Drug and non-drug treatments for chronic pain related to vascular disease. Gregory Chernish, MD, CIME

Size: px
Start display at page:

Download "Drug and non-drug treatments for chronic pain related to vascular disease. Gregory Chernish, MD, CIME"

Transcription

1 Drug and non-drug treatments for chronic pain related to vascular disease 1

2 Greg Chernish MD Assistant Professor, Family Medicine U of M Chengdu College of Traditional Chinese Medicine 1990 Certified Independent Medical Examiner Private Healthpoint Clinic University of Manitoba Medical School Integrative Medicine Developer and Course Representative University of Manitoba Liason, National Working Group on CAM in UME Prairie Representative, Chronic Non-Cancer Pain Program Committee, Section of Family Physicians with Special Interests and Focused Practices, College of Family Physicians of Canada 2

3 Objective: Envision an evidence-based framework for integrating drug and non-drug treatments for chronic pain in a patient-centered model 3

4 Types of pain we will review Limb ischemia and claudication Chronic ulcer pain Phantom limb pain and stump pain Ischemic neuropathy 4

5 Chronic Pain 101 5

6 6

7 2 Complementary Mechanisms of Treatment BOTTOM UP: Anti-nociceptive (drugs, anesthetic blocks) TOP DOWN: Activation of descending pain inhibitory pathways (acupuncture, other non-drug treatments, TCA s, SNRI s) 7

8 NOT a linear extension of acute pain NOT a biomedical problem that will respond to a bottom up approach NOT a psychological problem A biospsychosocial condition that requires bottom up AND top-down approaches 8

9 Bottom up culture: Pharmacological treatment is always 1 st line and pain intensity dictates pain treatment Non-pharmacological treatments should not substitute for adequate pharmacological treatment. Multimodal treatment=multimodal drug treatment 9

10 Patient-centered model: patients prefer non-drug options Why? Risk aversion and willingness to accept some discomfort Patients informed about the risks and benefits of drug and non-drug therapies will prefer the latter if that option is offered. (Povar et al Am J PublicHealth 1984;74: ) 10

11 Hierarchy of patientcentered goals and values: Analgesia Maintenance of function; rehabilitation Preservation of higher consciousness Prevention of suicide, accidental death Risk aversion, QOL Other specific patient preferences 11

12 SIO multimodal treatment recommendations for pain, mood, quality of life Mind-body modalities (meditation, yoga etc.) 1B Support groups, CBT 1A Massage 1C Exercise specialist 1B Acupuncture (inc. nausea) 1A; xerostomia 1B 12

13 Non-narcotic medications Duloxetine Venlafaxine Tricyclic antidepressants 13

14 14

15 Acupuncture for claudication and limb ischemia 15

16 Mechanisms of action Acupuncture affects the autonomic nervous system, with documented effects on blood pressure, blood flow and body temperature Chinese Medicine 16

17 Sympathetic Ganglion Stimulation

18 Points Chinese Medicine 18

19 Points Chinese Medicine 19

20 20

21 ??? 21

22 22

23 Erythromelalgia 23

24 Chinese herbal medicine Chinese Medicine 24

25 Phantom limb and stump pain 25

26 Trigger point referral 26

27 Neuropathic pain Acupuncture: shooting pain SNRI s TCA s: burning pain 27

28 Ulcer pain 28

29 Stasis Ulcer Chinese Medicine 29

30 Local mechanisms of action Acupuncture microtrauma creates a current of injury which attracts immune system cells with effects on pain, swelling, peripheral nerve function and wound healing Chinese Medicine 30

31 Jing Wan Hong

32 Chinese Medicine 32

33 Chinese Medicine 33

34 Pain and comorbid depression: a distinct entity 34

35 Depression, chronic pain and suicide by overdose Risk of successful suicide in CPP 2x controls When treating this patient population, the standard of care should include the routine screening of depression and risk assessment of suicide potential with validated tools. -Cheatle, Pain Med 2011; 12: S

36 Validated screening tools; more than a feeling BDI, POMS recommended by Initiative on Methods, Measurements and Pain Assessment in Clinical Trials (IMMPACT) consensus group on measuring emotional states in chronic pain clinical trials REMEMBER: Pain affects provider recognition of depression 36

37 Kroenke et al SCAMP trial JAMA 2009; 301(20): Optimized antidepressant therapy followed by a pain self-management program resulted in substantial improvement in depression as well as moderate reductions in pain severity and disability on top of that achieved with usual medical care. 37

