Pain Rehabilitation the process of managing pain and assessment

pain managment aproches

1. Pain Rehabilitation

2. Pain?
•An unpleasant sensory and emotional experience associated
with actual and/or potential tissue damage, or described in
terms of such damage
•International Association for the Study of Pain
•Pain  Adaptive function  warning system design to protect
one from harm

3. •Subjective and personal, influenced by multiple psychosocial
variables.
•Acute pain  direct response to a “noxious” event  correlate
tissue damage
•Chronic pain  involves more dynamic interplay of
psychological and behavioral mechanism  underlying tissue
pathology less correlate to pain level

4. •Chronic pain multiple problems :
•unnecessary suffering, increase medical care use,
medication overuse, excess disability, comorbid
emotional problem, and increase economic cost.
•Rehabilitation approach  maximizing independent
physical functioning, improving psychosocial state,
returning patients to work or previous leisure
pursuits  reintegration to community

5. Assessment
•Pain evaluation involves
•Thorough physical examination
•Comprehensive evaluation of pain intensity
•Psychosocial factors related to pain experience
•Interference with sleep, daily activities, family life and employment

6. •History taking
•Pain description : quality, location, radiation, intensity, onset, duration,
frequency, pattern of progression, aggravating/relieving factor,
previous tests result, treatment effects, and other associated
manifestations
•Mechanisms of injury
•Chronical medical problems
•Limitation in functional
•Dependency

7. •Intensity  Visual analogue scale (0-10 scale)
•McGill Pain Questionnaire SF  sensory, affective, and evaluative
•Psychometric measure  mood, attitude, beliefs, functional
capacity, activity interference, and personality traits

8. •Physical examination  identify related impairments, pain
behaviours, and postural abnormalities
•Pain disorder criteria  pain is in one/more anatomic sites,
causes clinically significant distress, psychological factors
judged to play important role, not intentionally produced, not
better accounted for by another condition.

9. •Functional assessment  observe the patient changing
position, sitting, standing, and walking. Identify whether pain
interfere with function.
•Independency level  Barthel Index
•Provocative tests  I,e. Straight leg raising, Tinel’s sign,
Finkelstein test, Empty can test.

11. Rehabilitation approach
Acute Pain
• real tissue damage
•Treating underlying etiology
•Acute pain treatment principle  discontinuing source of
damage, resting the damage part, pain-relieving modalities, short
term use of non-narcotic analgesics (acetaminophens and
NSAIDs), muscle relaxants

12. •Protection
•Rest
•Icing
•Compression
•Elevation

13. Rehabilitation p.o.v
•3 stages of Acute pain recovery
•Stage 1 : pain relieve by physical modalities  Cold therapy, heat
therapy, electrotherapy, or Laser therapy
•Stage 2 : regaining of normal muscle length through ROM and
flexibility exercises
•Stage 3 : Gradual muscle strengthening and aerobic exercise.

14. •Preventive and ergonomic measure has to be educated
•Prevent progression to chronic pain
•Anticipating significant psychosocial issues

15. Chronic pain, rehab intervention?
•Can be caused by persistence of organic pathology (i.e cancer
pain) or other non-malignant source  persistence of pain
perception despite recovery of tissue damage (i.e chronic pain
syndrome)
•The treatment goal is aimed at helping the patient control or
cope with the residual pain

16. Chronic pain - deconditioning cycle
Percepts
Injury/harm to
The body part(s)
Avoid any
Movement/activty
That cause pain
Behaviour change
Fearfull of moving
Increase level
of inactivity
Physical
deconditioning
Original
Tissue
Damage
PAIN
Pain threshold
lower

17. •Principle of treatment : emphasized in mobilization of affected
areas, the use of behavioral management, and avoidance
addictive medication

18. •Patient educations
•Planned learning pain experiences + facilitating them adopt and
maintain good heath-conducive behaviour
•Patient education enhance compliance to the therapeutic regimens,
produce physiologic and immunologic changes  significant
improvements in health outcome

19. •…patient education :
•Ensure successful education :belief systems about the disease and
efficacy of treatment, motivation, locus of control, skill necessary to
make behavioral changes, and reinforcing factors.
•Should be focused not only on improving knowledge but also on
changing attitudes, beliefs, and behabiors.

20. •Physical modalities
•Therapeutic heat (superficial/deep heating agents)
•Therapeutic cold (cold pack, vapocoolabt spray)
•Hydrotherapy
•Electrotherapy
•Low power laser
•Phonophoresis

21. •…Physical modalities
•Must be combined with more active exercises
•Pain masking modulation mechanisms
•Prevent cascade physiological consequences that evoke pain
•No phys modalities are superior than one another

23. •Orthoses, gait aid, adaptive devices
•Can be prescribed if a specific joint or limb must be rested or protected
due to tissue damage

24. Orthoses
Wrist-Finger Ortheses

25. Therapeutic Exc
•Therapeutic Exercise is medicine
•Important adjunct in pain therapy 
Reeducate involved tissue  creating
proper behavior of tissue, mostly neural
and muscular
•Like other medicine, it has “dosage”  can be proper dosage, under
dosage, or overdosage

26. •Therapeutic exercises
•Isometric contraction exercise can be initiated early (combination of
phys. Modalities)
•Gentle ROM exercise and flexibility started as soon as inflammation
subside
•Strengthening exercise can be started when pain improves
•Relaxation exercises

27. •Therapeutic exercises
•Basic principle of “dosage”
•Type : Strengthening, flexibility, endurance
•Timing : when to do?
•Frequency : How often?
•Intensity : How hard?

29. •Vertebral traction
•Release compression on narrowing of foramine intervertebra  source of
nerve root irritation
•Relieve muscle spasm
•Cervical and lumbar

30. Occupational therapist
•With chronic pain, the therapist also needs to set out a gradual
progression of activities focused on improving function in
ordinary daily activities such as walking, sitting, standing,
climbing stairs, lifting and carrying
•The therapists give reinforcement for activities done
appropriately and do their best to ignore and not reinforce
pain behaviors.
•to desensitize patients to the ordinary activities they have
become fearful of and shows them that they can do more and
improve without significantly aggravating their symptoms.

31. •Oral and parenteral medication
•Analgesics : Acetaminophen, Tramadol, NSAID, steroids, opioid
•Adjuvant analgesics : antidepressant, neuroleptics, anticonvulsant
•Topical analgesics agents : NSAID, topical local anaesthetics,
capsaicin

32. •Psychosocial and self-regulation technique
•Psychosocial support
•Coping-skill training
•Vocational councelling

33. Rehabilitation intervention on pain
•All programs is very tailored to patient condition
•No program can be applicable to everyone
•Every patient is unique so are the programs
•Successful rehab program relies on proper assessment,
cooperative patients, and solid rehabilitation team.

34. Thank you