Episode 02: What we know about Pain
Pain has a purpose! The biological processes within our pain system act like an alarm to warn us of potential harm. These processes are linked to our fight, flight or freeze response which is a physiological reaction located in the Amygdala, or primitive brain in response to a real or perceived threat. Our ability to pay attention to pain and respond with purpose is essential for human survival.
When activated, these complex biological processes have the ability to alter pain signalling within the central and peripheral nervous system based on information rapidly gathered from higher-level sites within the brain.
Structured Approach to Pain
Use pain specific “Talking Points” that minimize fear and promote a safe caring environment.
Expose and debunk “worse case scenario” thinking of the patient
(Be open, curious, compassion, culturally sensitive, and non-judgemental)
1. Overall Message: “I believe you”
2. Acute pain: “When we experience pain, our brain is telling us that our tissue needs protection and attention. Can you tell me about the pain you’re having today?”
3. Chronic pain: “I can’t imagine how difficult living with chronic pain is for you. Can you tell me about the pain you’re having today?”
Are there any Interventions you can try?
Clinical actions that can modify the pain experience for the patient.
For example: Splinting, casting, nerve blocks, canes, crutches
Are there any Alternative Therapies you can try?
Therapeutic practices that have the healing effects of medicine but are not based on a scientific medical model.
For example: Acupuncture, homeopathy
What Pharmacotherapy could you try?
Pharmaceuticals that can modify our pain chemistry.
For example: Acetaminophen, anti-inflammatories
Risk Stratify for harm if Opioids or cannabinoids are used to manage pain.
Opioid Risk Tool
6 Step Approach to Chronic Pain
1. LISTEN to the patient’s pain story
2. ACKNOWLEDGE suffering
3. EXAM carefully for any new pathology or progression of a pre-existing disease
4. MAXIMIZE non-opioid and non-cannabinoid therapies
5. RISK STRATIFY for harm if opioids and cannabinoids are used to manage pain
6. MANAGE the risk by MAPing out an approach to opioids and cannabinoids
MONITOR opioid and cannabinoid use for aberrancy
ADJUST immediately if aberrancy present
PRESCRIBE using principles of harm reduction