38 Issues peculiar to opioids Opioid-induced neurotoxicity Opioid-induced endocrinopathy Accidental death Intentional suicide Worsening depression 38

39 Opioid deaths Increased use of OPR has contributed to overall increases in rates of overdose death in US (14,800 due to OPR in 2008) -CDC Morbidity and Mortality Weekly 14/11/11 39

40 And don t forget chronic pain is multifactorial Other metabolic causes of pain can coexist, esp in those with autoimmune issues Unrecognized general medical conditions can complicate primary pain picture 40

41 Barriers to treatment Awareness Assumptions Availability Affordability Adjudication 41

42 Questions 42

Guidance on competencies for management of Cancer Pain in adults

Guidance on competencies for management of Cancer Pain in adults Guidance on competencies for management of Cancer Pain in adults Endorsed by: Contents Introduction A: Core competencies for practitioners in Pain Medicine B: Competencies for practitioners in Pain Medicine

More information

Test Content Outline Effective Date: June 9, 2014. Pain Management Nursing Board Certification Examination

Test Content Outline Effective Date: June 9, 2014. Pain Management Nursing Board Certification Examination Pain Management Nursing Board Certification Examination There are 175 questions on this examination. Of these, 150 are scored questions and 25 are pretest questions that are not scored. Pretest questions

More information

Assessment and Management of Chronic Pain Guideline Summary

Assessment and Management of Chronic Pain Guideline Summary I CSI I NSTITUTE FOR CLINICAL S YSTEMS IMPROVEMENT Implementation Tool: Assessment and Management of Chronic Pain Guideline Summary Assessment Algorithm A = Annotation 1 Patient has pain 2 Critical first

More information

Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment

Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment Questions and answers on breast cancer Guideline 10: The management of persistent pain after breast cancer treatment I ve had breast cancer treatment, and now I m having pain. Does this mean the cancer

More information

Pain is a common symptom reported

Pain is a common symptom reported MULTIPLE SCLEROSIS FACT SHEET MANAGING YOUR PAIN Pain is a common symptom reported by people with multiple sclerosis (MS). Approximately 50-60% of people with MS experience acute or chronic pain at some

More information

FEDERAL PAIN PORTFOLIO PREVIEW

FEDERAL PAIN PORTFOLIO PREVIEW FEDERAL PAIN PORTFOLIO PREVIEW Federal Agencies: AHRQ, CDC, DoD, FDA, NIH, VA Interagency Pain Research Coordinating Committee March 27, 2012 IPRCC Charge I. Develop a summary of advances in pain care

More information

Chronic Low Back Pain

Chronic Low Back Pain Chronic Low Back Pain North American Spine Society Public Education Series What is Chronic Pain? Low back pain is considered to be chronic if it has been present for longer than three months. Chronic low

More information

3/10/2015. SPEAKER NAME AND CREDENTIALS: Roberta Goff, MSN Ed, RN-BC, ACNS-BC, ONC

3/10/2015. SPEAKER NAME AND CREDENTIALS: Roberta Goff, MSN Ed, RN-BC, ACNS-BC, ONC GOAL OF PROGRAM: To gain understanding about caring for different pain populations and keeping them safe. SUCCESSFUL COMPLETION: To receive contact hours, participants must attend the entire program. Please

More information

Integrative Pain Management. The Goal of Integrative Pain Management. If pain is not treated what can happen?

Integrative Pain Management. The Goal of Integrative Pain Management. If pain is not treated what can happen? IPM ASPMN National Conference March 24-27, 2007 Addison, Texas Cynthia Knorr-Mulder APRN, NP-C, CHt Nurse Practitioner Northern New Jersey www.integrative-medicine.biz Integrative pain management is a

More information

Michigan Department of Licensing and Regulatory Affairs Pain and Symptom Management Speakers Bureau

Michigan Department of Licensing and Regulatory Affairs Pain and Symptom Management Speakers Bureau Michigan Department of Licensing and Regulatory Affairs Pain and Symptom Management Speakers Bureau Are you looking for a speaker to present at your conference, ground rounds, or brown bag lunch? If you

More information

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse

More information

Tension-type headache Non-pharmacological and pharmacological treatment

Tension-type headache Non-pharmacological and pharmacological treatment Danish Headache Center Tension-type headache Non-pharmacological and pharmacological treatment Lars Bendtsen Associate professor, MD, PhD, Dr Med Sci Danish Headache Center, Department of Neurology Glostrup

