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pain management

Back Education: Does it Work for Patients?

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,

Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

CLINICAL TOOLS

Abstract: Back education or “Back Schools” are used both as a method of prevention and, in conjunction with traditional rehabilitation and exercise programs, as a component in treatment of recurrent or persistent low back pain. It is challenging to evaluate the effectiveness of this educational effort. Models have varied from brochures, booklets and simple office conversations to formal scheduled classes. Content has ranged from purely mechanical instruction to complex cognitive behavioural therapy. Essential to success is the ability to integrate the instructions into activities of daily living. The composition of those lessons remains the subject of continuing debate.
Key Words: Back School, education, body mechanics, prevention, pain management.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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Back education programs do not reduce the frequency or severity of future back pain attacks.
The educational message should be consistent, frequent and stress self-management.
Group education is useful but the message must be tailored to the individual.
Information must be integrated into the patient's daily routine.
Back education should be part of rehabilitation and is probably most effective during the sub-acute phase of recovery when the pain is still present but not so distracting that it prevents learning.
Comprehensive back school includes spinal anatomy, instruction in proper body mechanics, individualized pain control techniques plus the recognition and treatment of pain disorder through cognitive behavioural therapy when required.
The back program should follow the precepts of adult education with frequent interaction, problem solving, practical applications and a focus on participation.
A successful back school educates the patient about the benign nature of back pain and provides the tools to transfer knowledge about back hygiene into practice in the patient's life.
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Prescribing Opioids to Older Adults: A Guide to Choosing and Switching Among Them

Prescribing Opioids to Older Adults: A Guide to Choosing and Switching Among Them

Teaser: 

Marc Ginsburg, RN, MScN, NP, Medical Student, University of Sint Eustatius School of Medicine, Sint Eustatius, Netherlands-Antilles.
Shawna Silver, MD, PEng, Resident, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON.
Hershl Berman, MD, FRCPC, Assistant Professor, Faculty of Medicine, University of Toronto; Staff Physician, Department of Medicine, University Health Network; Associated Medical Services Fellow in End-of-Life Care Education, University of Toronto; Centre for Innovation In Complex Care, University Health Network, Toronto, ON.

The use of opioid medications and converting among them in the older adult population can often be challenging. Physiological changes in older adults may affect metabolism and cognitive abilities. Due to renally cleared metabolites, some opioids, such as morphine, should be used with caution among older adults. Others, such as meperidine, should never be used at all. When prescribing or changing opioids, the choice of the correct formulation, appropriate counselling, and close follow-up are essential for optimal pain management and in order to prevent adverse outcomes.
Key words: opioids, pain management, older adults, analgesia, opioid conversion.

Optimizing Pain Management in Long-Term Care Residents

Optimizing Pain Management in Long-Term Care Residents

Teaser: 

Evelyn Hutt, MD, Associate Professor of Medicine, University of Colorado at Denver and Health Sciences Center; Director, Colorado Research in Care Coordination, VA Eastern Colorado HCS, Denver, CO, USA.
Martha D. Buffum, DNSc, APRN, BC, CS, Associate Chief Nurse for Research, VA Medical Center, San Francisco; Associate Clinical Professor, School of Nursing, University of California, San Francisco, CA, USA.
Regina Fink, RN, PhD, FAAN, Research Nurse Scientist, University of Colorado Hospital, Aurora, CO, USA.
Katherine R. Jones, RN, PhD, FAAN, Sarah Cole Hirsh Professor and Associate Dean for Evidence-Based Practice, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
Ginette A. Pepper, PhD, RN, FAAN, Professor and Helen Lowe Bamberger Colby Endowed Chair in Gerontological Nursing Associate Dean for Research and PhD Program, University of Utah College of Nursing, Salt Lake City, UT, USA.

Pain is common among long-term care residents and is often undertreated. A high prevalence of dementia, sensory impairment, and disability, as well as structural issues such as staffing patterns and turnover in long-term care facilities make assessment and management of pain challenging. An overview of the evidence regarding the assessment and treatment of pain in individual residents, and recommendations for improving the overall quality of pain management in the long-term care setting, is presented.
Key words: pain, dementia, long-term care, pain assessment, pain management.

Aging and Cultural Disparities in Pain at the End of Life

Aging and Cultural Disparities in Pain at the End of Life

Teaser: 


Lucia Gagliese, PHD, CIHR New Investigator, School of Kinesiology and Health Sciences, York University; Department of Anesthesia, University Health Network; Department of Anesthesia and Psychiatry, University of Toronto, Toronto, ON.
Rinat Nissim, MA, PhD Candidate, Department of Psychology, York University; Doctoral Fellow, Psychosocial Oncology & Palliative Care, University Health Network, Toronto, ON.
Melissa Jovellanos, BSc, MSc Candidate, School of Kinesiology and Health Sciences, York University; Department of Anesthesia, University Health Network, Toronto, ON.
Nataly Weizblit, BSc Candidate, Department of Psychology, York University; Department of Anesthesia, University Health Network, Toronto, ON.
Wendy Ellis, RN, Clinical Research Co-ordinator, Department of Anesthesia, University Health Network, Toronto, ON.
Michelle M. Martin, PhD, Postdoctoral Fellow, Department of Anesthesia, University Health Network, Toronto, ON.
Gary Rodin, MD, Professor, Department of Psychiatry, Director, Psychosocial Oncology & Palliative Care, Joint University of Toronto/University Health Network; Harold and Shirley Lederman Chair in Psychosocial Oncology and Palliative Care, Toronto, ON.

Both older adults and minority patients are at risk of undertreatment and mismanagement of pain. Caregivers report that many older adults are in pain before death, and doctors are often less willing to prescribe strong opioids to the dying. Underutilization of narcotics with older minority populations has also been reported. The Canadian population is aging rapidly, and Canada is home to one of the most ethnically diverse cities in North America. In this context, the above findings are unacceptable. Recommendations for improvements in the health care system are made.
Key words: end-of-life care, pain management, racial disparities.

CME: Chronic Noncancer Pain Management in Older Adults

CME: Chronic Noncancer Pain Management in Older Adults

Teaser: 

Jacqueline Gardner-Nix, MBBS, PhD, MRCP(UK), Assistant Professor, Department of Anaesthesia, University of Toronto; Chronic Pain Consultant, Sunnybrook & Women’s College Health Sciences Centre; St. Michael’s Hospital Pain Clinic, Department of Anaesthesia, Toronto, ON.

Older adults pose additional challenges in pain management when noncancer pain has become chronic. Health care professionals are increasingly aware of the effect of past and current life stressors on the pain experience, and the roles of gender, genetics and culture. Reduced activity as individuals age often amplifies the disabling effects of pain. Pain medications are more problematic in this age group due to many factors, including polypharmacy, comorbidities and reduced renal function. However, judicious use of opioid analgesics in a subset of the population may allow increased function and access to activities, which become part of their pain management.
Key words: older adults, opioids, pain management, noncancer pain, holistic.