DOCSLIB.ORG

Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management Health Care Guideline Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management How to Cite this Document Hooten M, Thorson D, Bianco J, Bonte B, Clavel Jr A, Hora J, Johnson C, Kirksson E, Noonan MP, Reznikoff C, Schweim K, Wainio J, Walker N. Institute for Clinical Systems Improvement. Pain: Assess- ment, Non-Opioid Treatment Approaches and Opioid Management. Updated August 2017. ICSI Members, Sponsors and organizations delivering care within Minnesota borders, may use ICSI documents in the following ways: • ICSI Health Care Guidelines and related products (hereinafter “Guidelines”) may be used and distributed by ICSI Member and Sponsor organizations as well as organizations delivering care within Minnesota borders. The guidelines can be used and distributed within the organization, to employees and anyone involved in the organization’s process for developing and implementing clinical guidelines. • ICSI Sponsor organizations can distribute the Guidelines to their enrollees and those care delivery organizations a sponsor holds insurance contracts with. • Guidelines may not be distributed outside of the organization, for any other purpose, without prior written consent from ICSI. • The Guidelines may be used only for the purpose of improving the health and health care of Member’s or Sponsor’s own enrollees and/or patients. • Only ICSI Members and Sponsors may adopt or adapt the Guidelines for use within their organizations. • Consent must be obtained from ICSI to prepare derivative works based on the Guidelines. • Appropriate attribution must be given to ICSI on any and all print or electronic documents that reference the Guidelines. All other copyright rights for ICSI Health Care Guidelines are reserved by the Institute for Clinical Systems Improvement. The Institute for Clinical Systems Improvement assumes no liability for any use, adaptations, revisions or modifications made to ICSI Health Care Guidelines by the user or others. www.icsi.org Copyright © 2017 by Institute for Clinical Systems Improvement Health Care Guideline: Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management Pain Assessment Algorithm Eighth Edition August 2017 Text in blue in this algorithm Patient presents with indicates a linked corresponding pain complaint/concern annotation. Assessment 1 Assess quality-of-life, function and pain 2 Determine the pain 3 Dental /orofacial pain generator diagnosis and treatment • Treat acute dental with 3 NSAIDs and yes acetaminophen Dental? • Refer to dental provider ASAP no • Avoid opioid 4 medication Assess physical and behavioral health comorbidities • Consider screening for substance use disorder and other comorbidities • Consider specialty referral 5 Determine patient barriers Shared 6 decision-making Patient engagement • Use shared decision-making and motivational interviewing to set achievable goals and expectations • Review risks and benefits of treatment options, reach agreement and get informed consent as needed See Pain Treatment Plan algorithm Return to Table of Contents www.icsi.org Copyright © 2017 by Institute for Clinical Systems Improvement 1 Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management Eighth Edition/August 2017 Pain Treatment Plan Algorithm Text in blue in this algorithm indicates a linked corresponding 7 annotation. Develop pain treatment plan Shared decision-making 8 9 10 11 12 Complementary Physical Psychotherapy Interventional Pharmacologic and integrative rehabilitation strategies treatment treatment medicine modalities Shared decision-making Consider opioids if: • Other treatments are not sufficient • Emergent pain relief is indicated 14 Coordination of Care and Follow-Up 13 • Proactive management of condition and Opioid management collaborative care referrals (see Acute Opioid • Team-based patient care Treatment algorithm) • Follow-up and communication plan • Periodic reassessment of goals and function Goals met? Is care plan Return to patient • Function no no implemented as engagement to re-establish • Comfort planned? treatment goals • Barriers yes yes Ongoing pain management as needed Is diagnosis no Return to pain assessment correct? yes Shared decision-making • Reassess treatment plan • Consider multidisciplinary team referral, and/or a pain medicine specialist Return to Table of Contents www.icsi.org Institute for Clinical Systems Improvement 2 Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management Eighth Edition/August 2017 Acute Opioid Treatment Algorithm 13 Text in blue in this algorithm 13.2 Opioid indicates a linked corresponding Risk assessment management annotation. Consider ABCDPQRS: • Alcohol use • Benzodiazepines and other 13.1 drug use Return to Pain • Clearance and metabolism