More information

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Section I: Preamble The Michigan Boards of Medicine and Osteopathic Medicine & Surgery recognize that principles of quality

More information

Treatment of Chronic Pain: Our Approach

Treatment of Chronic Pain: Our Approach Treatment of Chronic Pain: Our Approach Today s webinar was coordinated by the National Association of Community Health Centers, a partner with the SAMHSA-HRSA Center for Integrated Health Solutions SAMHSA

More information

Prescription Opioid Addiction and Chronic Pain: Non-Addictive Alternatives To Treatment and Management

Prescription Opioid Addiction and Chronic Pain: Non-Addictive Alternatives To Treatment and Management Prescription Opioid Addiction and Chronic Pain: Non-Addictive Alternatives To Treatment and Management Dr. Barbara Krantz Medical Director Diplomate American Board of Addiction Medicine 1 Learning Objectives

More information

Collaborative Care Plan for PAIN

Collaborative Care Plan for PAIN 1. Pain Assessment *Patient s own description of pain is the most reliable indicator for pain assessment. Pain intensity to be assessed using the ESAS (Edmonton Symptom Assessment Scale) Use 5 th Vital

More information

How To Treat Chronic Pain With Nonpharmacological Medicine

How To Treat Chronic Pain With Nonpharmacological Medicine . Report to The Vermont Legislature Treatment of Chronic Pain In Accordance with Act 75, Sections 14(d)(2) and 14a An Act Relating to Strengthening Vermont s Response to Opioid Addiction and Methamphetamine

More information

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller

Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller Elizabeth A. Crocco, MD Assistant Clinical Professor Chief, Division of Geriatric Psychiatry Department of Psychiatry and Behavioral Sciences Miller School of Medicine/University of Miami Question 1 You

More information

Managing Chronic Pain

Managing Chronic Pain Managing Chronic Pain Chronic pain can cripple the body, mind and spirit. Feeling broken? You may benefit from Cleveland Clinic s Section of Pain Medicine, which tailors comprehensive, innovative treatment

More information

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN Janice K. Brewer Governor Arizona State Board of Nursing 4747 North 7 th Street, Suite 200 Phoenix, AZ 85014-3655 Phone (602) 889-5150 Fax - (602) 889-5155 E-Mail: arizona@azbn.gov Home Page: http://www.azbn.gov

More information

Fact Sheet. Queensland Spinal Cord Injuries Service. Pain Management Following Spinal Cord Injury for Health Professionals

Fact Sheet. Queensland Spinal Cord Injuries Service. Pain Management Following Spinal Cord Injury for Health Professionals Pain Management Following Injury for Health Professionals and Introduction Pain is a common problem following SCI. In the case where a person with SCI does have pain, there are treatments available that

More information

MQAC Rules for the Management of Chronic Non-Cancer Pain

MQAC Rules for the Management of Chronic Non-Cancer Pain MQAC Rules for the Management of Chronic Non-Cancer Pain Effective January 2, 2012 246-919-850 Pain management Intent. These rules govern the use of opioids in the treatment of patients for chronic noncancer

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: spinal_cord_stimulation 3/1980 10/2015 10/2016 10/2015 Description of Procedure or Service Spinal cord stimulation

More information

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

PAIN MANAGEMENT AT UM/SYLVESTER

PAIN MANAGEMENT AT UM/SYLVESTER PAIN MANAGEMENT AT UM/SYLVESTER W HAT IS THE PURPOSE OF THIS BROCHURE? We created this brochure for patients receiving care from the University of Miami Sylvester Comprehensive Cancer Center and their

More information

Rehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center

Rehabilitation Where You Recover. Inpatient Rehabilitation Services at Albany Medical Center Rehabilitation Where You Recover Inpatient Rehabilitation Services at Albany Medical Center You're Here and So Are We As the region s only academic medical center, Albany Medical Center offers a number

More information

CHPN Review Course Pain Management Part 1 Hospice and Palliative Nurses Association

CHPN Review Course Pain Management Part 1 Hospice and Palliative Nurses Association CHPN Review Course Pain Management Part 1 Disclosures Bonnie Morgan has no real or perceived conflicts of interest that relate to this presentation. Copyright 2015 by the. HPNA has the exclusive rights

More information

Making our pets comfortable. A modern approach to pain and analgesia.

