Treatment Essentials

What do to if:

• Depression/anxiety screen +: Take a more detailed history to confirm or refer for psychiatric evaluation.
• Poor coping/fear avoidance/low self-efficacy: Consult pain psychologist or PT with chronic pain expertise or interdisciplinary pain program.
• Sleep quality poor: Identify etiology and treat; consult sleep specialist if needed.
• Widespread pain: Consult rheumatology or pain clinic.
• Moderate-high opioid risk: Educate, co-manage with substance abuse program, interdisciplinary pain program.
• Myofascial pain:
  • Identify and treat perpetuating factors (physical, emotional, environment); consider gabapentin for neuropathic generators.
  • Trigger point deactivation.
  • PT for gentle stretching, strengthening.
• Positive SI maneuvers:
  • Identify/treat perpetuating factors (e.g., hip OA, recent LLD).
  • Conder SI injection as bridge.
  • PT (brace, walker, pelvic musculature Rx)
• IT band pain: Refer to Physical Therapy.
• Scoliosis/kyphosis: PT referral; consider walker to unload spine.
• Leg length discrepancy (LLD): If pain started after LLD ( e.g. after TKA, THA), refer to PT for evaluation and possible shoe lift.
• Poor balance or mobility: PT referral; Geriatric Medicine referral; avoid opioids, if possible.
• Mini-cog abnormal: If 0/3 recall refer to Geriatric Med; if 1-2/3 recall refer for neuropsych testing.