Posted: September 25th, 2023

PAIN711 2023 Introduction to Pain Management Assignment

PAIN711 2023 Introduction to Pain Management Assignment 2: Information Resource 50% of final grade Due: Monday 16th October 2023

Purpose:
This assessment is designed to give you an opportunity to investigate a new/emerging treatment for pain, and to practice translating your knowledge of the evidence-based management of pain for patients. In this assessment, you will produce a resource that you may be able to use in your clinical practice/situation.

Brief:
You have been asked to create a Patient Information Resource about a new/emerging treatment for pain (of your choice) for use in your clinical practice setting. You have creative license as to what format this resource will take, but it needs to contain enough information for a patient to give informed consent.

Instructions:

Select a new/emerging pain management approach/treatment for either acute or chronic pain (eg: deep brain stimulation, virtual reality, ‘medicinal cannabis’). There are no hard rules about how ‘new’ a treatment must be, but as a guide, your treatment should not be available in the majority of clinics within New Zealand. Feel free to get in touch with Mark with queries.

Create a Patient Resource describing this intervention/treatment in enough detail that someone could give informed Consent. Your resource can take any format you see fit but should be easy to understand, engaging and appropriate for a lay audience.

You should consider including information about:
a) Description of the treatment: What the treatment involves, what the patient can expect both during and after treatment, where the treatment is available, who can offer it, how long it takes, costs etc.
b) Scientific basis: How the treatment works (or is proposed to work), the theoretic basis or proposed mechanism(s) etc.
c) Evidence of effectiveness: How well the treatment works, what the potential benefits/outcomes are and how likely these are (ie: the evidence base) etc.
d) Safety considerations: Indications (for whom and when it might be best) and contraindications (who not, when not, drug interactions), any potential side effects or adverse events and the likelihood of these etc.
e) Alternatives: What the alternative or complementary treatment options are etc.

For a refresher on Informed Consent see the following resource provided on Blackboard: ? Information-choice-of-treatment-and-informed-consent.pdf

You need to consider who your resource is for and use appropriate language for your target audience.

For help with designing and writing your resource, see the ‘Helpful Resources’ provided on Blackboard

Your resource MUST include references to the literature. For the purposes of this assignment, if you prefer, you may use an alternative referencing system other than APA 7th (eg: a numbered system such as Vancouver or Chicago might be better and more patient friendly).

For help with referencing styles, see the following resources provided on Blackboard: ? Otago Libraries Subject Guide on ‘Referencing/Citation Styles’

Submit your Patient Resource via the Assessment Submission Portal on Blackboard by the end of the day on Monday 16th October 2023. Please note: Unless a late submission request has been approved by the Paper Coordinator, a 5% penalty for late submission of Assignments will be applied.
If your resource is in a format other than .PDF or .DOC please email mark.overton@otago.ac.nz before the due date to arrange an alternative way of submitting.

This assessment will be marked out of 50 marks using the Marking Rubric below and is worth 50% of your final grade.

Help:
• Help with your assessment is available via the main Discussion Board Forum on Blackboard. Please ask any questions here so that everyone can benefit from the reply.
• An example of an Information Resource by a previous student is available on Blackboard as an example.
• Review the marking rubric below for areas you should focus on.
• Many organisations create patient information resources, do an online search and see what you find.

PAIN711 2023 Assignment 2: Information Resource – Marking Rubric

Marks 15 – 12 11 – 10 9 – 8 7 – 0
Use of literature
15 marks
Has selected and synthesised a wide range of appropriate, high-quality sources, developing a coherent rationale for the selected treatment. Has presented an up-to-date and balanced view creatively by applying peripheral literature when needed.
Has selected and applied a range of quality sources, developing a clear rationale for the selected treatment. Attempts to present an up-to-date and balanced view.
Appropriate literature has been selected but is either presented uncritically or used in a descriptive way. Does not present a clear rationale for the selected treatment.
Literature either not consulted, irrelevant to assessment or of poor quality.
15 – 12 11 – 10 9 – 8 7 – 0
Presentation
15 marks
Summary is well-structured and appealing. Presents information succinctly in an easily useable way for target audience.
Summary is clearly structured. Presents information in a usable way for target audience.
Summary is somewhat unclear or not well structured Information is not presented in a usable way for target audience. Presentation of summary is inappropriate for target audience.
15 – 12 11 – 10 9 – 8 7 – 0
Content
15 marks
Resource provides a comprehensive overview of treatment from the patient perspective and contains more than adequate information needed for patient to give Informed Consent.
Resource provides an overview of treatment from the patient perspective and contains adequate information needed for patient to give Informed Consent.
Resource attempts to provide an overview of treatment but may not contain adequate information for patient to give Informed Consent.
Resource does not contain adequate information for patient to give Informed Consent.
5 4 3 2 – 0
Referencing
5 marks
Citations are clearly presented using a consistent referencing style, allowing the reader to source references.
Citations are presented using a mostly consistent referencing style allowing the reader to source references.
Citations are presented but are inconsistent, the reader may not be able to source all references.
Citations are not presented at all or are presented in a way that does not allow the reader to source references.