Making our pets comfortable. A modern approach to pain and analgesia. Making our pets comfortable. A modern approach to pain and analgesia. What is pain? Pain is an unpleasant sensory and emotional experience with awareness by an animal to damage or potential damage to its

More information

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION Effective June 13, 2010 02-313, 02-373, 02-380, 02-383, 02-396 Chapter 21 page 1 02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 313 BOARD OF DENTAL EXAMINERS 373 BOARD OF LICENSURE IN MEDICINE

More information

Clinical and Therapeutic Cannabis Information. Written by Cannabis Training University (CTU) All rights reserved

Clinical and Therapeutic Cannabis Information. Written by Cannabis Training University (CTU) All rights reserved Clinical and Therapeutic Cannabis Information Written by Cannabis Training University (CTU) All rights reserved Contents Introduction... 3 Chronic Pain... 6 Neuropathic Pain... 8 Movement Disorders...

More information

OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY. 1 Overview of Cognitive Behavioral Therapy

OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY. 1 Overview of Cognitive Behavioral Therapy OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY 1 Overview of Cognitive Behavioral Therapy TABLE OF CONTENTS Introduction 3 What is Cognitive-Behavioral Therapy? 4 CBT is an Effective Therapy 7 Addictions Treated

More information

Healthy Coping in Diabetes Self Management

Healthy Coping in Diabetes Self Management Healthy Coping in Diabetes Self Management Support for this product was provided by a grant from the Robert Wood Johnson Foundation in Princeton, New Jersey, 2009 Objectives Describe the relationship among

More information

Thinking About Complementary & Alternative Medicine

Thinking About Complementary & Alternative Medicine Thinking About Complementary & Alternative Medicine A guide for people with cancer PATIENT & family EDUCATION U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer

More information

Frequently Asked Questions About Prescription Opioids

Frequently Asked Questions About Prescription Opioids Mental Health Consequences of Prescription Drug Addictions Opioids, Hypnotics and Benzodiazepines Learning Objectives 1. To review epidemiological data on prescription drug use disorders Ayal Schaffer,

More information

Maryland Cancer Plan Pain Management Committee

Maryland Cancer Plan Pain Management Committee Maryland Cancer Plan Pain Management Committee IDEAL MODEL FOR CANCER CONTROL PROBLEM or ISSUE Lack of provider awareness regarding appropriate pain assessment and management and relevant policy Definition:

More information

www.centerforebp.case.edu

www.centerforebp.case.edu www.centerforebp.case.edu www.centerforebp.case.edu Managing the Drug-Seeking Patient in Hospital Settings Christina M. Delos Reyes, MD Medical Consultant Center for Evidence-Based Practices BHO Videoconference

More information

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths Joanna G Katzman, M.D., M.S.P.H Director, UNM Pain Center Associate Professor,

More information

in young people Management of depression in primary care Key recommendations: 1 Management

in young people Management of depression in primary care Key recommendations: 1 Management Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

More information

Focus on Assessment. Teaching Pain Assessment and Management: Pearls for Caring for Patients with Pain. #1. Pain is a Universal Experience.

Focus on Assessment. Teaching Pain Assessment and Management: Pearls for Caring for Patients with Pain. #1. Pain is a Universal Experience. Teaching Pain Assessment and Management: Pearls for Caring for Patients with Pain Jennifer Parsons, FNP Duke Pain Medicine Adaptive Teaches us about our environment Demands attention Can be all consuming

More information

Michigan Board of Nursing Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Board of Nursing Guidelines for the Use of Controlled Substances for the Treatment of Pain JENNIFER M. GRANHOLM GOVERNOR STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH LANSING JANET OLSZEWSKI DIRECTOR Michigan Board of Nursing Guidelines for the Use of Controlled Substances for the Treatment

More information

Medications for chronic pain

Medications for chronic pain Medications for chronic pain When it comes to treating chronic pain with medications, there are many to choose from. Different types of pain medications are used for different pain conditions. You may

More information

Primary care: Addictive disorders. Addiction a growing public health problem

Primary care: Addictive disorders. Addiction a growing public health problem Meditation, Addiction, and the Culture of Patient Satisfaction: An Evolving Primary Care Research Strategy Department of Family Medicine Aleksandra Zgierska, MD PhD UW School of Medicine & Public Health

More information

Understanding. Peripheral Neuropathy. Lois, diagnosed in 1998, with her husband, Myron.

