Spence Rehabilitation Center
1650 45th Ave. Suite 2C
Munster, IN 46321
Visit our Porter County location!
1620 Country Club Rd. Ste E
Valparaiso, IN 46383
Phone : (219) 513-2267
What is chronic pain?
Chronic pain is pain that has been present longer than the
normal healing time. This pain has usually been around for
3 to 6 months.
What labs are useful when assessing chronic pain?
1. CBC:
Used to look for infection and anemia.
2. Urinalysis:
To look for kidney problems.
3. Urine and blood toxicology:
To look for evidence of drug use.
What imaging studies are used to assess chronic
1. X-ray or CT of the affected body part:
To look for fractures, infections, tumors, or
inflammatory diseases.
2. MRI of the affected body part:
Most sensitive imaging tool to look for soft tissue
problems resulting in pain.
How are medications used to control Chronic pain?
The ladder approach has been developed by the World
Health Organization. This approach provides physicians
with guidelines on how to treat chronic pain effectively.
1. Nonopiate medications:
Are first tried such as Tylenol, NSAIDS, and Tramadol.
2. Adjuvant Medications:
Are started to enhance the effectiveness of pain
medications and control side effects.
3. Mild opiates:
Are started (ie. Tylenol #3, Vicodin, Darvocet, and
Norco) ± adjuvants, ± nonopioids.
4. Strong opioids:
Are started (ie. Fentanyl Patch, Morphine, Avinza)
Morphine ± adjuvants, ± nonopioids.
How are Opiates Started?
1. a short-acting (immediate-release) opiate is
And slowly raised while the effectiveness and the side
effects are monitored.
2. The amount of short acting drug that was used in a
24-hour period is added up and converted to a
sustained release medication that is taken two or
three times a day around the clock. If the patient
experiences intermittant breakthrough pain, a short
acting as needed (prn) medication is also prescribed.
Why are Long acting opiates used?
Patients with Chronic, Constant Pain are usually placed on
a long acting Opiate Medication instead of an as needed
medication. Patients given medication this way are more
comfortable and use less medication overall. Short acting
prn medications are used for intermittent pain.
Why are adjuvant Pain medications Used?
Adjuvant medications are used to enhance pain control and
minimize side effects. Adjuvant medications can also treat
other symptoms that are usually associated with chronic
pain such as depression, insomnia, and anxiety. Adjuvant
medications are also better at treating nerve pain also
known as neuropathic pain.
1. Benzodiazepines:
Are used to manage anxiety. This class of medication
can be addictive, cause sedation, and depress
breathing. Clonazepam is especially useful for nerve
(aka. neuropathic) pain.
2. Antispasmodics:
Commonly prescribed medications include flexeril and
3. Tricyclic Antidepressants:
Has been shown to improve pain control and treat
other symptoms such as depression, anxiety, and
a) An EKG is needed before started.
4. Anticonvulsants:
Are useful for lancinating (knifelike) pain. commonly
prescribed examples include neurontin, lyrica, valproic
acid, and phenytoin.
a) A complete blood count and baseline liver
function tests should be checked first.
What is Tolerance and How can Opiate Tolerance be
1. Patients who have been on opiate medications for a
long time may require a higher dose of medication
over time to maintain pain relief which is known as
2. Sometimes tolerance can be minimized by switching
to a different type of opiate that works a little
different on the body.
What are common withdrawal symptoms that
patients can experience when stopping opiates?
When opiates are stopped suddenly, patients will likely
develop withdrawal symptoms. Common symptoms are
listed below:
1. Sweating
2. Rapid heart rate
3. High blood pressure
4. Irritability
5. Anxiety
What are some common side effects of opiates?
1. Nausea and vomiting
2. Constipation
3. Blood pressure instability
What is an opiate contract and why is it used?
The individual will be required to sign and agree to an
Opiate contract before starting the medication. The
contract enforces the individual to comply with the
treatment plan prescribed by the doctor and minimize
the likelihood of medication abuse. If the patient does
not follow the contract, he or she may be taken off of
the medication or even have to find another doctor.
1. The agreement enforces that prescriptions only be
prescribed by one physician and one designated
2. The agreement usually specifies that the patient take
the medication only as prescribed.
3. By signing the agreement, the patients acknowledge
that they are responsible for their written prescription
medication, and that they refill their medications during
regular office hours. They also must plan ahead so as
not to run out of medication during weekends or
vacation periods.
What are some other Therapies commonly used to
treat chronic pain?
1. Physical Therapy:
Usually started with gentle range-of-motion and
stretching exercises progressing to strengthening.
2. Modalities:
Usually provided by the physical therapist. Some
common modalities are listed below:
a) Hot packs:
To increase blood flow and relax tissues.
b) Ultrasound:
Provides heat deep into the tissues.
c) Transcutaneous Electrical Nerve Stimulation
An low electrical impulse is applied to the body
which blocks the pain impulses from going to
the brain.
d) Traction:
The tissues are stretched in a controlled
e) Myofascial release:
  The soft tissues are mobilized.
3. Occupational Therapy:
To provide the patient with desensitization techniques
4. Recreational Therapy:
The individuals favorite activities are used to keep
them active.
5. Pain Psychology:
To assess and improve coping strategies. The
psychologist also teaches the individual relaxation
techniques and how to manage their stress. The
psychologist can also teach the individual biofeedback
6. Vocational Therapy:
The individual’s work history, education, and
motivation level to return to work are assessed by
a counselor. Afterwards, therapies are provided to
condition the individual so that they may return to
reasonable employment.
What types of surgical procedures can be used to
treat chronic pain?
1. Nerve blocks:
An anesthetic and steroid can be used to target the
nerves that go to the painful part of the body.
2. Sympathetic blocks:
Including stellate ganglion and lumbar sympathetic
blocks are used.
3. Spinal cord stimulators:
To treat irritated nerves that have failed to respond
to other less invasive treatments.
4. Pain pumps:
A pump can be implanted in the spine that delivers
the opiate medication directly to the receptors which
reduces the overall opiate concentration needed in
the body.
"Nothing contained on this website should be interpreted to be medical advice. This website is for general information only.
Please consult a physician for medical advice regarding any medical condition."
  © 2008 Spence Rehabilitation Center. All rights reserved. Designed by :   KSN TECHNOLOGIES PVT. LTD.