PMR in Management of Pain
An overview on how PMR can help with pain management
Living with pain can be a pain! Pain needs to be approached from different directions. What helps achieve this in PMR are: 1. Team Members 2. Medicines 3. Modalities 4. Interventions
1.TEAM MEMBERS
Each team member contributes to the overall improvement of the patient.
a. The Physician comes to a diagnosis, decides and directs the course of treatment
b. The Psychologist helps those who may be dealing with anxiety or fear. Pain coping strategies, Biofeedback and Acceptance are taught to them.
c. A Vocational counsellor analyses the persons' current or previous job, suggests what is right for them and advises regarding proper work mechanics/modifications
d. A Nurse gives basic instruction regarding pain pathways, nutrition, hygiene etc.
e. The Physiotherapist gives training on stretches, gait, stability, functional mobility, aerobic conditioning programs and many more. They also help manage pain by using modalities.
f. The Occupational Therapist educates patients regarding proper posture and ergonomics related to upper limb functional activities such as lifting and computer usage. The also address upper extremity-related Activities of Daily living such as feeding, hygiene, grooming, bathing, and dressing.
2. MEDICINES
a. Simple Analgesics are the first-line treatment for pain and inflammatory conditions, including osteoarthritis, rheumatoid arthritis, and various musculoskeletal-related conditions. When on analegesics, it is important to know the potential Gatrointestinal, Cardiovascular and Renal side effects.
b. Opioid Analgesics may be given in more severe cases of pain. Studies have demonstrated moderate levels of pain relief in chronic pain. It is important to have a patient-centered goal setting and plan for discontinuation before a person is started on Opioids. The physician should be capable of treating opioid-related adverse effects (i.e., constipation, nausea, somnolence, and endocrine dysfunction)
c. Antidepressants are very useful especially l in patients with Fibromyalgia, Chronic Pain Syndrome.
d. Anticonvulsants are the FDA approved medications for Neuropathic Pain
e. Skeletal Muscle Relaxants are also given for pain secondary to muscle spasms and spasticity
3. MODALITIES
Non pharmacologic, Non interventional forms of treatment are usually preferred by most patients. Each modality has its own distinct advantages and disadvantages that can influence the success or failure of the therapeutic intervention.
a. Superficial Heating Modalities such as Hydrocollator Packs, Heating Pads, Paraffin Bath, Hydrotherapy and Deep Heating Modalities such as Ultrasound Therapy and Short Wave Diathermy are useful for Sprains,Spasms, Inflamed joints, Arthritic pain and stiffness. Proper care should be taken to avoid thermal injuries.
b. Cold Modalities such as Ice packs, vapocoolant sprays are useful for pain, acute trauma, acute inflammation, joint effusion and sports related injuries.
c. Contrast Bath are used in Arthritis and pain syndromes
d. Electrical Stimulation such as TENS are a useful pain reducing measure for post operative pain and Arthritic pain.
4. INTERVENTIONS
Many times, we may not get to the point of interventions, as patients get better with medications and modalities.
Interventions most commonly performed for pain management include Injections into inflamed joints or tendons secondary to Arthritis, Injury or degeneration
Nerve blocks are also done for acute and chronic pain.
Trigger point injections into muscles are performed for non remitting myofascial pain.
The above injections are mostly done using medications such as Steroids. However, current practice also uses certain proliferants to inject into torn tissues, ligaments, tendons, cartilages or nerves. The most commonly used proliferants include Dextrose and Platelet Rich Plasma (PRP).
Before we conclude, we would like to add TWO new modalities of pain management which are an interesting area of current research.
1. VIRTUAL REALITY
Researchers have become more confident that Virtual Reality (VR ) is not only capable of distracting a patient from their acute pain, but of blocking their brain's pain receptors in much the same way a prescription opioid would. They found that pain decreased an average of 60% during the session and 33% after the session, and the relief lasted from 2 to 48 hours after completion of the game. It has been practiced in those suffering pain related to Cancer, Fibromyalgia, Chronic Pain and Burn injuries.
2. NEUROLOGIC MUSIC THERAPY
Music is an Art and it is a known fact that Art increase levels of Serotonin, a neurotransmitter known as the " happy chemical " due to its mood-boosting properties. Evidence based Music Therapy Interventions have been done in persons with Anxiety, Palliative Care Patients and those undergoing sedation before major surgeries showing reduced need for analgesics. More studies to prove the scientific relation of music to the brain are under way.