Managing Chronic Pain

About this course

Approximately 25% of the United States population suffers from chronic pain. Although chronic pain is a common ailment, it is often mismanaged, which can lead to significant morbidity and mortality. Because of its effects on morbidity and mortality, healthcare professionals must fully understand the diagnosis of chronic pain. This learning activity provides a review of chronic pain, its evaluation, and treatment options.

Learning objectives

• Define chronic pain
• Describe various approaches to evaluate chronic pain
• Review general options for managing chronic pain
• Review interprofessional team strategies for improving the treatment of chronic pain

Course outline

15 sections · finish in any order across devices

1. 1

   Introduction

   An individual’s quality of life is affected by the management of chronic pain. Chronic pain is described as a recurrent pain that lasts more than 3 to 6 months, which adversely affects a person’s well-being. ³ There are multiple sources of chronic pain, and often, individuals diagnosed with chronic

   4 min

2. 2

   Pain Types

   There are multiple categories and types of pain, including inflammatory, mechanical, musculoskeletal, neuropathic, nociceptive, and psychogenic pain. The following provides a brief overview of the pain types ³˒⁹˒¹¹:

   4 min

3. 3

   Completing the History and Physical

   When obtaining a history and physical, the history should include the onset of pain, the location, whether the pain radiates, the quality, severity, and frequency of the pain, the occurrence of breakthrough pain, any factors that contribute to relief or worsening of the pain, and any mechanisms of i

   4 min

4. 4

   Evaluation of Pain

   A pain scale is often a visual method that allows one to track their pain, its intensity, and other symptoms. These scales can be self-reported verbal rating scales, and can also be judged by behavioral or observation, especially in children and nonverbal adults. The following are various forms of p

   4 min

5. 5

   0-10 Pain Scale

   The 0-10 pain scale is the most used scale to assess for pain. This scale is simple and effective and works for many people, but it can be limiting to individuals who do not understand numerical order, or what each number represents. Also, the healthcare professionals understanding of a number assoc

   4 min

6. 6

   Wong-Baker FACES®

   The Wong-Baker FACES pain scale is a reliable way to diagnose pain in children and nonverbal adults. It uses a zero to ten scale to judge pain and correlates facial expressions to the pain numbers. One disadvantage to this scale is that it may not be descriptive enough to assess pain and may not be

   4 min

7. 7

   Visual Analog Scale

   A Visual Analog Scale (VAS) is a scale used to determine a person’s intensity of pain that is experienced. It consists of a line that is approximately 10-15 cm in length, with the left side signifying no pain and the right side signifying the worst pain ever. The VAS recognizes that many people do n

   4 min

8. 8

   FLACC Scale

   The face, legs, arms, cry, and consolability (FLACC) pain scale uses expression, leg movements, activity, crying, and consolability to categorize pain. It is often used to assess pain in children, but it is also a useful tool to assess pain in nonverbal adults.

   4 min

9. 9

   Psychiatric Considerations

   Psychiatric disorders can increase pain making symptoms of pain worse. ²˒¹⁵ There are twice as many prescriptions for opioids prescribed each year to people with underlying pain and a comorbid psychiatric disorder compared to people without psychiatric disorders. Major depressive disorder and genera

   4 min

10. 10

    Treatment Options

    Current recommendations for chronic pain include referring an individual to pain management when the pain is debilitating and unresponsive to initial therapy. The pain may be located at multiple locations and require multimodal treatment or invasive procedures to control pain. ¹ Treatment of both pa

    4 min

11. 11

    Nonopioid Analgesic Agents

    If administered intravenously, side effects include nausea, vomiting, pruritus, constipation, and abdominal pain. For children, regardless of the route of administration, the most common adverse reactions are nausea, vomiting, agitation, constipation, pruritus, and atelectasis. ¹³

    4 min

12. 12

    Opioid Agents

    Opioids are a broad class of medications with structural resemblance to the natural plant alkaloids found in opium. ⁴˒⁸ Opioids are recognized as the most effective and widely used drugs in treating severe pain, but they have also been among the most controversial analgesics, mainly due to their pot