of no Have non-opioid drug Treatment Plan approaches been • Delirium, dementia and falls algorithm considered? risk yes • Psychiatric comorbidities • Query the prescription 13.2 Risk Assessment monitoring program Consider • Respiratory insufficiency and ABCDPQRS sleep apnea • Safe driving, work, storage and disposal Is patient: 13.3 • Pregnant, lactating or woman of yes See Special childbearing age Populations section • Geriatric • Pediatric? no Shared decision-making Does potential no benefit of opioid outweigh potential risk? yes Shared 13.4 decision-making Prescriber responsibility with opioid prescription, not limited to: • Patient education • Safe use, storage and disposal • Shared decision-making • Consider patient provider agreement • Consider offering naloxone 13.5 Acute or acute on chronic pain 13.6 The first opioid prescription for acute pain Avoid opioid use for chronic pain. should be the lowest possible effective For patients currently on opioids see strength of a short-acting opioid, not to Consideration of Continuing Opioid exceed 100 MME total. Patients should be Treatment for Pain algorithm. instructed that three days or less will often be sufficient. 14 Return to “Coordination of Care and Follow-Up” on Pain Treatment Pain algorithm Return to Table of Contents www.icsi.org Institute for Clinical Systems Improvement 3 Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management Eighth Edition/August 2017 Consideration for Continuing Opioid Treatment Algorithm Consideration of Text in blue in this algorithm continuing opioid indicates a linked corresponding treatment for pain annotation. 13.2 13.1 Risk assessment no Have non-opioid Consider ABCDPQRS: approaches been • Alcohol use considered? • Benzodiazepines and other drug use Return to Pain Treatment Plan yes • Clearance and metabolism of algorithm, modalities and Shared drug non-opioid pharmacology decision-making • Delirium, dementia and falls no Is opioid still risk effective? • Psychiatric comorbidities • Query the prescription monitoring program yes • Respiratory insufficiency and 13.2 sleep apnea Risk Assessment • Safe driving, work, storage Consider and disposal ABCDPQRS Is patient: • Pregnant, lactating or 13.3 woman of yes See Special childbearing age Populations section • Geriatric • Pediatric? no Shared decision-making Does potential no benefit of opioid outweigh potential risk? yes 13.4 Prescriber responsibility with opioid prescription, not limited to: • Patient education • Safe use, storage and disposal • Shared decision-making • Consider patient provider agreement 13.7 MME: Morphine Ongoing treatment of pain with opioids Opioid pharmacology milligram equivalents Manage dose limits to • MME conversion factors SUD: Substance use < 100 MME/day or < 50 MME/day with • Opioid rotation disorder SUD or benzodiazepine use 13.8 Monitoring considerations for opioid use: • Patient provider agreement • Monitor patient at least monthly until stable, then every 3 months • Query prescription monitoring program twice a year • Urine drug screening once a year • Have referral source for psychiatry, physical therapy, substance use disorder treatment and pain medicine 13.9 Return to If opioid use disorder is suspected “Coordination of Care consider referral to addiction medicine and Follow-Up” on specialist Pain Treatment Plan 13.10 algorithm Offer discontinuation of opioids or taper Return to Table of Contents at intervals of six months www.icsi.org Institute for Clinical Systems Improvement 4 Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management Eighth Edition/August 2017 Table of Contents Work Group Leaders Algorithms and Annotations ........................................................................................ 1-80 Michael Hooten, MD Algorithm – Pain Assessment ...............................................................................................1 Anesthesiology, Mayo Clinic David Thorson, MD Algorithm – Pain Treatment Plan .........................................................................................2 Sports Medicine, Entira Family Algorithm – Acute Opioid Treatment ...................................................................................3 Clinics Algorithm – Consideration for Contuining Opioid Treatment .............................................4 Work Group Members Evidence Grading ............................................................................................................. 7-8 Allina Medical Clinic Justin Hora, PharmD Recommendations Table ................................................................................................ 9-16 Specialty Foreword Emergency Physicians, PA Introduction ............................................................................................................