Understanding. Peripheral Neuropathy. Lois, diagnosed in 1998, with her husband, Myron. Understanding Peripheral Neuropathy Lois, diagnosed in 1998, with her husband, Myron. What Is Peripheral Neuropathy? Peripheral neuropathy is a nerve disorder. It may cause numbness, tingling, and weakness.

More information

PCORI Workshop on Treatment for Multiple Sclerosis. Breakout Group Topics and Questions Draft 3-27-15

PCORI Workshop on Treatment for Multiple Sclerosis. Breakout Group Topics and Questions Draft 3-27-15 PCORI Workshop on Treatment for Multiple Sclerosis Breakout Group Topics and Questions Draft 3-27-15 Group 1 - Comparison across DMTs, including differential effects in subgroups Consolidated straw man

More information

Prioritizing Comparative Effectiveness Research Questions: PCORI Stakeholder Workshops. March 7, 2016

Prioritizing Comparative Effectiveness Research Questions: PCORI Stakeholder Workshops. March 7, 2016 Prioritizing Comparative Effectiveness Research Questions for Management of Sickle Cell Disease: Questions submitted for consideration by workshop participants Prioritizing Comparative Effectiveness Research

More information

Interdisciplinary Care in Pediatric Chronic Pain

Interdisciplinary Care in Pediatric Chronic Pain + Interdisciplinary Care in Pediatric Chronic Pain Emily Law, PhD Assistant Professor Department of Anesthesiology & Pain Medicine University of Washington & Seattle Children s Hospital + Efficacy: Psychological

More information

The Role of Complementary and Alternative Medicine

The Role of Complementary and Alternative Medicine The Role of Complementary and Alternative Medicine By Leslie Mendoza Temple, MD and Cynthia A. Holmes, PhD According to Dr. Andrew Weil, Director of the Integrative Medicine program at the University of

More information

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications

PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications PARTNERSHIP HEALTHPLAN RECOMMENDATIONS For Safe Use of Opioid Medications Primary Care & Specialist Prescribing Guidelines Introduction Partnership HealthPlan is a County Organized Health System covering

More information

Implementing Prescribing Guidelines in the Emergency Department. April 16, 2013

Implementing Prescribing Guidelines in the Emergency Department. April 16, 2013 Implementing Prescribing Guidelines in the Emergency Department April 16, 2013 Housekeeping Note: Today s presentation is being recorded and will be provided within 48 hours. Two ways to ask questions

More information

Guidelines for Use of Controlled Substances for the Treatment of Pain

Guidelines for Use of Controlled Substances for the Treatment of Pain 1.0 Purpose: Use of Controlled Substances for the Treatment of Pain The Physicians Advisory Committee for Controlled Substances of the Medical Society of Delaware supports the Federation of State Medical

More information

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Dr. Joti Samra PhD, R.Psych. Adjunct Professor & Research Scientist CARMHA www.carmha.ca Dr. Merv Gilbert PhD, R.Psych. Principal

More information

Limb Preservation Strategies: Quality Outcomes for the ACO Model. SPEAKERS: Audrey K Moyer-Harris MBA BSN RN CWCN Martha Kelso RN HBOT COO MWS LEAP

Limb Preservation Strategies: Quality Outcomes for the ACO Model. SPEAKERS: Audrey K Moyer-Harris MBA BSN RN CWCN Martha Kelso RN HBOT COO MWS LEAP Limb Preservation Strategies: Quality Outcomes for the ACO Model SPEAKERS: Audrey K Moyer-Harris MBA BSN RN CWCN Martha Kelso RN HBOT COO MWS LEAP Disclosures Audrey K Moyer-Harris MBA BSN RN CWCN Executive

More information

Many people with MS use some form of conventional medical treatment, and many people also use complementary and alternative medicine (CAM).

