Complete Story
07/25/2010
Practice Guidelines for Chronic Pain Management
New Guidelines for chronic pain patients have been released, are published and available online for review. The highlight is the guide’s recommendation for multimodal care, not just narcotics, for injured workers in chronic pain. This recommendation is in line with Governor Ted Strickland’s Prescription Drug Abuse task Force. New ASA and ASRA Practice Guidelines for Chronic Pain Management is now available on line. This is an Updated Report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine
The task force defines chronic pain as pain of any cause not directly related to neoplastic involvement associated with a medical condition or extending in duration beyond the expected temporal boundary of tissue injury and normal healing and adversely affecting the function or well-being of the individual.
"Whenever possible," the task force reports, "direct and ongoing contact should be made and maintained with the other physicians caring for the patient to ensure optimal care."
The new guidelines advocate for multimodal interventions for patients with chronic pain. The task force suggests that a long-term approach that includes periodic follow-up evaluations should be developed and implemented as part of the overall treatment strategy. In addition, when available, multidisciplinary programs may be used. The new guidelines detail the use of
ablative techniques,
acupuncture,
pain blocks,
botulinum toxin,
electrical nerve stimulation,
epidural steroids,
intrathecal drug therapies,
minimally invasive spinal procedures,
pharmacologic management,
physical therapy and rehabilitation,
psychological treatment, and
trigger point injections.
The Guidelines advocate the use of multimodal or multidisciplinary interventions rather than monotherapies,
Multimodal or Multidisciplinary Interventions
Multimodal interventions constitute the use of more than one type of therapy for the care of patients with chronic pain. Multidisciplinary interventions represent multimodality approaches in the context of a treatment program that includes more than one discipline. The literature indicates that the use of multidisciplinary treatment programs compared with conventional treatment programs is effective in reducing the intensity of pain reported by patients for periods of time ranging from 4 months to 1 yr (Category A2 evidence). The literature is insufficient to evaluate comparisons of multimodal therapies with single modality interventions (Category D evidence), possibly because of the prevailing multimodal nature of the management of patients with chronic pain.
Pain Consultants, ASA members, and ASRA members strongly agree that multimodal interventions should be part of the treatment strategy for patients with chronic pain. They also strongly agree that a long-term approach that includes periodic follow-up evaluations should be developed and implemented as part of the overall treatment strategy, and that, whenever available, multidisciplinary programs should be used.
The new guideline also provide a list of drugs for chronic pain that include anticonvulsants, antidepressants, benzodiazepines, N-methyl-D-aspartate receptor antagonists, nonsteroidal anti-inflammatories, opioid therapy, skeletal muscle relaxants, and topical agents. The task force discusses each in detail and recommends strategies for monitoring and managing adverse effects and patient compliance.
Chiropractic physicians, often a portal of entry into what can be a complex and sometimes bewildering healthcare maze, are trained and willing to help Ohio’s citizens and injured workers navigate the maze.
The Ohio State Chiropractic Association believes that a doctor of chiropractic medicine should be thorough in taking a history and on doing an examination. They should be respectful of patient privacy and dignity, and yet ask the right questions and at the same time. It is the patient’s duty to be forthright in answering any questions about their condition or treatment. This requires discussing and reporting their findings and suggesting a treatment plan of action.
Even with the best planning and care, a small number of patients will go on to become chronic pain patients, and require ongoing care, this is where the chiropractic physician can be integrative, and direct the patient to another doctor in a specialty or sub-specialty to start multimodal care.
Respectfully submitted, David C. Radford, D.C., M.S, Diplomate, American Academy of Pain Management,