Load more

Recommended publications
  • Assessment of Emotional Functioning in Pain Treatment Outcome Research
    Assessment of emotional functioning in pain treatment outcome research Robert D. Kerns, Ph.D. VA Connecticut Healthcare System Yale University Running head: Emotional functioning Correspondence: Robert D. Kerns, Ph.D., Psychology Service (116B), VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516; Phone: 203-937- 3841; Fax: 203-937-4951; Electronic mail: [email protected] Emotional Functioning 2 Assessment of Emotional Functioning in Pain Treatment Outcome Research The measurement of emotional functioning as an important outcome in empirical examinations of pain treatment efficacy and effectiveness has not yet been generally adopted in the field. This observation is puzzling given the large and ever expanding empirical literature on the relationship between the experience of pain and negative mood, symptoms of affective distress, and frank psychiatric disorder. For example, Turk (1996), despite noting the high prevalence of psychiatric disorder, particularly depression, among patients referred to multidisciplinary pain clinics, failed to list the assessment of mood or symptoms of affective distress as one of the commonly cited criteria for evaluating pain outcomes from these programs. In a more recent review, Turk (2002) also failed to identify emotional distress as a key index of clinical effectiveness of chronic pain treatment. A casual review of the published outcome research in the past several years fails to identify the inclusion of measures of emotional distress in most studies of pain treatment outcome, other than those designed to evaluate the efficacy of psychological interventions. In a recent edited volume, The Handbook of Pain Assessment (Turk & Melzack, 2001), several contributors specifically encouraged inclusion of measures of psychological distress in the assessment of pain treatment effects (Bradley & McKendree-Smith, 2001; Dworkin, Nagasako, Hetzel, & Farrar, 2001; Okifuji & Turk, 2001).
    [Show full text]
  • Pain Management of Inmates
    PAIN MANAGEMENT OF INMATES Federal Bureau of Prisons Clinical Guidance JUNE 2018 Federal Bureau of Prisons (BOP) Clinical Guidance is made available to the public for informational purposes only. The BOP does not warrant this guidance for any other purpose, and assumes no responsibility for any injury or damage resulting from the reliance thereof. Proper medical practice necessitates that all cases are evaluated on an individual basis and that treatment decisions are patient- specific. Consult the BOP Health Management Resources Web page to determine the date of the most recent update to this document: http://www.bop.gov/resources/health_care_mngmt.jsp Federal Bureau of Prisons Pain Management of Inmates Clinical Guidance June 2018 TABLE OF CONTENTS 1. PURPOSE OF THIS GUIDANCE.................................................................................................................. 1 2. INTRODUCTION TO PAIN MANAGEMENT IN THE BOP .................................................................................. 1 The Prevalence of Chronic Pain ........................................................................................................ 1 General Principles of Pain Management in the BOP .......................................................................... 2 Multiple Dimensions of Pain Management ................................................................................... 2 Interdisciplinary Pain Rehabilitation (IPR) .................................................................................... 2 Roles
    [Show full text]
  • DSM-IV Pain Disorder in the General Population an Exploration of the Structure and Threshold of Medically Unexplained Pain Symptoms
