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An Overview of Chronic Pain
Transcript of An Overview of Chronic Pain
Dr. Ajit Panickar, MBBS MRCP(UK) FRCA
Consultant, Anaesthesia & Pain Management
South Glasgow University Hospitals
Acute pain is
Acute pain is
Chronic Pain is...
Exclude treatable illness
Nerves are wires
But nerves are more than wires....
> 3 months
extends beyond expected
period of healing
"something we can manage but not cure"
Pain goes away as
‘Gunshot Wounds and Other Injuries':
The last of the immediate symptoms of grave lesions of nerves is pain,
elsewhere than in the wound
..(in some) the pain was of that
strange burning nature
...it was rare to observe this peculiar and agonizing form of suffering among the immediate consequences of a nerve wound.
The seat of burning pain is very various. Its favourite site is the foot and hand. Its
from the most trivial burning to a state of torture. The part itself becomes
a touch or a tap of the finger increases the pain
. Exposure to the air is avoided by the patient with a care which seems absurd and most bad cases keep the hand constantly wet, finding relief in the moisture.
As the pain increases, the
general sympathy becomes more marked
, the face becomes
and has a look of
sleep is restless
. At last the patient grows
, carries the limb tenderly with the sound hand, is
all kinds of expedients
for lessening his pain.
Removal of stress (injury)
does not lead to
relief of pain
Pain persists once injury healed
The pain service
Make a diagnosis
54 year old male
Longstanding low back pain
Off work for 6 months
Long periods bed rest
Cannot go out/socialize
scared to bend/exert himself
Now walks with a stick - embarassed
Depressed, cannot sleep
MRI: "wear and tear"
Worried about serious illness
convinced doctors have "missed problem"
looking for cure
wife insists on "looking after him"
mobility, range of movement, strength
education is key
review of patients & medication
fear & worry
thoughts, beliefs, emotions
A chronic pain diagnosis
mechanical back pain + neuropathic leg pain
unhelpful beliefs about cause & meaning of pain
unhelpful coping strategies
"An unpleasant sensory &
associated with actual or
or described in terms of such damage"
some chronic pain conditions
trauma & surgery
soft tissue conditions
Conversation, not lecture
I avoid emotive or technical terms
I don't assume understanding
I take time (more if needed)
RED HARVESTER ANT
SCHMIDT STING PAIN INDEX
1.0: "light, fruity; a tiny spark has singed a single hair on your arm"
2.0: "hot, smoky, a cigar extinguished on your tongue"
3.0: "bold, unrelenting, using a drill to excavate your own toenail"
4.0: "pure, intense, like walking over charcoal with a nail in your heel"