    4 min

13. 13

    Nonpharmacological Therapies

    The list of nonpharmacological therapies for chronic pain is extensive. Nonpharmacological options include acupuncture, aerobic exercise, chiropractic, cognitive behavioral therapy, group counseling, heat and cold therapy, physical therapy, relaxation therapy, and ultrasound stimulation. ¹³˒¹⁷ In ad

    4 min

14. 14

    Interprofessional Pain Management

    Chronic pain is a significant public health concern with considerable morbidity and mortality. ¹⁴ Because of this, chronic pain should be managed by an interprofessional team, using a multimodal approach. Without proper pain management, an individual’s quality of life can be severely reduced.

    4 min

15. 15

    Conclusion

    Prevention is critical in the treatment of chronic pain, and chronic pain is best managed with an interprofessional team. A multimodal treatment approach is optimal to obtain better pain control and outcomes as well as to minimize the need for high-risk treatments such as opioids. When medication is

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Chelly, J. (2017). Faculty opinions recommendation of Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature.
• Darnall, B. D. (2019). Pain-specific psychological factors. Psychological treatment for patients with chronic pain, 63-75.
• Dirk, K., Rachor, G. S., & Knopp-Sihota, J. A. (2019). Pain assessment for nursing home residents. Nursing Research, 68(4), 324-328.
• Hallvik, S. E., El Ibrahimi, S., Johnston, K., Geddes, J., Leichtling, G., Korthuis, P. T., & Hartung, D. M. (2021). Patient outcomes following opioid dose reduction among patients with chronic opioid therapy. Pain, Publish Ahead of Print.
• Hutson, M., & Ward, A. (2015). Oxford textbook of musculoskeletal medicine. Oxford University Press.
• Khan, S., Andrews, K. L., & Chin-Dusting, J. P. (2019). Cyclo-oxygenase (COX) inhibitors and cardiovascular risk: Are non-steroidal anti-inflammatory drugs anti-inflammatory? International Journal of Molecular Sciences, 20(17), 4262.
• Long, S. S. (2016). Nonsteroidal anti-inflammatory drugs: Risks outweigh benefits. The Journal of Pediatrics, 175, 1-4.
• Lubrano, M., Wanderer, J. P., & Ehrenfeld, J. M. (2015). Long-term opioid therapy for chronic pain. Annals of Internal Medicine, 163(2), 147.
• Moayedi, M., & Davis, K. D. (2018). Neural mechanisms underlying pain. Oxford Scholarship Online
• Pope, J. E., & Deer, T. R. (2019). Opioids for chronic non-cancer pain. Deer's Treatment of Pain, 231-232.
• Raja, S. (2010). 113 opioids for the treatment of chronic neuropathic pain: The evidence. European Journal of Pain Supplements, 4(S1), 34-34.
• Rajasekar, S., & S Thotta, R. (2019). Assessment of quality of life in patients with chronic cancer pain using brief pain inventory.
• Slaughter, T. (2018). Faculty opinions recommendation of effect of opioid vs Nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature
• Sleep, pain, and quality of life in chronic pain patients. (2020). Case Medical Research.
• Sullivan, M. D. (2016). Why does depression promote long-term opioid use? Pain, 157(11), 2395-2396.
• Van Den Noortgate, N., & Sampson, E. (2017). Pain assessment and management in cognitively intact and impaired patients. Oxford Textbook of Geriatric Medicine, 1203-1208.
• Yvonne Buowari, D. (2021). Pain management in older persons. Update in Geriatrics.
• Managing Chronic Pain Posttest
• Mechanical Pain is described as:
• Any type of back pain caused by placing abnormal stress and strain on muscles of the vertebral column.
• Pain that affects the muscles, ligaments and tendons, and bones.
• Pain that is caused by tissue damage and injury.
• A recurrent pain that lasts more than 3 to 6 months, which adversely affects a person’s well-being.
• Neuropathic Pain is described as
• Nerve pain that may occur because of a disease process.
• Increased sensitivity due to the inflammatory response associated with tissue damage.
• Pain that is caused by tissue damage and injury.
• Combination therapy that includes pharmacological and nonpharmacological treatments has shown to be effective in its management.
• Categories and types of pain include:
• Mechanical Pain may be caused by:
• Incorrect bending and lifting
• Associated symptoms of pain should be assessed, such as muscle spasms or aches, temperature changes, restrictions to range of motion, morning stiffness, weakness, changes in muscle strength, and changes in sensation.
