Pain Management for Primary CareDaniel Alves, MD, MPHAbout MePractice at Universal Pain ManagementOffices at:Victorville, CAPalmdale, CASanta Clarita, CAMedical School at U!oard certified s"ecialist in Ph#sical Medicine $ %eha&ilitation 'Medical College of (isconsin)S"ecialt# trained in Pain Management*UCA+(A VA hos"ital* PM$% "rogramGoals of Todays Lecture (h# sho,ld -e learn a&o,t Pain. Ho- is it meas,red (hat are the different t#"es of "ain /reatments StrategiesPain patients often need specialized care.Pain acco,nts for 012 of all "h#sician visits3ess than half '402) of "ain "atients felt the# -ere getting eno,gh information on the most effective -a#s to manage chronic "ain3052 of chronic "ain s,fferers re"ort an ina&ilit# to slee" -ell3512 of "ain "atients e6"erience &rea7thro,gh "ain one or more times dail#3What is Pain An ,n"leasant sensor# and emotional e6"erience associated -ith act,al or "otential tiss,e damage, or descri&ed in terms of s,ch damage3 *8ASP S,&9ective nat,re : sensation and emotional com"onent to it3Famous Descartes Image: "Fast moving particles of fire ..the disturbance passes along the nerve filament until it reaches the brain..." Descartes (1664)Components of Pain!iological : 8n9,r# or disease "rocess;removing tiss,e ma7es the "ain go a-a#3 Ps#chological ** Personalit# disorder, de"ressionSocial : eurogenic Claudication)pinal )tenosisCreater than I1 #ears of age ',s,all# in 51Ns or L1Ns)C+O !P and leg "ain -ith -al7ing%elieved -ith sittingCan &e ,nilateral or &ilateral8ncreased "ain -ith do-n hill -al7ing and &etter -ith -al7ing ,"hillR Esho""ing cartF sign)pinal )tenosis9Central or ,oraminal:Ma# &e ca,sed :congenital narro-ings"ond#lolisthesistra,madegenerative changes d,e to aging/reatmentmedications and e6ercisedecom"ressive laminectom# '?+A, ?+A, ?+A),acet -iseasePain ma# &e localiHed to lo- &ac7 or radiate into &,ttoc7s and "osterior thigh,n,s,al for this "ain to go &elo- the 7nee-orse -ith e6tension and -ith "rolonged standingcan &e d,ll toothache "ain or shar" sta&&ing "ain,acet -isease /reatment l,m&ar sta&iliHation "rogramfacet mo&iliHationsintra*artic,lar in9ections ,nder fl,orosco"#medial &ranch &loc7s+denervation ,nder fl,oro 'diagnosis and treatment))acroiliac -ysfunction Pain is located in the lo- &ac7 and radiates into the &,ttoc7s and "osterior thighs s"ecial tests not ver# relia&le "atient -ill "oint to S8 as so,rce of "ain can have associated "iriformis s"asm -ith EsciaticaF common in "regnanc# (hich of the follo-ing is associated -ith "ain arising from the sacroiliac 9oint. 'A)Paresthesia of the lateral thigh '!)Positive Patric7Ss '