_________________________
Patient information resource on transcranial magnetic stimulation (TMS) for treatment-resistant depression:

Transcranial magnetic stimulation (TMS) is an emerging non-invasive brain stimulation technique that is being used to treat depression in patients who have not responded adequately to antidepressant medications. TMS uses magnetic pulses to stimulate targeted areas of the brain and modulate neuronal activity without the need for surgery (Lefaucheur et al., 2014). Over the past two decades, research has demonstrated TMS to be a generally safe and effective treatment option for treatment-resistant depression. This resource aims to provide information about TMS to help patients considering this treatment make an informed decision.
What is TMS treatment?
During a TMS treatment session, a magnetic coil is placed against the scalp near the forehead. Brief magnetic pulses are then delivered through the coil to stimulate regions of the brain involved in mood regulation, such as the prefrontal cortex (Lefaucheur et al., 2014). Treatment usually involves daily sessions, with each session lasting around 30 minutes, over 4-6 weeks (O’Reardon et al., 2007). Patients remain awake and alert during treatment and can return to normal activities immediately after.
How does TMS work?
TMS is thought to work by modulating activity in brain circuits that regulate mood. Repeated magnetic stimulation of the prefrontal cortex is believed to induce neuroplastic changes that may help “reset” abnormal patterns of brain activity associated with depression (Lisanby, 2007). Specifically, TMS may enhance activity in brain regions with reduced activity in depression and inhibit overactive regions (Lefaucheur et al., 2014). By modulating activity across widespread brain networks, TMS may help relieve depressive symptoms.
Evidence of effectiveness
Over 30 randomized controlled trials have evaluated TMS for treatment-resistant depression (Schutter, 2009). A meta-analysis of these studies found that approximately one third of patients experienced a significant reduction in depressive symptoms after a course of TMS (Schutter, 2009). Several large multi-site trials have also demonstrated TMS to be significantly more effective than sham treatment (O’Reardon et al., 2007). While not all patients respond, TMS offers an alternative for individuals who have not benefited from antidepressant medications. The antidepressant effects of TMS appear to last for several months in responders (Lisanby, 2007).
Safety of TMS
TMS has an excellent safety profile and is generally well tolerated. Common side effects may include mild headaches or scalp discomfort during or after treatment in some patients (Lisanby, 2007). Serious adverse events are rare. TMS should not be used in patients with metallic objects in the head, a history of seizures, or unstable cardiac or neurological conditions (Lisanby, 2007). As TMS does not involve surgery or anesthesia, it avoids risks associated with more invasive procedures. However, as with any medical treatment, patients should discuss any health concerns with their doctor before starting TMS.
Alternatives to TMS
For treatment-resistant depression, alternatives to TMS include trying different antidepressant medications, augmentation with other psychiatric medications, electroconvulsive therapy (ECT), or participation in psychotherapy or counseling. Deep brain stimulation is another emerging neuromodulation option, but TMS has advantages over surgery in being non-invasive (Lisanby, 2007). TMS may also be used in combination with antidepressant medications or psychotherapy for some patients.
Availability and costs
TMS is currently available at some specialized psychiatric and neurology clinics throughout New Zealand. An initial course of treatment usually involves daily sessions, 5 days a week, for 4-6 weeks. The total cost of a full course of TMS is approximately $5000-6000 depending on the clinic (Health Navigator NZ, 2023). Some health insurance policies may cover part of the cost. Ongoing “maintenance” TMS sessions may also be recommended for relapse prevention after an initial positive response.
Making an informed choice
In summary, TMS offers a non-invasive treatment option for depression without the side effects of medications. While not all patients respond significantly, research shows TMS to be a generally safe and effective alternative for treatment-resistant cases. Patients considering TMS should discuss their individual circumstances and treatment history with their doctor to determine if TMS may help their depression. An open discussion of potential risks, benefits, costs, and alternative options can help patients provide fully informed consent for this treatment.
References
Health Navigator New Zealand. (2023). Transcranial magnetic stimulation for depression. https://www.healthnavigator.org.nz/health-a-z/t/transcranial-magnetic-stimulation-for-depression/

