Chronic Pain: A Primary Care Guide to Practical Management by Dawn Marcus

By Dawn Marcus

Patients with persistent soreness current a special set of demanding situations to the first care clinician. In continual soreness: a prime Care consultant to functional administration, moment variation, major ache professional sunrise A. Marcus, MD, back deals useful, transparent, and succinct evidence-based techniques to the analysis and remedy of the myriad painful stipulations clinicians see of their places of work each day, akin to headache, again ache, arthritis, fibromyalgia, and belly ache. Sections addressing ache administration in young ones, pregnant girls, and seniors also are incorporated. This new version is designed to supply a practical method of assessing and treating the advanced concerns and features of power ache sufferers. New chapters extend upon the evidence-based options and functional place of work instruments formerly supplied, with the addition of latest chapters addressing chance administration; discomfort syndromes within the shoulder, top extremity, and reduce extremity; and melanoma and end-of-life discomfort. continual discomfort: a major Care consultant to functional administration, moment variation offers thoughts and strategies which are designed to enhance the arrogance with which the first care medical professional can technique sufferers with complicated soreness proceedings, decrease employees pressure, and enhance sufferer success.

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A structured evidence-based review on the meaning of nonorganic physical signs: Waddell signs. Pain Med 2003;4:141–181 Chapter 5 Headache Key Chapter Points: ● ● ● ● Chronic headache needs to be treated because of its association with significant disability. Migraine is the most common type of headache presenting to primary care. Hallmarks of serious headache include change in headache pattern, posterior head pain, headache occurring after middle age, and associated neurological abnormalities. Regular, frequent use of analgesics and other acute headache medications aggravates underlying headaches and reduces efficacy of standard therapy.

Identifying the Malingerer To provide appropriate care for patients with chronic pain, the clinician must be able to trust the patient’s reports of discomfort and pain experiences, because there are no objective measures of pain. The clinician must also consider the fact that the patient’s descriptions and displays of pain are influenced by past pain experiences, gender, and cultural background. Different responses to pain can be readily noted in the labor suite, for example, where uterine contractions of the same magnitude result in quiet, deep breathing in one woman and loud cries from another.

Medication use must be vigilantly monitored. Opioid prescriptions should be limited to a single healthcare provider. Prescriptions must be logged in the patients’ records, with new prescriptions written on schedule to avoid medication overuse. In addition, random urine drug screens should be performed periodically on all patients using opioids to ensure appropriate medication use, confirm lack of abuse of non-prescribed habit-forming substances, and prevent drug diversion. It is important to remember, however, that most laboratories set limits for drug detection that are designed to identify common levels of drugs of abuse.

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