dental pain management – after hours care
	Headaches
	Pain Management in Long Term Care; Care plan, links
	Pain Management in the Emergency Department
	Case Management
	Pain Management Notes

Pharmacologic/Non-pharmacologic Pain Management

	Initial oral mild to moderate pain management
	Prescribing Guideline – California model guideline
	Medical Marijuana
	Opioid therapy
	Methadone
	Cancer Pain Management
	Topical NSAIDs for chronic musculoskeletal pain
	Neuralgic/Neuropathic Pain
	Pharmacologic Challenges for Sympathetically Maintained Pain
	Continuous Epidural Analgesia for the treatment of Complex Regional Pain Syndrome (CRPS)/Reflex SympatheticDystrophy (RSD)
	Coanalgesic drug therapy to manage specific pain syndromes (Table)
	Cognitive behavioral therapy
	Physical therapy for regional pain syndromes
	Cryoanalgesia and Cold Laser Therapy
	Pulsed Radiofrequency for Pain Management
	Trigger Point Injections
	Induced Lesions of Nerve Tracts, Medicare NCD
	PCA by proxy – JCAHO sentinel alert

Pain management patient self-evaluation tools

Pharmacy tables - drugs, eqianalgesic calculations

Addiction

Diversion

Complementary and Alternative Medicine; Approaches to pain management

	Acupuncture
	Biofeedback
	Bioelectromagnetic therapy
	Guided imagery
	Manual/massage therapies
	Naturopathy
	Relaxation therapy
	Transcendental meditation
	Resources - CAM

Legal issues related to pain management – California Medical Board policy statement and guideline

References/suggested reading by topic related to Pain Management

References/suggested reading by topic related to CAM

CAM web sites

Anesthesiology Pain Management Services

Anesthesia services - General Coverage Policy; Office-based anesthesia; Dental Anesthesia; Safe sedation of children; Pain Management; Intrathecal/subarachnoid injections; Epidural injections for pain; Continuous epidural analgesia; Cryoanalgesia and Cold Laser (low-energy or low-level) Therapy for wound healing, pain therapy, and other disorders;

Facet Joint Injections/Median Branch Nerve Blocks; Facet Denervation, Facet Denervation: Neurotomy, Facet Rhizotomy, or Articular Rhizolysis; Facet Denervation: Percutaneous Radiofrequency; Celiac plexus nerve blocks; Paravertebral Nerve Blocks; Percutaneous alcohol injections for the ablation of intractable pain; Anesthesiology Notes.

Resources - Pain Management

Pain Management Organization web links: CAM, Pain, and Palliative/End-of-Life Care

Consent and Agreement Forms for long-term controlled substance/opioid therapy

	Informed Consents for Long-term Narcotic Use - example
	Opioid Contract – UC Davis form

Pain Publications for Patients and Their Families

Palliative Care Leadership Centers

Model Policy for the Use of Controlled Substances for the Treatment of Pain. Federation of State Medical Boardsof the United States, Inc. 2004

Pain Management Provider Credentialing

Pain Management Notes

Part II Skeletal Muscular System Guidelines

· Knee

ü Arthroscopy, knee

ü Total Knee Replacement

ü Hyaluronidase, intra-articular injections for osteoarthritis, knee

ü Knee, general references

· Back and Neck Pain – Evaluation and Procedures

ü Low back pain (Acute, ‘slow to recover’)

ü Anti-depressant drug therapy for low back pain

ü Machines to test and treat low back pain

ü Algorithm for back pain evaluation

ü Chymopapain Chemonucleolysis

ü Endoscopic Anterior Spinal Surgery

ü Epidural injection of steroids for back pain

ü Facet Joint Injections/Nerve Blocks

ü Facet Denervation, Facet Neurotomy, Facet Rhizotomy, or Articular Rhizolysis

ü Hypertonic saline for the treatment of epidural adhesions, adhesive arachnoiditis, or failed back syndrome

ü Intradiscal electrothermal therapy (IDET)

ü Laminectomy

ü Magnets for the treatment of chronic low back pain

ü Meniscectomy

ü Microdiscectomy, Percutaneous Lumbar Discectomy

ü Percutaneous vertebroplasty

ü Spinal Instability – Pedicle screw fixation

ü Spinal stenosis

ü Trigger Point Injections

ü Cervical Pain, acute

ü Chiropractic Medicine

· Spinal manipulation under anesthesia

ü Bone stimulators, electric and low-intensity ultrasound

· Distraction osteosynthesis, Ilizarov method

· Olecranon bursa aspiration

· Total Hip Replacement (arthroplasty); Primary, excluding hip fracture;

· Injection, tendon sheath, ligament, or trigger points or ganglion cyst

· Arthrocentesis – Joints; Aspiration/Injection Ganglion Cyst

· Kyphoplasty

· Ultrasound therapy for calcific tendinitis of the shoulder

· Fibromyalgia

· Rheumatology links

· Post-work Injury Evaluation and Work Hardening

· ‘Prehab’

Web Sites – Skeletal-Muscular System-related

References – General - for skeletal-muscular pain management

E-mail apollomanagedcare@cox.net to request example pages or additional information.

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The practice of evidence-based medicine means integrating individual clinical expertise with the best-available external clinical evidence from systematic research.

Centre for Evidence-based Medicine, Oxford University

Pleasure is nothing else but the intermission of pain.

John Seldez (1584-1654)

There is a fine line between alternative therapies that make you feel good and those that are really doing some good.

Managed Healthcare, June, 1997

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Continuous Epidural Analgesia for the treatment of Complex Regional Pain Syndrome (CRPS)/Reflex SympatheticDystrophy (RSD)

Coanalgesic drug therapy to manage specific pain syndromes (Table)

Cognitive behavioral therapy

Cryoanalgesia and Cold Laser Therapy

Pulsed Radiofrequency for Pain Management

Trigger Point Injections

Induced Lesions of Nerve Tracts, Medicare NCD

Resources - CAM