Welcome to the Pain Management Unit (PMU)

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1 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: 1. Acute or Short Term Pain (STP) STP is usually of a brief duration (less than 6 months). It is related to tissue damage caused by illness or injury and goes away as a person heals. This pain is protective because it indicates injury and motivates the person to get treatment. It can be mild to severe, is accompanied with anxiety and resolves with healing. 2. Chronic or Long Term Pain (LTP) This pain continues beyond the time where normal healing should have taken place. It lasts more than 6 months. Serving no useful purpose, it is persistent, continuous or recurrent. When pain continues for this long, it usually indicates that the illness or injury that started the pain may have caused changes in the nerves that conduct pain related information to your brain. Most people think of the nervous system as a hard-wired, fixed and unchangeable system. In fact the nervous system is alive and can change (scientists call this plasticity meaning it can be changed). When there is damage, the wiring can get crossed up and can become stuck in the on position. This is similar to being unable to switch off your lights or computer. In other words, the nerves continue to send information to the brain as if the injury or illness is still there even when it is not. The pain no longer signals tissue damage. In this situation, it is normal for people with LTP to have pain even at rest. You may also notice that pain is caused by things that normally do not cause pain. Normal movements or light touch or pressure against your skin can now become painful. LTP can be mild to severe. It can cause irritability, frustration, anxiety, depression, poor concentration, poor memory and poor sleep. It can leave you feeling exhausted.

2 LTP is common and affects 29% of Canadians. This means about 150,000 people have LTP in the Maritimes. So the bottom line is: you are not alone. It is normal for LTP to have a major impact on your life. We will help you to get your life back. This does not mean we will be able to take away your pain. In most cases, once the damage has taken place we cannot cure it. We will do everything we can to help. Our goals are: to reduce the pain where possible. to improve the quality of our patients lives. to purse health and improve function in spite of pain. The PMU offers an inter-disciplinary approach to pain management. This means that the Team is made up of health professionals from several specialties. The treatment involves many things to help the whole person. We are not just interested in your pain, we are interested in you as a whole person who is living with pain. Who We Are The Pain Management Team includes: nurses occupational therapists doctors from several specialties including anesthesiology, rehabilitation medicine and psychiatry physiotherapists a vocational rehabilitation counselor and our office staff. What to Expect When you arrive at the PMU, you will be interviewed first by the nurse. She/he will provide the necessary information to the doctor. The doctor will then take a complete history of your pain and medical health as well as completing a physical examination. Previous tests will be reviewed, new tests may or may not be needed. The doctor will explain what is causing your pain. You and your doctor will discuss your management plan. 2

3 Treatment will be two-fold and may include: 1. Treatments to reduce the pain where possible These may include: Medications There are a number of different medications that may be suggested to reduce pain. These may include; antidepressants (if an antidepressant is suggested, this does not mean that the Team is suggesting that you are depressed or that the pain is in your head. Scientific studies have shown a direct pain relieving effect by antidepressant medications), anticonvulsants, anti-inflammatories and opioids. The doctor will explain these medications to you. It is important to be aware that these medications will not take the pain away completely. Pain doctors may supervise the initiation and stabilization of medication trials. Your family doctor will usually continue as your prescribing doctor. Trials of other treatments that might reduce pain Acupuncture Very thin needles are inserted into specific areas that are intended to decrease the pain. Both traditional Chinese and Western medical techniques are used. Electromotive Drug Administration (EMDA) An electric current from a small battery operated box permits the medicine particles to pass through the skin to the area where it is needed. EMDA may be done by a doctor or nurse. Nerve Blocks A solution is injected (local anesthetics or steroids) close to nerves. The nerve transmission to the brain is blocked. This procedure is done in a Block Room by a doctor. Nerve blocks only work for some types of pain. The doctor will tell you if a nerve block may be helpful for you. Trigger Point Injections A trigger point is a very tender spot in the muscle. Injecting this spot with an anesthetic solution may reduce the pain and allow gentle manipulation and stretching of the muscle. With each injection, the level of pain may be reduced for longer periods of time. A doctor will do these injections. Transcutaneous Electrical Nerve Stimulation (TENS) A TENS unit is a device that reduces pain by applying low-voltage electricity through electrode patches placed over the skin at or near the pain site. PMU staff may instruct you on how to use the unit. We will lend you a unit for a 4 week trial. 3

4 2. Strategies to live with the pain and pursue health. Even after we have tried all approaches to reduce your pain, it is likely that you will still have some pain that you will have to live with. The PMU Team will help you to learn some strategies to take more control over your pain and your life. Believe it or not, you can still be healthy even with LTP. In fact, it is even more important to pursue healthy approaches to living if you have LTP. The Pain Self Management Program This is an intensive 12-day program provided by occupational therapists, physiotherapists and psychologists. Group sessions run 3-1/2 days a week for 4 weeks. The goal is to assist with specific strategies to minimize pain and get more control over your life. Overnight accommodations are available for patients from out-of-town. Therapeutic Exercise You may be referred to a physiotherapist for exercise instructions. The focus is to avoid de-conditioning, and maintain or restore function after an injury. Relaxation Therapy Learning how to truly relax your body and mind can allow your body s built in pain defense system to work better. Pursuit of Health You will be expected to live a healthy lifestyle. This may include: quitting smoking, exercising, developing healthy eating habits, pacing your activities and living a balanced lifestyle. These strategies are even more important when you have chronic pain. Discharge Once you have completed your treatment course, you will be discharged from the PMU. If medications are a part of your pain management program, you will need to see your family doctor regularly. 4

5 Long Term Pain (LTP) Support Groups There are several support groups in the province. Monthly meetings are held on the last Monday of every month from 7-9 pm at the Holiday Inn, Kearney Lake Road, Halifax. Check these Books for more Information Managing Pain Before It Manages You Margaret A. Caudill. The Chronic Pain Control Workbook Ellen Mohr Catalano, Kimeron N. Harding. Looking for more health information? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia Prepared by: Pain Management Unit, QEII, Halifax Designed and Printed by: QEII Audio Visual and Printing Departments PM Revised August 2007 The information in this pamphlet is to be updated every 3 years. 5

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