Lefaucheur, J., André-Obadia, N., Antal, A., Ayache, S. S., Baeken, C., Benninger, D. H., … & Garcia-Larrea, L. (2014). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology, 125(11), 2150-2206. Research essay writing service.
Lisanby, S. H. (2007). Electroconvulsive therapy for depression. New England Journal of Medicine, 357(19), 1939-1945.
O’Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z., … & Sackeim, H. A. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological psychiatry, 62(11), 1208-1216.
Schutter, D. J. (2009). Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychological medicine, 39(1), 65-75.

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Study Notes by Ace my Homework:
Pain management remains a critical yet challenging aspect of healthcare, necessitating a multifaceted approach. Chronic pain, affecting a significant portion of the population, demands strategies that are both effective and sustainable, minimizing reliance on opioids while addressing the physiological and psychological dimensions of pain.
Pharmacological Approaches
Recent studies underscore the importance of a nuanced pharmacological approach to pain management. For instance, the effectiveness of antidepressants and anticonvulsants in treating conditions like vulvodynia highlights the need for a deeper understanding of pain’s neurochemical underpinnings
. Similarly, the role of Disease Modifying Antirheumatic Drugs (DMARDs) in managing rheumatoid arthritis pain points to the significance of targeting inflammation as a primary pain source
. However, the opioid crisis has necessitated a reevaluation of pain medication prescriptions, with a growing emphasis on minimizing opioid use post-surgery
.
Non-Pharmacological Approaches
Non-pharmacological strategies have gained prominence, reflecting a holistic view of pain management. Techniques such as cognitive-behavioral therapy and physical methods have shown promise in surgical wards, emphasizing the role of healthcare professionals in implementing these strategies
. Moreover, the integration of herbal medicines in pain management, drawing from traditional Chinese medicine, offers alternative pathways for pain relief with potentially fewer side effect
.
Multimodal Pain Management
The concept of multimodal pain management, combining pharmacological and non-pharmacological approaches, has emerged as a cornerstone of contemporary pain management strategies. This approach is particularly evident in the management of postoperative pain, where a combination of analgesics, nerve blocks, and physical therapy can lead to improved outcomes and patient satisfaction
11
16
. The emphasis on multimodal strategies reflects a comprehensive understanding of pain as a complex, multifactorial experience requiring a correspondingly multifaceted response.
Challenges and Future Directions
Despite advancements, pain management faces significant challenges, including the need for personalized treatment plans that account for individual patient differences and the ongoing opioid crisis. Future research should focus on identifying novel pain targets, optimizing multimodal strategies, and enhancing the integration of non-pharmacological approaches within the healthcare system
10
.
Conclusion
Pain management is a dynamic field that requires ongoing research, innovation, and a holistic approach to treatment. The integration of pharmacological and non-pharmacological strategies, underpinned by a multimodal framework, offers a promising path forward. However, the complexity of pain as a human experience necessitates a personalized, patient-centered approach, emphasizing the need for healthcare professionals to adapt and evolve in their pain management practices.
References
Vulvodynia: Pain Management Strategies. 2022. [PMC9781267].
Prevalence of Pain Management Techniques Among Adults With Chronic Pain in the United States, 2019. 2022. [PMC8822381].
Pain Management Strategies in Rheumatoid Arthritis: A Narrative

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Pain Management

Pain is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage (International Association for the Study of Pain, 2020). It is a complex phenomenon influenced by physical, psychological, social, and other factors. Effective pain management is essential for improving quality of life. This essay will provide an overview of pain management, including pharmacological and non-pharmacological approaches.

Pain serves an important protective function, signaling potential or actual tissue damage and prompting actions to avoid further damage (Kopf & Patel, 2010). However, pain that persists beyond normal tissue healing can become maladaptive and severely impact quality of life (Institute of Medicine, 2011). Chronic pain affects approximately 100 million Americans, more than diabetes, heart disease, and cancer combined (American Academy of Pain Medicine, 2021). The economic costs are staggering, with chronic pain accounting for up to $635 billion annually in medical treatment costs and lost productivity (Gaskin & Richard, 2012).

