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KEY POINTS

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  • Proper assessment is vital when treating a patient who suffers from pain. Assessments must include the physical effects of pain, as well as its psychological and social impacts.

  • Pain management may include nonpharmacologic, nonopioid, opioid, and adjuvant therapies. Several of these options are often used together to achieve better pain management.

  • Opioids have many side effects and can also cause dependency. It is important for MTM providers to understand the advantages and disadvantages of this treatment option when providing MTM services to patients suffering from pain.

  • Constipation is a very common side effect associated with opioid therapy, so it is imperative that MTM providers offer appropriate education, treatment, and monitoring.

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INTRODUCTION

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Pain is defined by the International Association for the Study of Pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."1 The term pain management is broad and includes not only the pharmacologic management of a variety of different types of pain, but also the use of nonpharmacologic treatments, complementary treatments, and other types of therapy to reduce or stop pain. Prior to developing a treatment plan for a patient with pain, MTM providers must understand the difference between nociceptive and neuropathic pain, as well as differences in the treatment of acute and chronic pain.

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Pathophysiology

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The understanding of the pathophysiology of pain continues to evolve. A variety of physiological and chemical changes happen peripherally and centrally when tissue is injured. Patients may have short-term pain (ie, acute pain) or continued pain leading to persistent or chronic pain. Pain can be classified by inferred pathophysiology into 1 of 2 categories: nociceptive pain, characterized as a "normal processing of stimuli that damages normal tissues or has the potential to do so if prolonged,"2 and neuropathic pain, characterized as the "abnormal processing of sensory input by the peripheral or central nervous system."2 It is very important for the MTM provider to understand the distinction between nociceptive and neuropathic pain so that therapeutic interventions can be appropriately tailored to the type of pain.

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Nociceptive Pain

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Nociceptive pain is defined as "pain that arises from actual or threatened damage to non-neural tissue, and is due to the activation of nociceptors."1 This is a natural response to the injury that is causing the painful stimulus. Nociceptive pain can be divided further into 2 distinct categories: somatic pain and visceral pain. Somatic pain is derived from muscle, skin, bone, or connective tissue and typically includes aching or throbbing pain that is easily pinpointed to an exact location. Visceral pain, on the other hand, is difficult to pinpoint because it originates from internal organs such as the pancreas or the GI tract. Patients often describe visceral pain as a generalized aching without a specific focal point. Visceral ...

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