• The 0-10 pain scale is the most used scale to assess for pain.
• The Wong-Baker FACES pain scale is a reliable way to diagnose pain in children and nonverbal adults.
• People with chronic pain are at increased risk for suicide ideation and suicide attempt.
• Treatment of both pain and a comorbid psychiatric disorder leads to a more significant reduction of both pain and symptoms of the psychiatric disorder.
• Managing Chronic Pain Posttest Answers
• Mechanical Pain is described as:
• Any type of back pain caused by placing abnormal stress and strain on muscles of the vertebral column.
• Pain that affects the muscles, ligaments and tendons, and bones.
• Pain that is caused by tissue damage and injury.
• A recurrent pain that lasts more than 3 to 6 months, which adversely affects a person’s well-being.
• Mechanical Pain: Is any type of back pain caused by placing abnormal stress and strain on muscles of the vertebral column.
• Neuropathic Pain is described as
• Nerve pain that may occur because of a disease process.
• Increased sensitivity due to the inflammatory response associated with tissue damage.
• Pain that is caused by tissue damage and injury.
• Neuropathic Pain: Nerve pain that may occur because of a disease process.
• Combination therapy that includes pharmacological and nonpharmacological treatments has shown to be effective in its management.
• There are multiple sources of chronic pain, and often, individuals diagnosed with chronic pain will complain of more than one type of pain…. Because of multiple modalities that are associated with pain, combination therapy that includes pharmacological and nonpharmacological treatments has shown to be effective in its management.
• Categories and types of pain include:
• There are multiple categories and types of pain, including inflammatory, mechanical, musculoskeletal, neuropathic, nociceptive, and psychogenic pain.
• Mechanical Pain may be caused by:
• Incorrect bending and lifting
• Mechanical Pain – Is any type of back pain caused by placing abnormal stress and strain on muscles of the vertebral column. Examples include:
• Incorrect bending and lifting
• Associated symptoms of pain should be assessed, such as muscle spasms or aches, temperature changes, restrictions to range of motion, morning stiffness, weakness, changes in muscle strength, and changes in sensation.
• When obtaining a history and physical, the history should include the onset of pain, the location, whether the pain radiates, the quality, severity, and frequency of the pain, the occurrence of breakthrough pain, any factors that contribute to relief or worsening of the pain, and any mechanisms of injury that may have caused the pain to occur. Also, associated symptoms should be assessed, such as muscle spasms or aches, temperature changes, restrictions to range of motion, morning stiffness, weakness, changes in muscle strength, and changes in sensation.
• The 0-10 pain scale is the most used scale to assess for pain.
• The 0-10 pain scale is the most used scale to assess for pain. This scale is simple and effective and works for many people, but it can be limiting to individuals who do not understand numerical order, or what each number represents.
• The Wong-Baker FACES pain scale is a reliable way to diagnose pain in children and nonverbal adults.
• The Wong-Baker FACES pain scale is a reliable way to diagnose pain in children and nonverbal adults. It uses a zero to ten scale to judge pain and correlates facial expressions to the pain numbers.
• People with chronic pain are at increased risk for suicide ideation and suicide attempt.
• It is crucial to realize people with chronic pain are at an increased risk for suicide and suicidal ideation, and people with chronic pain should be screened for depression.
• Treatment of both pain and a comorbid psychiatric disorder leads to a more significant reduction of both pain and symptoms of the psychiatric disorder.
• Treatment of both pain and a comorbid psychiatric disorder leads to a more significant reduction of both pain and symptoms of the psychiatric disorder. There are multiple pharmacological, adjunct, nonpharmacological, and interventional treatments for chronic, severe, and persistent pain.

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