    DSM-IV pain disorder in the general population An exploration of the structure and threshold of medically unexplained pain symptoms Christine Fröhlich,· Frank Jacobi, Hans-Ulrich Wittchen Received: 18 March 2005 / Accepted: 12 September 2005 / Published online: 18 November 2005 Abstract Background Despite an abundance of questionnaire data, the prevalence of clinically significant and medically unexplained pain syndromes in the general population has rarely been examined with a rigid personal-interview methodology. Objective To examine the prevalence of pain syndromes and DSM- IV pain disorder in the general population and the association with other mental disorders, as well as effects on disability and health-care utilization. Methods Analyses were based on a community sample of 4.181 participants 18–65 years old; diagnostic variables were assessed with a standardized diagnostic interview (M-CIDI). Results The 12-month prevalence for DSM-IV pain disorder in the general population was 8.1%; more than 53% showed concurrent anxiety and mood disorders. Subjects with pain disorder revealed significantly poorer quality of life, greater disability, and higher health-care utilization rates compared to cases with pain below the diagnostic threshold. The majority had more than one type of pain, with excessive headache being the most frequent type. Conclusions Even when stringent diagnostic criteria are used, pain disorder ranks among the most prevalent conditions in the community. The joint effects of high prevalence in all age groups, substantial disability, and increased health services utilization result in a substantial total burden, exceeding that of depression and anxiety. Key words: DSM-IV pain disorder, pain syndromes, comorbidity, impairment, Composite International Diagnostic Interview (CIDI) Introduction Chronic pain is well known as a highly prevalent condition in the general population.
    [Show full text]
  • Assessment and Measurement of Pain and Pain Treatment
    2 Assessment and measurement of pain and pain treatment Section Editor: Prof David A Scott 2 2.1 | Assessment Contributors: Prof David A Scott, Dr Andrew Stewart 2.2 | Measurement Contributors: Prof David A Scott, Dr Andrew Stewart 2.3 | Outcome measures in acute pain management Contributors: Prof David A Scott, Dr Andrew Stewart 5th Edition | Acute Pain Management: Scientific Evidence 3 2.0 | Assessment and measurement of pain and pain treatment Reliable and accurate assessment of acute pain is necessary to ensure safe and effective pain management and to provide effective research outcome data. The assessment and measurement of pain is fundamental to the process of assisting in the diagnosis of the cause of a patient’s pain, selecting an appropriate analgesic therapy and evaluating then modifying that therapy according to the individual patient’s response. Pain should be assessed within a sociopsychobiomedical model that recognises that physiological, psychological and environmental factors influence the overall pain experience. Likewise, the decision regarding the appropriate intervention following assessment needs to be made with regard to a number of factors, including recent therapy, potential risks and side effects, any management plan for the particular patient and the patient’s own preferences. A given pain ‘rating’ should not automatically trigger a specific intervention without such considerations being undertaken (van Dijk 2012a Level IV, n=2,674; van Dijk 2012b Level IV, n=10,434). Care must be undertaken with pain assessment to avoid the process of assessment itself acting as a nocebo (see Section 1.3). 2.1 | Assessment The assessment of acute pain should include a thorough general medical history and physical examination, a specific “pain history” (see Table 2.1) and an evaluation of associated functional impairment (see Section 2.3).