Many people with MS use some form of conventional medical treatment, and many people also use complementary and alternative medicine (CAM). Complementary and alternative medicine (CAM) CAM therapies can generally be divided into the following categories: Biologically based therapies (eg, dietary supplements, diets, bee venom therapy, hyperbaric

More information

WA Opioid Dosing Guidelines Centers for Disease Control 1/14/2009

WA Opioid Dosing Guidelines Centers for Disease Control 1/14/2009 WA Opioid Dosing Guidelines Centers for Disease Control 1/14/2009 Gary M. Franklin, MD, MPH Research Professor Departments of Environmental Health and Neurology University of Washington Medical Director

More information

Acupuncture: An Introduction

Acupuncture: An Introduction Acupuncture: An Introduction Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine (TCM), acupuncture aims to restore and maintain health through the stimulation

More information

Tension-type headache Non-pharmacological and pharmacological treatment

Tension-type headache Non-pharmacological and pharmacological treatment Danish Headache Center Tension-type headache Non-pharmacological and pharmacological treatment Lars Bendtsen Associate professor, MD, PhD, Dr Med Sci Danish Headache Center, Department of Neurology Glostrup

More information

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013)

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals: Timely access to geographically located acute stroke unit care with a dedicated interprofessional team

More information

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN Doug Ducey Governor Arizona State Board of Nursing 4747 North 7 th Street, Suite 200 Phoenix, AZ 85014-3655 Phone (602) 771-7800 Fax - (602) 771-7888 E-Mail: arizona@azbn.gov Home Page: www.azbn.gov Joey

More information

There are four groups of medications most likely to be used for depression: Antidepressants Antipsychotics Mood stabilisers Augmenting agents.

There are four groups of medications most likely to be used for depression: Antidepressants Antipsychotics Mood stabilisers Augmenting agents. What this fact sheet covers: Physical treatments (medication, ECT and TMS) Psychological treatments Self-help & alternative therapies Key points to remember Where to get more information. Introduction

More information

Welcome to the Pain Management Unit (PMU)

Welcome to the Pain Management Unit (PMU) Welcome to the Pain Management Unit (PMU) This pamphlet describes who we are and what you can expect from us, along with a few facts about chronic pain. Facts About Chronic Pain The 2 kinds of pain are:

More information

How To Become A Physio And Rehabilitation Medicine Specialist

How To Become A Physio And Rehabilitation Medicine Specialist EUROPEAN BOARD OF PHYSICAL AND REHABILITATION MEDICINE LOGBOOK EUROPEAN UNION OF MEDICAL SPECIALISTS UEMS IDENTIFICATION... 2 INSTRUCTIONS FOR USE... 3 THE TRAINING COURSE... 3 TRAINING PROGRAMME... 4

More information

Medication Management of Depressive Disorders in Children and Adolescents. Satya Tata, M.D. Kansas University Medical Center

Medication Management of Depressive Disorders in Children and Adolescents. Satya Tata, M.D. Kansas University Medical Center Medication Management of Depressive Disorders in Children and Adolescents Satya Tata, M.D. Kansas University Medical Center First Line Medications SSRIs Prozac (Fluoxetine): 5-605 mg Zoloft (Sertraline):

More information

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE 1 DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for depression and any history of depression? 2. Did staff

More information

KIH Cardiac Rehabilitation Program

KIH Cardiac Rehabilitation Program KIH Cardiac Rehabilitation Program For any further information Contact: +92-51-2870361-3, 2271154 Feedback@kih.com.pk What is Cardiac Rehabilitation Cardiac rehabilitation describes all measures used to

More information

Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working

Critically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working Rationale of Module Accurate nursing assessment is the key to effective diabetic foot ulcer prevention, treatment and management. A comprehensive assessment identifies ulcer aetiology and the factors which

More information

Why are antidepressants used to treat IBS? Some medicines can have more than one action (benefit) in treating medical problems.

Why are antidepressants used to treat IBS? Some medicines can have more than one action (benefit) in treating medical problems. The Use of Antidepressants in the Treatment of Irritable Bowel Syndrome and Other Functional GI Disorders Christine B. Dalton, PA-C Douglas A. Drossman, MD What are functional GI disorders? There are more

More information

Objectives. Pain Management Knowing How To Help Yourself. Patients and Family Requirements. Your Rights As A Consumer

Objectives. Pain Management Knowing How To Help Yourself. Patients and Family Requirements. Your Rights As A Consumer Objectives Pain Management Knowing How To Help Yourself Jackie Carter, RN MSN CNS Become familiar with the definitions of pain Be aware of your rights to have your pain treated Become familiar with the

More information

Palmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM

Palmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM Palmer MacKie, MD MS Director, Integrative Pain Program, Eskenazi Department of Medicine, IUSOM Attorney General s Prescription Drug Abuse Task Force Member AIT Laboratories Advisory Board In 2009, 44%

