Anesthesia Student Survival Guide.pdf - Index of

PerioPerAtive ACute And ChroniC PAin MAnAGeMent ● 425
Physical Therapy
Physical therapy has an important role in the treatment of the chronic pain
patient to reduce disability, restore and increase function, and improve strength.
Exercise may increase endurance and muscle strength while at the same time
decrease the patient’s subjective experience of pain. Passive forms of physical
therapy can include electrostimulation, heat and cold therapy, and ultrasound.
Psychological Therapy
Psychological evaluation of the patient may help to diagnose and treat psychiatric
issues such as malingering, substance abuse and somatization disorders
and other issues such as depression, anxiety, and sleep disorders contributing
to the patient’s pain disorder. Early diagnosis and treatment of psychological
issues have demonstrated to effect a patient’s pain level, ability to cope, return
to work, and medication compliance.
Palliative Care
Palliative care focuses on providing pain relief and care of a terminally ill
patient and his/her family over the remainder of the patient’s life. It focuses on
pain relief and symptomatic relief of nausea, vomiting, and dyspnea. Care may
take place at home (usually through hospice) or in an inpatient palliative care
unit, acute care hospital, or nursing home.
Case Study
A 32-year-old woman seeks consultation with you in the pain management
clinic. Six months ago she sprained her left elbow and wrist in a fall while
roller blading. After recovering uneventfully with splinting of her wrist and
wearing a sling for 4 weeks, she has developed severe pain again. She describes
it as burning and constant. She describes tingling, “electric shock” sensations
over the affected area. It covers the dorsum of her hand, both sides of her forearm,
and the posterior aspect of the elbow and lower arm. She notes that she
cannot type with her left hand and that she cannot lift her backpack with her
left arm. She finds showering painful and keeps the arm out of the water; she
avoids long-sleeved shirts because the fabric rubbing against her skin is painful.