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martoof (@martoof)

What is pain management?

Chronic Pain | Last Active: Nov 22, 2021 | Replies (51)

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I am sorry @martoof, to hear of this awful experience. That is not Pain Management. I would love to have people refer to the process (subspecialty) as "Active Pain Management" because it is not a passive process of adding another pill…

Pain management as practiced by my Pain Management specialist consists of the following:
– Review patient medical records for history and present and past symptoms and treatments
– Interview patient (in my case remote, due to Covid) to determine current state, hopes, expectations and willingness to fully participate
– Coordinate with primary care practitioner
– Explain the concepts of actual physical pain response, Central Sensitization Syndrome (CSS), Chronic Regional Pain Syndrome (CRPS), Neuropathy and philosophy of using a multi-pronged strategy to deal with whichever is causing the most problem. In my case, I have CSS and physical pain from arthritis.
– Explain that opioids do not really cure pain, and that the goal, if currently used, is to end or minimize their use. My body had never become dependent on narcotics for pain management, so I didn't have to break that cycle.
– Explain that the goal is to minimize and manage pain, as the underlying causes usually don't "go away"
– Develop a comprehensive pain management strategy. In my case it was a combination of physical therapy (PT) and myofascial release (MFR) by a specially trained therapist, a home routine of stretching, strengthening and walking, medication (non-narcotic), visualization exercises, and becoming attuned to what my body is saying to me.
– Review progress and adjust to find balance.

Since I started active pain management almost a year and a half ago, I have gotten my life back. It is not perfect – there are bad days and good days, I have learned to take them as they come, and which tactic to use for specific issues. I have learned that all of the strategies must stay in place for life – if you stop, the pain can come roaring back. I have hard surgery 3 times since I began active pain management, and managed recovery from each one with minimal opioids (2 days max) by using Tylenol, ice and my PM strategies. I use topical NSAIDS only for arthritis pain because I cannot use the meds internally, combined with ice or heat as needed.

Sorry, I cannot refer you to my pain management specialist, she operates on referral only, and from within the clinical practice where my primary is located. Mayo offers an inpatient Pain Rehab Clinic (https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691) There are other qualified Pain Management specialists and practices all over the country. Based on your experience, I would call and pre-interview any place to which I was referred to learn their philosophy.

I encourage anyone with a Pain Management experience to tell us about it.

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Replies to "I am sorry @martoof, to hear of this awful experience. That is not Pain Management. I..."

Thank you, Sue! It appears to me, then that the operational definition of "pain management" is training to be stoic. Exercises, visualizations, PT, etc., are suggested so that that stoicism becomes easier to present. Having been socialized under the "take two [or whatever amount] and you feel better quickly/soon/later" I have, INCORRECTLY, felt that many instances of pain can be "managed" this way. Context: 3 aneurysm repair surgeries; 2 clot removals; 1 knee & 1 hip replacement; chronic, severe osteoarthritis in back, legs, knees and hands; neuropathy and other nerve-related issues that *attack* the bottoms of both feet. Regarding surgeries – you take some meds, do PT, and in time you heal or improve. But the arthritis & nerve issues: Ice, heat, exercises, PT…….nothing REALLY helps. I see I have to conceptualize pain completely differently than I have been. Again, Sue – my thanks!

Wow, thank you Sue! I have just been referred to pain management by a nurse practitioner who I thought would be a neurologist to explain what my MRI’s showed. I won’t go into that now. All she offered was PM, I will definitely research the clinic which I was referred to. I will not take narcotics for any pain, there are too many horror stories out there I will Search for a natural remedy to manage my pain. Thank you again Sue.

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