OVMC:Pain and Substance Use Disorder: Difference between revisions

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OVMC Pain and Substance Use Disorder is a resource for providers and nursing staff on the topic of Pain Management and Substance Use Disorder.  These resources are only a guideline.  All clinical care decisions are left to the discretion of the treating provider.
OVMC Pain and Substance Use Disorder is a resource for providers and nursing staff on the topic of Pain Management and Substance Use Disorder.  These resources are only a guideline.  All clinical care decisions are left to the discretion of the treating provider.
'''Non-Medication Modalities'''
*Cold/Warm compress-use one or alternate with both-cold has been found to decrease nerve conduction velocity (Herrera, Sandoval, Camargo, & Salvini, 2010)
*Stop smoking-this constricts small blood vessels which decrease oxygen to the tissues.
*Start anti-inflammatory diet – (detail below) (Hal, 2013)
*Lose weight- Weight loss-5% weight reduction results in an 18% improvement in function.  For every 1 pound lost 4 pounds of force is reduced on each knee.  Weight watchers is covered for LA Care patients.
*Encourage activity-Yoga type exercises are best for back pain.  Muscle Strengthening and Stretching- especially of the quadriceps. Walking and swimming (although swimming may aggravate lumbar OA due to extension of the spine). 
*DME-Braces, Shoe wedges, walkers and canes
*Encourage participation in Wellness Center
*Physical and/or Occupational Therapy-Strengthening, Stretching, Iontophoresis, Phonophoresis, Taping, etc
Discourage bed rest-Any activity is beneficial.  If exercises are intolerable, encourage them to do something, bed rest beyond a good 8 hours sleep, is counterproductive.
*Psych Referral for Cognitive Behavior Therapy (CBT) (McBeth, et al., 2011)  (Berkowitz & Katz, 2012)
*Acupuncture
*Transcutaneous Electrical Stimulation (TENS)
*Meditation- Recent evidence has shown how meditation can produce better outcomes than medications. (Cherkin, et al 2016) (Hilton, 2017)
'''Non-Opiate Over the Counter Medications'''
*Acetaminophen - Consider starting Tylenol 500mg q 8 ATC.  This will not eliminate all the pain but it will help.  Most pain studies consider a 30% reduction "meaningful pain relief"). (monitor hepatic function) May be used in combination with NSAID.
*NSAIDS- e.g. Ibuprofen  - monitor for GI symptoms - efficacy over Tylenol may not be appreciated until the disease process is more advanced.  Low dose should be sufficient since inflammation is minimal in OA.  Consider using with PPI or misoprostol.  (H2-blockers not shown to improve GI protection when used with an NSAID). There are 5 different classifications of NSAIDS with slightly different mechanism of action.  While one may not work and another might.

Revision as of 21:18, 14 March 2019

OVMC Pain and Substance Use Disorder is a resource for providers and nursing staff on the topic of Pain Management and Substance Use Disorder. These resources are only a guideline. All clinical care decisions are left to the discretion of the treating provider.

Non-Medication Modalities

  • Cold/Warm compress-use one or alternate with both-cold has been found to decrease nerve conduction velocity (Herrera, Sandoval, Camargo, & Salvini, 2010)
  • Stop smoking-this constricts small blood vessels which decrease oxygen to the tissues.
  • Start anti-inflammatory diet – (detail below) (Hal, 2013)
  • Lose weight- Weight loss-5% weight reduction results in an 18% improvement in function. For every 1 pound lost 4 pounds of force is reduced on each knee. Weight watchers is covered for LA Care patients.
  • Encourage activity-Yoga type exercises are best for back pain. Muscle Strengthening and Stretching- especially of the quadriceps. Walking and swimming (although swimming may aggravate lumbar OA due to extension of the spine).
  • DME-Braces, Shoe wedges, walkers and canes
  • Encourage participation in Wellness Center
  • Physical and/or Occupational Therapy-Strengthening, Stretching, Iontophoresis, Phonophoresis, Taping, etc

Discourage bed rest-Any activity is beneficial. If exercises are intolerable, encourage them to do something, bed rest beyond a good 8 hours sleep, is counterproductive.

  • Psych Referral for Cognitive Behavior Therapy (CBT) (McBeth, et al., 2011) (Berkowitz & Katz, 2012)
  • Acupuncture
  • Transcutaneous Electrical Stimulation (TENS)
  • Meditation- Recent evidence has shown how meditation can produce better outcomes than medications. (Cherkin, et al 2016) (Hilton, 2017)

Non-Opiate Over the Counter Medications

  • Acetaminophen - Consider starting Tylenol 500mg q 8 ATC. This will not eliminate all the pain but it will help. Most pain studies consider a 30% reduction "meaningful pain relief"). (monitor hepatic function) May be used in combination with NSAID.
  • NSAIDS- e.g. Ibuprofen - monitor for GI symptoms - efficacy over Tylenol may not be appreciated until the disease process is more advanced. Low dose should be sufficient since inflammation is minimal in OA. Consider using with PPI or misoprostol. (H2-blockers not shown to improve GI protection when used with an NSAID). There are 5 different classifications of NSAIDS with slightly different mechanism of action. While one may not work and another might.