More information

DOCTOR DISCUSSION GUIDE FOR RHEUMATOID ARTHRITIS

DOCTOR DISCUSSION GUIDE FOR RHEUMATOID ARTHRITIS DOCTOR DISCUSSION GUIDE FOR RHEUMATOID ARTHRITIS Talking your Doctor About Rheumatoid Arthritis Preparing for your Doctor s Appointment Early and aggressive treatment can help you forestall the joint damage

More information

Systems for Musculoskeletal Pain: Questions submitted for consideration by workshop participants

Systems for Musculoskeletal Pain: Questions submitted for consideration by workshop participants Systems for Musculoskeletal Pain: Questions submitted for consideration by workshop participants Prioritizing Comparative Effectiveness Research Questions: PCORI Stakeholder Workshops June 9, 2015 Patient-Centered

More information

Halloween Costume Ideas - The Ultimate Party Planning Formula

Halloween Costume Ideas - The Ultimate Party Planning Formula Patient Type 2 Diabetes Aboriginal Health Workers Audiologists Chiropractors Diabetes Educators Dietitians Exercise Physiologists Mental Health Nurses Mental Health Social Workers Occupational Therapists

More information

BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM

BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM 3 rd Quarter 2015 BENZODIAZEPINE CONSIDERATIONS IN WORKERS COMPENSATION: IMPLICATIONS FOR WORK DISABILITY AND CLAIM COSTS By: Michael Erdil MD, FACOEM Introduction Benzodiazepines, sometimes called "benzos",

More information

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Section I: Preamble The New Hampshire Medical Society believes that principles

More information

Measurement Tool for Clinical Practice Guideline Implementation: Measures for Depression

Measurement Tool for Clinical Practice Guideline Implementation: Measures for Depression ment Tool for Clinical Practice Guideline : Establish process and clinical outcomes measures before implementing the Depression in the Long Term Care Setting Clinical Practice Guideline (CPG). As much

More information

Algorithm for Initiating Antidepressant Therapy in Depression

Algorithm for Initiating Antidepressant Therapy in Depression Algorithm for Initiating Antidepressant Therapy in Depression Refer for psychotherapy if patient preference or add cognitive behavioural office skills to antidepressant medication Moderate to Severe depression

More information

Knowledge Brochure Series MS & SYMPTOM MANAGEMENT

Knowledge Brochure Series MS & SYMPTOM MANAGEMENT Knowledge Brochure Series MS & SYMPTOM MANAGEMENT Identifying your multiple sclerosis (MS) symptoms 1 A chronic disease like MS can cause a number of different symptoms and spotting yours is the first

More information

Duke Integrative Primary Care

Duke Integrative Primary Care Duke Integrative Primary Care What is Duke Integrative Medicine? We are a premier medical facility located on Duke University s Center for Living Campus. Our physicians are among the best in the field,

More information

THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents

THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, Massachusetts 02114-2017 DEVAL L. PATRICK Governor PHILIP L. HILLMAN Director TIMOTHY P. MURRAY

More information

Lora McGuire MS, RN Educator and Consultant lmcguire@jjc.edu. Barriers to effective pain relief

Lora McGuire MS, RN Educator and Consultant lmcguire@jjc.edu. Barriers to effective pain relief Lora McGuire MS, RN Educator and Consultant lmcguire@jjc.edu Barriers to effective pain relief Freedom from pain is a basic human right -WHO Pain is whatever the experiencing person says it is and exists

More information

Eating Disorder Treatment Protocol

Eating Disorder Treatment Protocol Eating Disorder Treatment Protocol All Team Members: Patient Self-Management Education & Support Eating Disorders are incredibly debilitating and are associated with significant medical and psychosocial

More information

Got Pain? 11/19/2013. Pain Kill Beyond The Pill. Yet it is often inadequately treated.

Got Pain? 11/19/2013. Pain Kill Beyond The Pill. Yet it is often inadequately treated. Pain Kill Beyond The Pill An Innovative & Personalized Approach to Pain Treatment MAZEN BAISA, PharmD, RPh., MBA, ABAAHP, FAARM, CPE Director of Clinical Services BioMed Specialty Pharmacy Pain Kill Beyond

More information

TAKING CARE OF YOUR RHEUMATOID ARTHRITIS

TAKING CARE OF YOUR RHEUMATOID ARTHRITIS TAKING CARE OF YOUR RHEUMATOID ARTHRITIS RHEUMATOID ARTHRITIS (RA) FAST FACTS What is Rheumatoid Arthritis? Rheumatoid arthritis (RA) is a chronic disease that can affect your ability to function and be

