Sneak Peek at PAINWeek Digital All Access 2024: Tips

Chronic pain management offers more treatment options than ever, yet significant barriers remain. Despite the knowledge and tools available, the challenge lies in translating these resources into effective patient care. This is complicated by diverse patient needs, disparities in access, limited pain management training, and personal beliefs influencing treatment choices. Patients often struggle to communicate their pain clearly or express concerns about medications, creating further challenges for healthcare providers. 

To address these complexities, clinicians need practical, patient-centered strategies that go beyond what they learned in school. This includes exploring non-pharmacologic therapies and considering cultural views on pain. In this sneak peek from PAINWeek Digital All Access 2024, discover the latest insights from our expert faculty, offering real-world approaches to advance pain management and enhance patient care. 

Centering Pain Management on Each Patient 

Effective pain management starts with deeply understanding each patient’s unique needs and background. For example, patients with a history of substance use often need a pain management plan that minimizes any potential for relapse or dependency. For others, such as those with chronic conditions like sickle cell disease or severe burns, a structured, multi-faceted approach combining medication, integrative therapies, and regular pain assessments is recommended. 

Involving patients and their caregivers in creating these plans can significantly affect adherence and outcomes. This approach helps ensure that treatment fits the realities of each patient’s life, leading to better long-term results. 

Conducting a Comprehensive Pain Assessment 

A multidimensional pain assessment is the bedrock of effective pain management, especially for patients with complex, chronic pain. A comprehensive assessment covers several key areas: 

• Location, Quality, and Severity: Encourage patients to describe their pain in their own words for more precise insights. 

• Changes Over Time: Track how pain evolves, which may affect treatment decisions. 

• Impact on Daily Life: Assess how pain interferes with work, school, and everyday tasks. 

• Past Treatment History: Reviewing what has or hasn’t worked before helps develop an effective plan. 

Regular assessments are necessary, particularly for patients with overlapping pain conditions or high opioid tolerance. Recognizing patterns and triggers allows for more informed treatment adjustments, offering patients sustained relief. 

Insights from Complex Clinical Cases 

Case Study: Severe Burns 

• Patient Profile: 28-year-old male with extensive burns covering >65% of the body from a motor vehicle accident, requiring numerous surgeries and ongoing inpatient care. 

• Pain Challenge: Persistent burn pain, opioid tolerance, and the need for regular neuro assessments due to the severity of injuries and procedures. 

• Management Insight: Management involves a multidisciplinary team addressing complex burn pain with opioid tapering strategies. This includes high-dose opioid weaning plans, considering ketamine versus methadone for adjunctive relief, tailored to evolving needs and neuro assessments. 

Case Study: Sickle Cell Crisis 

• Patient Profile: 30-year-old female with sickle cell disease, frequent pain crises, and chronic opioid use, resulting in over 17 hospitalizations in the past year. 

• Pain Challenge: Identifying opioid-induced hyperalgesia (OIH) amidst complex pain from sickle cell crises and the added challenge of non-adherence to outpatient care due to frequent hospitalizations. 

• Management Insight: Key strategies focus on assessing OIH within sickle cell pain, addressing barriers to outpatient adherence due to frequent admissions, evaluating readiness for change, and transitioning from high-dose opioid PCA to buprenorphine with structured outpatient follow-up. 

Case Study: Rare Genetic Disease Chronic Pain with Mental Health Issues

• Patient Profile: 36-year-old male with chronic neuropathic pain from Fabry’s Disease, compounded by mental health issues and substance use disorder. 

• Pain Challenge: Navigating rare diagnoses, substance use, and complex psychosocial dynamics. 

• Management Insight: Focus on building rapport to understand the patient’s use of non-prescribed substances, which complicates outpatient follow-up. Align pain management with patient and family goals, weighing risks and benefits, particularly when palliative care isn’t suitable. Emphasize harm reduction alongside effective pain control. 

Case Study: Gastrointestinal Pain with Substance Use History 

• Patient Profile: 45-year-old male with severe, recurrent pancreatitis and alcohol use disorder (AUD), presenting with severe pain and malnutrition. 

• Pain Challenge: Managing gastrointestinal pain complicated by AUD and safety concerns with CNS depressants in the context of alcohol use. 

• Management Insight: Prioritize safety by addressing CNS depressant risks with concurrent alcohol use and integrating AUD treatment with pain management. Utilize PEth testing to monitor alcohol use, consider available analgesic administration routes, and balance acute pain management with a structured outpatient plan. Effective inpatient pain control should align with a feasible outpatient follow-up strategy and consistent support. 

Integrating Non-Pharmacologic Options 

For long-term pain management, guidelines increasingly recommend non-pharmacologic treatments—such as physical therapy, cognitive-behavioral therapy, and complementary therapies—as first-line options before considering or escalating opioid use, particularly for chronic conditions.

Incorporating these options effectively into a pain management plan can involve using a structured “pain bundle,” which may include: 

• Complementary Techniques: Techniques like acupuncture or guided imagery provide alternatives to medication. 

• Scheduled Pain Rounds: Regular check-ins allow for timely adjustments to treatment as patient needs evolve. 

• Patient Education: Providing resources for self-care empowers patients to manage their pain beyond clinical visits. 

Practical Steps to Improve Pain Management 

Pain management success relies on a combination of methods tailored to individual patients. Key steps include: 

• Implementing Pain Bundles and Comfort Menus: Design customized care plans with patient-specific treatments prioritizing safety and effectiveness. 

• Monitoring for Opioid-Induced Hyperalgesia: Particularly in chronic cases, signs of hyperalgesia may indicate a need to explore other methods. 

• Focusing on Comprehensive Pain Assessment: Include physical, emotional, and social factors in assessments to create a holistic pain management approach. 

Take Charge of Pain Management Today 

Managing pain in complex cases is challenging but achievable with a well-rounded, patient-focused approach. The PAINWeek Digital All Access 2024 offers a wealth of insights across 12 learning tracks and more than 65 CME credits, with practical strategies for handling the diverse needs of your patients. These resources can help you apply evidence-based methods to improve patient outcomes and quality of life. 

Get started with PAINWeek Digital All Access 2024. Access actionable tools and insights that can elevate your pain care approach. Find new support for your patients and enhance your expertise in pain management on your schedule.

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