hospicecourse-unit1
TRANSCRIPT
The Principles of Pain Management(Part 1):
Pain and its subtypes, definitions and concepts
By: Babak Roozrokh, MD
Palliative Care Doctors Group, Inc.
Pain
Pain
Physical
Pain
Physical
Emotional
PhysicalPain
PhysicalPain
PhysicalPain
Nocioceptive
PhysicalPain
Nocioceptive
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
PhysicalPain
Nocioceptive
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
PhysicalPain
Nocioceptive
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart: Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart: Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic
Central
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart: Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart: Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Sympathetic
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart: Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Sympathetic
•Tingling •Burning•Numbness•Itching•Stabbing
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart: Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Sympathetic
•Tingling •Burning•Numbness•Itching•Stabbing
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart:
Post Herpetic Neuralgia
Diabetic Neuropathy
Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Sympathetic
Mixed ( Nocioceptive & Neuropathic ) : Cancer
•Tingling •Burning•Numbness•Itching•Stabbing
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart:
Post Herpetic Neuralgia
Diabetic Neuropathy
Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Sympathetic
Mixed ( Nocioceptive & Neuropathic ) : Cancer
•Tingling •Burning•Numbness•Itching•Stabbing
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
EXAMPLE
89 year old male with metastatic pancreatic cancer (metastasized to femur and spine) describes his pain as
“dull and achy” and sometimes “stabbing and sharp” in his back and feels “numbness and burning” in his legs.
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart:
Post Herpetic Neuralgia
Diabetic Neuropathy
Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Sympathetic
•Tingling •Burning•Numbness•Itching•Stabbing
Mixed ( Nocioceptive & Neuropathic ) : Cancer
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart:
Post Herpetic Neuralgia
Diabetic Neuropathy
Skin Burn, Pulmonary Embolism, Myocardial
infarction
Functional (Pain for secondary gain)
PhysicalPain
Nocioceptive
Neuropathic Peripheral
Central
Sympathetic
•Tingling •Burning•Numbness•Itching•Stabbing
Mixed ( Nocioceptive & Neuropathic ) : Cancer
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
EXAMPLE
24 year old army soldier wants to hang out with his buddies for upcoming high school reunion complains of severe
abdominal pain.
Physical exam, labs and all imagings are normal. Pain is “gone” when he is allowed to go home “to rest”.
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart:
Post Herpetic Neuralgia
Diabetic Neuropathy
Skin Burn, Pulmonary Embolism, Myocardial
infarction
Functional (Pain for secondary gain)
PhysicalPain
Nocioceptive
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart:
Neuropathic Peripheral
Central
Sympathetic
Functional (Pain for secondary gain)
Psychogenic (Somatization)
•Tingling •Burning•Numbness•Itching•Stabbing
Post Herpetic Neuralgia
Diabetic Neuropathy
Mixed ( Nocioceptive & Neuropathic ) : Cancer
Skin Burn, Pulmonary Embolism, Myocardial
infarction
PhysicalPain
Nocioceptive
Bone (Constant ache): Osteoarthritis, Rheumatoid Arthritis
Neuropathic Peripheral
Central
Sympathetic
Functional (Pain for secondary gain)
Psychogenic (Somatization)
•Tingling •Burning•Numbness•Itching•Stabbing
Mixed ( Nocioceptive & Neuropathic ) : Cancer
EXAMPLE
30 year old registered nurse just heard that her grandmother whom she was very closed to passed away suddenly. She now has severe pain in her right foot and can not walk.
Visceral (Crampy) i.e.Bowels: Small Bowel Obstruction
Somatic (Sharp) i.e. Skin, Lungs, Heart:
Post Herpetic Neuralgia
Diabetic Neuropathy
Skin Burn, Pulmonary Embolism, Myocardial
infarction
Emotional(Suffering)
Emotional(Suffering)
Psychological / Spiritual
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
AngerWhat have I done to deserve this?
Why did God do this to me?
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
What have I done to deserve this?
Why did God do this to me?
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
What have I done to deserve this?
Why did God do this to me?
Physical Disability / Isolation
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
What have I done to deserve this?
Why did God do this to me?
Physical Disability / IsolationHair loss secondary to cancer
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
What have I done to deserve this?
Why did God do this to me?
Physical Disability / IsolationHair loss secondary to cancer
Wheelchair bound and isolated
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
What have I done to deserve this?
Why did God do this to me?
Physical Disability / IsolationHair loss secondary to cancer
Wheelchair bound and isolated
EXAMPLE
56 year old former beauty queen was just diagnosed with breast cancer. She is refusing chemotherapy because she
does not want to become “bald”.
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
What have I done to deserve this?
Why did God do this to me?
Physical Disability / Isolation
Short / Tall – Obese/ Thin
Hair loss secondary to cancer
Wheelchair bound and isolated
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
What have I done to deserve this?
Why did God do this to me?
Physical Disability / Isolation
Short / Tall – Obese/ Thin
Cultural differences: Accent
Hair loss secondary to cancer
Wheelchair bound and isolated
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
Financial
What have I done to deserve this?
Why did God do this to me?
Physical Disability / Isolation
Short / Tall – Obese/ Thin
Cultural differences: Accent
Hair loss secondary to cancer
Wheelchair bound and isolated
Emotional(Suffering)
Psychological / SpiritualAnxiety: Fear of death
Anger
Social
Financial
Other…
What have I done to deserve this?
Why did God do this to me?
Physical Disability / Isolation
Short / Tall – Obese/ Thin
Cultural differences: Accent
Hair loss secondary to cancer
Wheelchair bound and isolated