Definition and Overview

Pain is one of the main indicators that something is wrong with the body. It can be acute when it happens suddenly, has an identifiable cause, and recedes or disappears after treatment is provided. Meanwhile, it is described as chronic if it happens continuously, occurs at regular intervals and lasts more than six months. Chronic pain is debilitating and can significantly affect the patient’s quality of life.

The first step to managing pain is assessing the condition and identifying its causes. The initial pain management consultation determines how the treatment will proceed. It can be difficult to assess pain because healthcare providers will have to rely solely on patient’s opinion and this can be very subjective and hard to interpret. To create an objective and better measurement of pain levels, the following set of questions that are based on the PQRST system, may be used:

  • Provoked: What causes the pain? What makes it better or worse?

  • Quality: What kind of pain is it? What does it feel like? Dull, sharp, stabbing, burning or crushing?

  • Region: Where is the pain located? Does it stay in the same spot or does it move or spread out?

  • Severity: What is the level of pain? (Use a pain scale to determine the answer)

  • Timing: When did the pain begin? How often do you feel it? How long do you feel it or does it not stop?

Once a comprehensive assessment has been completed, the doctor will create an individualized pain management program that usually involves the use of pain medications to treat both acute and chronic pain. Analgesics (pain relievers) are prescribed for mild to moderate acute pain while opioid pain medications are used for moderate to severe chronic pain.

Who Should Undergo and Expected Results

Pain medicine follow-up is for every person who has gone through pain medicine consultation and proceeded with a pain management program. Here are some instances that make this follow-up necessary:

  • For regular follow-up check-up – Not only is it necessary to monitor the progress of the patient but also to prevent the overuse, misuse and abuse of pain medications, which may lead to addiction, complications and dangerous, even life-threatening, side effects.

  • The current treatment protocol is not effective – Regular follow-up appointments are usually spaced one month apart to give the medication ample time to take effect. If during this period, the treatment protocol does not seem to have any effect, like if there is no recession of pain, the follow-up visit can be used to make necessary adjustments.

  • Side effects have become unmanageable – Patients need to go through this follow-up, even ahead of their regular appointment, if the side effects become unmanageable. The doctor will then make necessary adjustments to minimize the side effects.

How Does the Procedure Work

After a prescribed treatment protocol, it is common for a patient to return for regular follow-ups. During these visits, the pain management team will evaluate the condition in response to the pain medication that was previously given. The team will then conduct an assessment using a specific set of criteria to ensure that the evaluation is objective as much as possible. In some clinics, they provide a comprehensive questionnaire for the patient to fill out. This includes the following:

  • Current pain conditions – The PQRST system used in the initial consultation will be used to assess the patient’s current pain conditions to determine whether there is a significant change in his or her pain levels.

  • Level of adherence – The success of pain management will ultimately rely on the patient’s adherence to the prescribed treatment program. Thus, the patient’s dedication and compliance with all the instructions related to the dosage, schedule of pain medication, therapy (if any) and lifestyle changes will be assessed during the follow-up consultation.

  • Review of medications – The pain management team will review the medications being taken and will pay particular attention to drug dependency behavior and other adverse effects.

  • Physical examination and other diagnostic tests – The pain medicine follow-up is not only necessary for pain monitoring but also to check how the body is reacting to the medication. Thus, doctors may require liver and kidney tests and perform a physical exam to ensure that the patient’s health is not adversely affected. A urine screening test may also be required to make sure that the patient is not taking other non-prescribed medications.

  • Prescription drug monitoring – Doctors can also refer to a drug registry that collects and monitors prescription data from pharmacies and dispensing providers.

After an evaluation of the answers from this questionnaire, the pain management team will formulate a new treatment protocol or simply continue with the current one if no adjustments are required.

A treatment contract will then be presented to the patient for his signature. This identifies the pain medication that the patient will be taking, including its side effects and risks. This contract is essential because it signifies the patient’s understanding of and agreement to his treatment protocol. A copy will be given to the patient and another will be kept in his medical record.

The patient may be referred to undertake other pain management protocols if there is evidence of pain medication addiction and dependence and/or if there is no progress or no change to the patient’s pain problems.

Possible Complications and Risks

A pain medicine follow-up may unearth complications related to a patient’s non-adherence to his treatment program. This can mean that instead of getting better, there is no change or there is hardly any progress to his pain problems. A different treatment protocol may then be recommended. The risk of an overdose is also possible and may result in worse conditions, including those that are life-threatening.

Reference:

  • Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 16.
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