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

Sample Treatment Protocol

Sample Treatment Protocol Sample Treatment Protocol 1 Adults with acute episode of LBP Definition: Acute episode Back pain lasting

More information

Table of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression

Table of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression Table of Contents Visit www.healthreferenceseries.com to view A Contents Guide to the Health Reference Series, a listing of more than 16,000 topics and the volumes in which they are covered. Preface...xv

More information

Scientific Facts on. Psychoactive Drugs. Tobacco, Alcohol, and Illicit Substances

Scientific Facts on. Psychoactive Drugs. Tobacco, Alcohol, and Illicit Substances page 1/5 Scientific Facts on Psychoactive Drugs Tobacco, Alcohol, and Illicit Substances Source document: WHO (2004) Summary & Details: GreenFacts Context - Psychoactive drugs such as tobacco, alcohol,

More information

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics

POST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped

More information

Common Elements in Guidelines for Prescribing Opioids for Chronic Pain

Common Elements in Guidelines for Prescribing Opioids for Chronic Pain Common Elements in Guidelines for Prescribing Opioids for Chronic Pain The use of opioids for treating chronic pain has been increasing. 1 In 2010, an estimated 20% of patients presenting to physician

More information

Step 4: Complex and severe depression in adults

Step 4: Complex and severe depression in adults Step 4: Complex and severe depression in adults A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive

More information

PAIN RELIEF GUIDE. Tips and advice from your pharmacist.

PAIN RELIEF GUIDE. Tips and advice from your pharmacist. PAIN RELIEF GUIDE Tips and advice from your pharmacist. Rite Aid Pharmacists: Your Pain Relief Managers Rite Aid is committed to providing everyday products and services that help our valued customers

More information

Chronic Headaches. David R. Greeley, MD, FAAN Northwest Neurological, PLLC October 23, 2015

Chronic Headaches. David R. Greeley, MD, FAAN Northwest Neurological, PLLC October 23, 2015 s David R. Greeley, MD, FAAN Northwest Neurological, PLLC October 23, 2015 Why is Headache Important? 36,000,000 people have migraine - more than asthma and diabetes combined 13,000,000 have chronic daily

More information

2014 Nursing and Allied Health Publications

2014 Nursing and Allied Health Publications 2014 Nursing and Allied Health Publications Authoritative protocols and best practices Innovative information to ensure optimal patient outcomes Leading-edge data for improving care across the lifespan

More information

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx Alcohol Abuse By Neva K.Gulsby, PA-C, and Bonnie A. Dadig, EdD, PA-C Posted on: April 18, 2013 Excessive

More information

of the Nurse Practitioner

of the Nurse Practitioner The Emerging Role of the Nurse Practitioner Rhonda Hettinger DNP, NP C, CLS Introduction The American health care system is in need of a fundamental change (Institute t of Medicine, 2001). Nurse practitioner

More information

The Role of the Haematology Specialist Nurse. Catherine Chapman RN. BSc (Hons)

The Role of the Haematology Specialist Nurse. Catherine Chapman RN. BSc (Hons) The Role of the Haematology Specialist Nurse Catherine Chapman RN. BSc (Hons) Key Roles Information Support Advice Patient advocate Education Coordination of care Information Patient Family Carers Health

More information

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the

More information

Keeping a Healthy Mind in a World of Stress

Keeping a Healthy Mind in a World of Stress Keeping a Healthy Mind in a World of Stress James Randy Mervis, M.D. QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture. 1 Talk Outline Definition of Stress Types of Stress,

More information

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES Pursuant to section 453-1.5, Hawaii Revised Statutes, the Board of Medical Examiners ("Board") has established guidelines for physicians with respect to the care and treatment of patients with severe acute

More information

DIABETES A chronic, debilitating and often deadly disease A global epidemic Diabetes in Africa

DIABETES A chronic, debilitating and often deadly disease A global epidemic Diabetes in Africa DIABETES A chronic, debilitating and often deadly disease Diabetes is a chronic condition that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin

More information

PAIN MANAGEMENT During Your Hospital Stay

PAIN MANAGEMENT During Your Hospital Stay PAIN MANAGEMENT During Your Hospital Stay TABLE OF CONTENTS Understanding Pain...2 Pain Assessment...2 Describing Your Pain...5 Pain Treatment...5 Comfort Measures...6 Medication...7 Specialty Procedures...8

More information