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KEY POINTS

KEY POINTS

  • Proper assessment is vital when treating a patient suffering from pain and must include the physical effects of pain as well as the psychological and social impact of pain.

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

  • Many concerns are associated with opioid therapy, and it is important for medication therapy management (MTM) providers to understand the advantages and disadvantages of this treatment option when managing patients suffering from pain.

  • Constipation is a very common side effect associated with opioid therapy, and proper education, treatment, and monitoring by MTM providers is imperative.

INTRODUCTION

The International Association for the Study of Pain defines 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 very broad and includes not only the pharmacological management of a variety of different types of pain, but also the use of nonpharmacological treatments, complementary treatments, and other types of treatments 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.

Pathophysiology

The understanding of the pathophysiology of pain continues to evolve. When a tissue injury occurs, various physiological and chemical changes happen peripherally and centrally. Patients may experience short-term pain (ie, acute pain) or continued pain leading to persistent or chronic pain. Pain can be classified by inferred pathophysiology into one of two categories: physiological pain or pathological pain.2 Physiological pain includes nociceptive pain and inflammatory pain. Nociceptive pain is characterized as “pain that arises from actual or threatened damage to nonneural tissue and is due to the activation of nociceptors,”1 and inflammatory pain involves activation of the immune system resulting from tissue injury.3 Pathological pain is a maladaptive process, which occurs when the nervous system is not functioning properly; it can present as neuropathic pain or centralized pain.2 Neuropathic pain is characterized as the “abnormal processing of sensory input by the peripheral or central nervous system (CNS).”1 Centralized sensitization is a dysfunction in the CNS in which the pain processing process leads to hypersensitivity and spontaneous pain.3 It is very important for the MTM provider to understand the distinction between nociceptive and neuropathic pain so that therapeutic interventions can be tailored to address the appropriate type of pain.

Nociceptive Pain

Nociceptive pain is a natural response to the injury that is causing the painful stimulus. Nociceptive pain can be further divided into two distinct categories: somatic pain and visceral pain. Somatic pain is a type of pain that is derived from muscle, skin, bone, or ...

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