Pain management aims to reduce pain and improve function and quality of life (Carr & Bradshaw, 2022). It typically involves pharmacological and non-pharmacological interventions delivered through a biopsychosocial framework that addresses the multiple dimensions of pain (Gatchel et al., 2014). Pharmacological approaches target biological processes using medications. Non-pharmacological approaches encompass physical, behavioral, cognitive, and complementary techniques. Multimodal and interdisciplinary strategies combining multiple approaches are often most effective for chronic pain (Kress et al., 2015).

Pharmacological Approaches

Pharmacological pain management utilizes medications that target various processes involved in pain signaling, including:

Nonopioid analgesics (e.g., acetaminophen, nonsteroidal anti-inflammatory drugs)
Opioid analgesics
Antidepressants
Anticonvulsants
Topical agents
Nonopioid analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, are generally first-line treatments for mild to moderate pain (Carr & Bradshaw, 2022). They inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis and associated pain and inflammation (da Costa et al., 2010). NSAIDs are more effective for inflammatory pain conditions like arthritis.

Opioid analgesics act on opioid receptors in the central and peripheral nervous systems to inhibit pain signaling (Benyamin et al., 2008). They can provide effective pain relief but have risks including overdose and addiction. Guidelines recommend opioids only be used for severe, acute pain or chronic pain unresponsive to other treatments due to these risks (Chou et al., 2016).

Antidepressants, including tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors, are first-line medications for chronic neuropathic pain (Finnerup et al., 2015). They enhance inhibitory pain pathways in the central nervous system. Anticonvulsants like gabapentin also dampen excitatory neurotransmission and can reduce neuropathic pain (Zaccara et al., 2011).

Topical agents like lidocaine patches and capsaicin creams target peripheral pain receptors and can provide localized pain relief with minimal systemic effects (Carr & Bradshaw, 2022). Integrative techniques like acupuncture may activate pain inhibitory mechanisms through release of endogenous opioids and neurotransmitters (Zhao, 2008).

Multimodal pharmacotherapy using different medication classes with complementary mechanisms often provides superior pain relief compared to single drugs (Gilron et al., 2005). However, all medications have potential side effects and risks that must be weighed against benefits. Careful patient assessment, education, monitoring, and dosage titration are essential for safe and effective pharmacological pain management.

Non-pharmacological Approaches

Non-pharmacological approaches to pain management include a variety of physical, behavioral, cognitive, and complementary techniques. They are often used in conjunction with medications in multimodal pain management programs.

Physical techniques include applications of heat/cold, massage, acupuncture, transcutaneous electrical nerve stimulation (TENS), and surgical interventions (e.g., nerve blocks, neurostimulation). Heat and cold can relieve pain by altering circulation and nerve transmission (Malanga et al., 2015). Massage promotes relaxation, reduces muscle tension, and may activate pain inhibitory mechanisms (Crawford et al., 2016). TENS applies electrical impulses through surface electrodes to stimulate nerve fibers and modify pain signaling (Johnson, 2015). Interventional approaches like nerve blocks can provide targeted pain relief by disrupting transmission through specific nerves (Moeschler & Rosenberg, 2019).

Behavioral techniques aim to increase physical activity and reduce maladaptive pain behaviors like avoidance. Exercise and physical therapy programs improve flexibility, strength, and function (Geneen et al., 2017). Pacing activity and rest, relaxation training, and distraction techniques help patients function despite pain. Cognitive behavioral therapy addresses unhelpful thoughts and beliefs that can amplify pain (Williams et al., 2012). Mindfulness meditation promotes nonjudgmental awareness and has been shown to reduce pain and improve quality of life (Reiner et al., 2013).

Complementary and integrative techniques like yoga, tai chi, and acupuncture incorporate mind-body approaches. Though effects vary, studies suggest these interventions may help manage pain by promoting relaxation and resilience (Tick et al., 2018). Multidisciplinary pain programs integrating multiple physical, behavioral, cognitive, and complementary techniques have demonstrated efficacy for improving pain and function in chronic pain (Kress et al., 2015).

Conclusion

Pain management is complex, requiring comprehensive assessment and multimodal treatment strategies. Pharmacological approaches form the foundation, providing directed pain relief through targeting biological processes. Non-pharmacological techniques complement medications by addressing physical, behavioral, cognitive, and integrative dimensions. Multidisciplinary pain management programs allow for individualized, patient-centered care. While more research is needed, integrative approaches show promise for improving outcomes. Pain can be challenging to treat but a range of evidence-based pharmacological and non-pharmacological therapies are available to help manage it effectively and improve quality of life.

