Professional Documents
Culture Documents
Tim Lee
Hospitalist, VMMC
Pain
Ref.
Journal of Hospital Medicine, Feb 2014
IV opioids
Active heroin addiction.
Methadone maintenance.
Long-term opioids (high-dose)
IV Opioids
Emotional:
Anxiety ↑ pain intensity.
Depression ↑ risk of chronic pain.
Depression negatively impacts outcome.
Treating depression ↓ pain.
PTSD, poor sleep, substance abuse can worsen pain.
Cognitive behavioral:
Catastrophic thoughts, disabling beliefs: “This is bad.” “hurt = harm” “I can’t function with pain.”
belief in oneself as disabled by pain, belief one has no control over pain.
Fear-avoidance behavior.
Physical:
Inactivity, poor pacing
Disuse syndrome ↑ pain, hyperalgesia
Attention:
Focusing on pain. no outside interests, valued activities, goals.
Pain Modulation
Central
stimulus
Peripheral
stimulus