    [Show full text]
  • Psychological Tests Commonly Used in the Assessment of Chronic Pain *
    Colorado Division of Workers’ Compensation COMPREHENSIVE PSYCHOLOGICAL TESTING Psychological Tests Commonly Used in the Assessment of Chronic Pain * TEST TEST CHARACTERISTICS STRENGTHS AND LENGTH, SCORING WEAKNESSES OPTIONS & TEST TAKING TIME Comprehensive Inventories For Medical Patients BHI™ 2 (Battery for What it Measures: Depression, anxiety and hostility; Strengths: Well-developed theoretical basis tied 217 items, 18 scales including Health Improvement – 2nd violent and suicidal ideation; borderline, emotional to a paradigm of delayed recovery in medical 3 validity measures, 40 edition ) dependency, chronic maladjustment, substance abuse, patients, and to assessing primary (“red flag”) content-based subscales, 25 history of abuse, perseverance, conflicts with and secondary (“yellow flag”) risk factors. Has critical items, 25-35 minutes, Pearson Assessments employer, family and physician, pain preoccupation, nationally normed 0-10 pain profiling. Two computerized scoring and www.pearsonassessments.c somatization, disability perceptions and others. norms groups are available, based on national report. om rehabilitation patient and community samples, Uses: Useful for identifying affective, both of which are stratified to match US census 6th grade reading level Standardization: S characterological, psychophysiological and social data. English and Spanish versions available. Scientific Review: JBG factors affecting pain and disability reports. Also Standardized audio tape administration for Intended for: M useful for assessing patients
    [Show full text]
  • Fibromyalgia in Migraine: a Retrospective Cohort Study Mark Whealy1* , Sanjeev Nanda2, Ann Vincent2, Jay Mandrekar3 and F
    Whealy et al. The Journal of Headache and Pain (2018) 19:61 The Journal of Headache https://doi.org/10.1186/s10194-018-0892-9 and Pain SHORT REPORT Open Access Fibromyalgia in migraine: a retrospective cohort study Mark Whealy1* , Sanjeev Nanda2, Ann Vincent2, Jay Mandrekar3 and F. Michael Cutrer1 Abstract Background: Migraine is a common and disabling disorder. Fibromyalgia has been shown to be commonly comorbid in patients with migraine and can intensify disability. The aim of this study was to determine if patients with co-morbid fibromyalgia and migraine report more depressive symptoms, have more headache related disability, or report higher intensity of headache as compared to patients with migraine only. Cases of comorbid fibromyalgia and migraine were identified using a prospectively maintained headache database at Mayo Clinic Rochester. One-hundred and fifty seven cases and 471 controls were identified using this database and the Mayo Clinic electronic medical record. Findings: Depressive symptoms as assessed by PHQ-9, intensity of headache, and migraine related disability as assessed by MIDAS were primary measures used to compare migraine patients with comorbid fibromyalgia versus those without. Patients with comorbid fibromyalgia reported significantly higher PHQ-9 scores (OR 1.08, p < .0001) and headache intensity scores (OR 1.149, p = .007). There was no significant difference in migraine related disability (OR 1.002, p = .075). Patients with fibromyalgia were more likely to score in a higher category of depression severity (OR 1.467, p < .0001) and more likely to score in a higher category of migraine related disability (OR 1.23, p = .004).
    [Show full text]
  • Assessment of Pain
    ASSESSMENT OF PAIN Pediatric Pain Resource Nurse Curriculum © 2017 Renee CB Manworren, PhD, APRN, FAAN and Ann & Robert H. Lurie Children’s Hospital of Chicago. All rights reserved. Objectives • Critically evaluate pain assessment tools for reliability, validity, feasibility and utility Table of Contents for communicating pediatric patients’ pain experiences • Formulate processes and policies to ensure the organization’s pain assessment and care planning for pediatric patients is sensitive to children’s pain by acknowledging the sensory, cognitive and affective experience of pain and behavioral responses as influenced by social, cultural, spiritual and regulatory context. • Engage in pain assessment demonstrating evidence-based processes, modeling assessment principles, and using valid and reliable tools that are appropriate for the developmental level, cognitive ability, language, and care needs of pediatric patients cared for in your clinical area. page page page page page 3 8 15 17 30 Why Assess Pain in Principles of Pain Pain Assessment Process Initial Assessment Choosing Pain Children? Assessment Assessment Tools page page page page page 35 48 56 63 66 Pain Assessment Tools Assessment of Those Special Populations In Summary References for Self-report Unable to Self-report | 2 Why Assess Pain in Children? Why do you think it is Type your answer here. important to screen for and assess pain in children? | 4 Because… Assessment and treatment of pain is a fundamental human right. Declaration of Montreal , The International Association for the Study of Pain., 2011 Pain in children occurs across a spectrum of conditions including everyday pains, acute injuries and medical events, recurrent or chronic pain, and pain related to chronic or life-limiting conditions.
