When I create a pain treatment algorithm or plan for my patients, I really want to understand, not just how bad their pain is, but how their pain affects their daily activities of life, their functionality, and their quality of life.
Assessing the Best Way to Achieve Pain Relief
My interaction with my patients is very much like a detective. I'm trying to find out exactly how bad the pain is and what the impact or the burden of that pain is on their life. Once I understand that and I feel their pain, then I can start to address how we're going to manage their pain.
Addressing Pain Relief Holistically
What we do in pain medicine is we try to address the patient in what we call a "bio-psycho-social model." That means addressing the patient very holistically; looking at all these different elements and then matching up an individualized treatment for our patient.
And when we start to think about how those treatments actually work in our patients, we're going to offer them pharmacological treatments and non-pharmacological treatments. And when we do that, it's called "multimodal therapy;" we combine the two together.
A Non-Invasive Approach to Pain Relief
So, non-pharmacological treatments may include things like rest and ice and exercise and physical rehabilitation. And it's critically important that those are included in a pain management strategy.
When we start to think about interventions from the sense of pharmacological strategies, those can be achieved in many different ways. I usually like to start with the least invasive.
Delivering Pain Relief Directly at the Source
So, I'll think of topical agents; agents where I can apply them directly where the pain is. And then, we'll progress from a topical agent maybe to an oral agent.
Sometimes the patients will need more than one pain medication because pain can be controlled at different points along the pain pathways. So, we may combine different types of drugs. We call that a "multi-mechanistic analgesic regimen." And with this type of regimen where we may be using oral agents and topical agents, we're usually able to get adequate pain relief.
Pain Relief Means Quality of Life
But it's not just about pain relief. You have to have functionality; you have to have quality of life. You have to be having activities of daily living. And this has a lot to do with patient satisfaction. So, I'm very much gauging how much pain relief I can give my patients in correspondence to how it's improving their life.
Difference Between Chronic and Acute Pain Relief
Now, there are differences between chronic pain and acute pain, but the acute pain, we expect it to resolve naturally over a short period of time. And so, those type of patients, I want to provide them with appropriate and adequate analgesia and I really want to address the pain, particularly the severity of the pain.
With chronic pain patients, this is something that, unfortunately, is going to be around for a long time and they usually have had it for a long time before they come to see me. And now what I'm trying to do is I'm trying to reduce the pain, probably not eliminate it 100 percent, but reduce it as best as I can and then start to address activities of daily living, quality of life, patient satisfaction, and more.