Objectives. Provide a framework for comprehensive pain evaluation and individualized multimodal treatment. Improve quality of life and function in patients experiencing pain, while reducing the morbidity and mortality associated with pain treatments, particularly opioid analgesics.
A team-based approach, adequate consultative support, and training can begin to address some of these barriers. Patients may have individual barriers to accessing care or participating in self-management. Provide them with specific support as needed.
In some cases, underlying neurobiologic mechanisms may be overlapping, and more than one pain syndrome may be present.
Although not completely understood, the pathophysiology is thought to involve the following two mechanisms:
Obtain a thorough social history of interpersonal relationships at home, work, or in other environments that may improve or negatively impact the adjustment to chronic pain. Consider screening patients with chronic pain for a history of trauma and for adverse childhood experiences.
If you regularly have trouble either falling or staying asleep — a condition called insomnia — make an appointment with your health care provider. Treatment depends on what's causing your insomnia.
The principles of pain management are detailed in this article. Acute pain management, chronic noncancer pain management, and pain management in palliative care are detailed separately.
Sleep. For all patients recommend good sleep habits. Screen for sleep disturbance. Sleep complaints occur in 67–88% of individuals with Shop Now chronic pain. Sleep and pain are often linked. Sleep disturbances may decrease pain thresholds and contribute to hypersensitivity of neural nociceptive pathways.
Insurance companies may have restrictions on which sleeping pills are covered. And they may require that you try other approaches first to try to manage your insomnia.
Current psychological interventions for chronic pain are based on recent advances in our understanding of the complexity of pain perception. Pain is influenced by a wide range of psychosocial factors, such as emotions, sociocultural context, and pain-related beliefs, attitudes and expectations.
Fentanyl. Do not prescribe fentanyl for opioid naïve patients. Only consider prescribing fentanyl in a few unusual situations. Possible examples include: transdermal when gut mu receptors should be avoided; in head and neck cancer when oral intake is challenging; end of life care; intravenous in a patient with intrathecal “pain pump”; buccal and sublingual for episodic and breakthrough end-stage cancer pain.
Some evidence exists for methadone use in this population as well. However, it is less promising than buprenorphine.
Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint.
Ensure caregiver receives education on appropriate Intranasal Narcan use and administration to the patient if indicated