Chronic Pain Management
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Chronic Pain Management Guide

Curriculum

  • 4 Sections
  • 54 Lessons
  • Lifetime
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  • Overview
    Overview
    1
    • 1.1
      Overview
  • The Chronic Pain Management Guide
    Chronic Pain Management Guide
    11
    • 2.1
      Baseline History Essentials
    • 2.2
      Opioid Risk Tool
    • 2.3
      Physical Examination Essentials
    • 2.4
      Follow-Up Assessment
    • 2.5
      Treatment Essentials
    • 2.6
      Stepped Care Drugs for Nociceptive Pain
    • 2.7
      Stepped Care Drugs for Neuropathic Pain
    • 2.8
      Drugs of Abuse Urine (DAU)
    • 2.9
      Patient Teaching Tools
    • 2.10
      Definitions
    • 2.11
      Other Tools
  • Physical Examination Videos
    Physical Examination Videos
    40
    • 3.1
      Adam’s Forward Bending Test
    • 3.2
      Apley’s Compression Test
    • 3.3
      Carnett’s Test
    • 3.4
      Cervical Range of Motion
    • 3.5
      Cross Arm Test/Scarf Test
    • 3.6
      Empty Can Test
    • 3.7
      Erector Spinae Palpation
    • 3.8
      FABER
    • 3.9
      Femoral Nerve Tension Test
    • 3.10
      Gluteus Medius Palpation
    • 3.11
      Hawkins-Kennedy Test
    • 3.12
      Hornblower’s
    • 3.13
      Infraspinatus Test
    • 3.14
      Integrated Low Back Exam
    • 3.15
      Internal Rotation of the Hip
    • 3.16
      Lachman Test
    • 3.17
      Lhermitte’s Sign
    • 3.18
      Liftoff Test
    • 3.19
      Lumbar Range of Motion
    • 3.20
      McMurray Test
    • 3.21
      Neer Test
    • 3.22
      Noble Compression Test
    • 3.23
      Ober’s Test
    • 3.24
      Patellofemoral Compression Test
    • 3.25
      Pelvic Compression
    • 3.26
      Phalen’s Test
    • 3.27
      Piriformis Test
    • 3.28
      Quadratus Lumborum Palpation
    • 3.29
      Righting Reflexes
    • 3.30
      Sacroiliac (SI) Joint Palpation
    • 3.31
      Seated Slump Test
    • 3.32
      Speed’s Test
    • 3.33
      Spurling’s Test
    • 3.34
      Straight Leg Raise Test
    • 3.35
      Thigh Thrust
    • 3.36
      Tinel’s Sign for Carpal Tunnel Syndrome
    • 3.37
      Tinel’s Test for Cubital Tunnel Syndrome
    • 3.38
      Tinel’s Test for Tarsal Tunnel
    • 3.39
      Upper Extremity Neural Tension Test
    • 3.40
      Yergason’s Test
  • References
    References & Acknowledgements
    2
    • 4.1
      References
    • 4.2
      Acknowledgements

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.
Follow-Up Assessment
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