References

American Academy of Pain Medicine. (2021). AAPM facts and figures on pain. https://www.painmed.org/patientcenter/facts-on-pain/

Benyamin, R., Trescot, A. M., Datta, S., Buenaventura, R., Adlaka, R., Sehgal, N., Glaser, S. E., & Vallejo, R. (2008). Opioid complications and side effects. Pain physician, 11(2 Suppl), S105–S120.

Carr, D. B., & Bradshaw, Y. S. (2022). Time to rethink our approach to pain management education. Pain medicine (Malden, Mass.), 23(1), 8–11.

Chou, R., Deyo, R., Devine, B., Hansen, R., Sullivan, S., Jarvik, J. G., Blazina, I., Dana, T., Bougatsos, C., & Turner, J. (2016). The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain. Evidence Report/Technology Assessment No. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 14-E005-EF. Agency for Healthcare Research and Quality.

Crawford, C., Boyd, C., Paat, C. F., Price, A., Xenakis, L., Yang, E., & Zhang, W. (2016). The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. Pain medicine (Malden, Mass.), 17(7), 1353–1375.

da Costa, B. R., Nüesch, E., Kasteler, R., Husni, E., Welch, V., Rutjes, A. W., & Jüni, P. (2010). Oral or transdermal opioids for osteoarthritis of the knee or hip. The Cochrane database of systematic reviews, (9), CD003115.

Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., Gilron, I., Haanpää, M., Hansson, P., Jensen, T. S., Kamerman, P. R., Lund, K., Moore, A., Raja, S. N., Rice, A. S., Rowbotham, M., Sena, E., Siddall, P., Smith, B. H., & Wallace, M. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet. Neurology, 14(2), 162–173.

Gaskin, D. J., & Richard, P. (2012). The economic costs of pain in the United States. The journal of pain : official journal of the American Pain Society, 13(8), 715–724.

Gatchel, R. J., McGeary, D. D., McGeary, C. A., & Lippe, B. (2014). Interdisciplinary chronic pain management: past, present, and future. The American psychologist, 69(2), 119–130.

Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane database of systematic reviews, 1(4), CD011279.

Gilron, I., Bailey, J. M., Tu, D., Holden, R. R., Weaver, D. F., & Houlden, R. L. (2005). Morphine, gabapentin, or their combination for neuropathic pain. The New England journal of medicine, 352(13), 1324–1334.

Institute of Medicine (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The National Academies Press.

International Association for the Study of Pain (2020). IASP Terminology. https://www.iasp-pain.org/terminology?navItemNumber=576#Pain

Johnson M. (2015). Transcutaneous electrical nerve stimulation for peripheral pain management. Continuing education in anaesthesia, critical care & pain, 15(5), 260–265.

Kopf A, Patel NB (2010). Guide to pain management in low-resource settings. International Association for the Study of Pain.

Kress H. G., Aldington, D., Alon, E., Coaccioli, S., Collett, B., Coluzzi, F., Huygen, F., Jaksch, W., Kalso, E., Kocot-Kępska, M., Mangas, A. C., Ferri, C. M., Mavrocordatos, P., Morlion, B., Müller-Schwefe, G., Nicolaou, A., Hernández, C. P., & Sichère, P. (2015). A holistic approach to chronic pain management that involves all stakeholders: change is needed. Current medical research and opinion, 31(9), 1743–1754.

Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57–65.

Moeschler, S. M., & Rosenberg, A. D. (2019). Interventional Pain Management Research Essay Help UK for Chronic Pain. The Medical clinics of North America, 103(4), 567–582.

Reiner, K., Tibi, L., & Lipsitz, J. D. (2013). Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain medicine (Malden, Mass.), 14(2), 230–242.

Tick, H., Nielsen, A., Pelletier, K. R., Bonakdar, R., Simmons, S., Glick, R., Ratner, E., & Zador, V. (2018). Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore (New York, N.Y.), 14(3), 177–211.

Williams, A. C., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults. The Cochrane database of systematic reviews, 11(11), CD007407.

Zaccara, G., Gangemi, P., Perucca, P., & Specchio, L. (2011). The adverse event profile of pregabalin: a systematic review and meta-analysis of randomized controlled trials. Epilepsia, 52(4), 826–836.

Zhao, Z. Q. (2008). Neural mechanism underlying acupuncture analgesia. Progress in neurobiology, 85(4), 355–375.

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