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Pain Management Tools

Pain Management Tools. Dr. Michael Negraeff Dr. David May. Assessment. Pain Diagram. Psychosocial Yellow Flags: Helping Someone at Risk. Suggested steps to better early behavioral management of low back pain problems.

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Pain Management Tools

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  1. Pain Management Tools Dr. Michael Negraeff Dr. David May

  2. Assessment

  3. Pain Diagram

  4. Psychosocial Yellow Flags: Helping Someone at Risk Suggested steps to better early behavioral management of low back pain problems The information presented here is taken entirely, without any content modification from: Kendall, N A S, Linton, S J & Main, C J (1997). Guide to Assessing Psycho-social Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Accident Compensation Corporation and the New Zealand Guidelines Group, Wellington, New Zealand. (Oct, 2004 Edition).

  5. PHQ-9

  6. GAD-7

  7. Pain Catastrophizing Scale  . RATING 0 1 2 3 4 MEANING Not at all To a slight To a moderate To a great All the degree degreedegree time The Pain Catastrophizing Scale: Development and Validation, Michael J. L. Sullivan, Scott R. Bishop and Jayne Pivik, Psychological Assessment, 1995, Vol. 7, No. 4, 524-532

  8. DN4

  9. Goals Decided with Patient:

  10. Conditions Opioids Have Efficacy In: • Osteoarthritis • Rheumatoid arthritis • Neuropathic pain • Mixed nociceptive and neuropathic states Limited evidence or no efficacy in: • Fibromyalgia • Headache disorders

  11. Furlan et al. 2011 – Cochrane review • 62 RCTs • 12,000 subjects with 4100 dropouts • 35% dropout in opioid arm • 38% dropout in control arm • Opioids better than placebo for pain relief (medium) • Nociceptive pain: medium effect size 0.60 • Neuropathic pain: medium effect size 0.56 • Opioids better than placebo for function (small) • Small ES for function (ES = 0.34)

  12. Opioid Initiation

  13. Urine Drug Screen

  14. RACE

  15. Algorithm

  16. Break

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