    [Show full text]
  • Pain Module 2: Pain Assessment and Documentation Module 3: Management of Pain and Special Populations
    Foundations of Safe and Effective Pain Management Evidence-based Education for Nurses, 2018 Module 1: The Multi-dimensional Nature of Pain Module 2: Pain Assessment and Documentation Module 3: Management of Pain and Special Populations Adapted from: Core Competencies for Pain Management: Results of an Inter--professional Consensus Summit: Pain Med 2013; 14(7) 971-981 Module 2: Pain Assessment and Documentation Objectives a. Understand the multidimensional features of pain assessment. b. Use valid and reliable tools for assessing pain and associated symptoms. • Initial Screening • Ongoing Assessments (Including Discharge Assessment) c. Assist patients in setting realistic acceptable pain intensity levels. d. Identify tools for assessing acute and persistent pain and for patients unable to self-report pain. e. Discuss the importance of empathic and compassionate communication during pain assessment. f. Discuss the inclusion of patient and others, in the education and shared decision-making process for pain care. ASPMN (2017-08-02). Core Curriculum for Pain Management Nursing. Elsevier Health Sciences. Patient Screening, Assessment and Management of Pain (Policy and Procedure #30327.99) A. Perform a Pain Screening during the initial assessment • Determine the presence of pain or history of persistent pain. • Identify whether the patient is opioid tolerant. B. Perform an Initial Comprehensive Pain Assessment if the Initial Pain Screening indicates pain. C. Perform Pain Screening at a frequency determined by individual patient need with consideration of patient’s condition, history, risks and treatment or procedures likely to cause pain. (Note: Assessing pain as the 5th Vital Sign is no longer a regulatory requirement) A. Perform Ongoing Pain Assessment with any report of pain and as determined by individual patient clinical condition/need.
    [Show full text]
  • Practical Pain Management
    PRACTICAL PAIN MANAGEMENT To start with… This is based upon various sources of information in the publications below and the way they have helped me to approach this subject. So for more information consult the following: Oxford Handbook of Palliative Care 2nd Ed: M Watson et al: Oxford University Press publications Symptom Management in Advanced Cancer 4th Ed: R Tywcross et al: PalliativeDrugs.com publications Palliative Care Formulary 4th Ed: R Twycross et al: PalliativeDrugs.com publications Drugs in Palliative Care 2nd: Andrew Dickman: Oxford University Press publications INTRODUCTION “Think Holistically” (see Figs 1-4) Remember - two important principles of palliative care are that all care should be: o PATIENT-CENTRED – putting patients & their significant others at the centre of healthcare o HOLISTIC – a healthcare approach where considering all aspects relevant to a person’s care [ie making up ‘the whole’ person] is more beneficial to the person than just focusing one of the aspects [eg. those most familiar to a healthcare worker of a particular discipline – ie doctors can focus on physical aspects alone] NB: This approach is not unique to palliative care and is seen in other disciplines eg. general practice Palliative care is holistic in the broadest extent: o The Patient: holistic by considering the physical, psychological, spiritual & social aspects relevant to the person (fig.1) which also means considering ‘The Triangle of Significant Others’ – family, carers & significant others (fig.2) o The Team: holistic in palliative care because of the fully multidisciplinary team approach It may be helpful to understand the extent of this holistic assessment by considering the following diagrams: o Fig.
    [Show full text]
  • Factsheet: Chronic Pain and Related Functional Impairment Interagency Collaboration
    SHNIC Specialized Health Needs Factsheet: Chronic Pain and Related Functional Impairment Interagency Collaboration What is it? Pediatric chronic can present in a variety of ways and often overlaps with psychological effects. It represents a developmental health issues because of its ability to significantly impair a student’s functional ability. Chronic pain can be persistent and episodic with both an underlying health condition (E.g. Sickle cell disease) and pain that is the pain disorder itself (E.g. Complex Regional Pain Disorder.) The symptoms extend beyond the expected healing period and is commonly described as persisting for at least 3 months. The three most common pain disorders in children include primary headaches, abdominal pain, and recurrent musculoskeletal and joint pain. A child’s developmental perspective affects how he/she will perceive and respond to pain. Psychological variables influencing pain prevalence include anxiety, depression, low self esteem, low socio-economic status, and other chronic health conditions. Chronic pain may peak during adolescence; related to puberty and the physical, emotional, social, and cognitive changes during this stage. Pediatric chronic pain can affect all aspects of daily living including appetite, sleep, socialization, school attendance, academic performance, and peer relationships. A child’s perception of pain and response to pain can also be influenced by parental characteristics like emotional function, behavior, health history, and environment. Pediatric chronic pain can also surface without clear medical evidence to a broader syndrome or condition. Functional somatic symptoms, like pain and fatigue, are physical symptoms not fully explained by a well-defined medical psychiatric or somatic illness. A growing number of patients are seeking pain treatments for sensory processing disorders.
    [Show full text]
  • Chronic Pelvic Pain & Pelvic Floor Myalgia Updated
    Welcome to the chronic pelvic pain and pelvic floor myalgia lecture. My name is Dr. Maria Giroux. I am an Obstetrics and Gynecology resident interested in urogynecology. This lecture was created with Dr. Rashmi Bhargava and Dr. Huse Kamencic, who are gynecologists, and Suzanne Funk, a pelvic floor physiotherapist in Regina, Saskatchewan, Canada. We designed a multidisciplinary training program for teaching the assessment of the pelvic floor musculature to identify a possible muscular cause or contribution to chronic pelvic pain and provide early referral for appropriate treatment. We then performed a randomized trial to compare the effectiveness of hands-on vs video-based training methods. The results of this research study will be presented at the AUGS/IUGA Joint Scientific Meeting in Nashville in September 2019. We found both hands-on and video-based training methods are effective. There was no difference in the degree of improvement in assessment scores between the 2 methods. Participants found the training program to be useful for clinical practice. For both versions, we have designed a ”Guide to the Assessment of the Pelvic Floor Musculature,” which are cards with the anatomy of the pelvic floor and step-by step instructions of how to perform the assessment. In this lecture, we present the video-based training program. We have also created a workshop for the hands-on version. For more information about our research and workshop, please visit the website below. This lecture is designed for residents, fellows, general gynecologists,
    [Show full text]
  • Co-Players in Chronic Pain: Neuroinflammation and the Tryp- Tophan-Kynurenine Metabolic Pathway
    Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 4 June 2021 doi:10.20944/preprints202106.0128.v1 Review Co-players in Chronic Pain: Neuroinflammation and the Tryp- tophan-Kynurenine Metabolic Pathway Masaru Tanaka1,2, Nóra Török1,2, Fanni Tóth2, László Vécsei1,2,* 1 MTA-SZTE, Neuroscience Research Group, Semmelweis u. 6, Szeged, H-6725 Hungary 2 Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary * Correspondence: [email protected]; Tel.: +36-62-545-351 Abstract: Chronic pain is an unpleasant sensory and emotional experience that persists or recurs more than three months and may extend beyond the expected time of healing. Recently nociplastic pain has been introduced as a descriptor of mechanism of pain, which is due to disturbance of neural processing without actual or potential tissue damage, appearing to replace a concept of psychogenic pain. An interdisciplinary task force of the International Association for the Study of Pain (IASP) compiled a systematic classification of clinical conditions associated with chronic pain, which was published in 2018 and will officially come into effect in 2022 in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization. ICD-11 offers the option for recording the presence of psychological or social factors in chronic pain; however, cognitive, emotional, and social dimensions in the patho- genesis of chronic pain are missing. Earlier pain disorder was defined as a condition with chronic pain associated with psychological factors, but it was replaced with somatic symptom disorder with predominant pain in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013.
    [Show full text]