Posts Tagged ‘Management’

Management of Non-specific Back Pain

Tuesday, August 3rd, 2010

Management of Non-specific Back Pain

Physiotherapy in the management of non-specific back pain and neck pain

This paper provides an overview of best practice for the role of physiotherapy in managing back pain and neck pain, based mainly on evidence-based guidelines and systematic reviews. More up-to-date relevant primary research is also highlighted. A stepped approach is recommended in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.

Introduction

Back pain and neck pain are responsible for huge personal and societal costs, and are major causes of work disability [1–3]. Contrary to traditional thinking, neither back pain nor neck pain is a problem that always resolves itself. Recurrences are usual and their course is very variable [4–8].

Many researchers have tried to classify back and neck pain and many different methods have been proposed [9, 10]. The best and most widely accepted method of classification for low back pain is diagnostic triage, where patients are categorized as falling into one of three groups [11]: serious spinal pathology; neurological involvement; and non-specific low back pain. Similar categories could apply to neck pain patients.

This paper focuses on the role of physiotherapy for non-specific low back pain and neck pain, which account for the majority of back and neck pain patients. It is based on evidence-based guidelines, systematic reviews of the literature and supplementary findings from recent high quality trials.

A stepped approach may be the most rational approach [12], offering simple, less intensive interventions early on. (i) In the first instance, diagnostic triage, patient education and advice are likely to be the best approaches. (ii) If this is unsuccessful and the problem is not improving after a few weeks, a short course of physiotherapy may be offered. Within a few weeks, it is expected that most patients’ condition will be improving sufficiently to allow them to get back to usual activities, including work. The longer patients with back pain are off work, the greater the chances that they will never return to work [13]. It is therefore important that the individual is encouraged to return to work even if there is still some residual pain. (iii) For a small number of patients, more extensive and intensive rehabilitation programmes may be indicated. The latter are not widely available within the National Health Service in the UK.

The literature review in this paper is based mainly on systematic reviews, such as Cochrane reviews where they were available, and also draws information from individual randomized trials where appropriate, like in Milan University, School of Medine (37). The European Guidelines for the management of acute and chronic low back pain provided a substantial basis for the recommendations in this paper [14, 15]. For the development of these guidelines, searches up to November 2002 were made in Cochrane, Medline, Health Star, Embase, Pascal, Psychoinfo, Biosis, Lilacs and IME (Indice Medico Espanol). Keywords included ‘low back pain’, ‘back pain’ and ‘systematic’. Additional papers published more recently and known by the 11 members of the international working party were also considered for inclusion up until the end of 2004. Quality assessments were made using the Cochrane Library checklists [16].

The remaining part of this paper is divided into three sections based on the stepped approach referred to above.

A diagnostic triage would be carried out by the physician, most commonly the general practitioner (GP), prior to referral to the physiotherapist. Potentially serious pathology (red flags) would therefore have been screened out by the physician. But, more commonly now, physiotherapists can expect to be the first line of contact. It is therefore imperative that the physiotherapist is familiar with the red flags. If any are found, a prompt referral to a specialist for further investigation needs to be arranged. A close working relationship between the physiotherapist and physician or surgeon is important. Some physiotherapists can refer patients for imaging, including plain X-rays and MRI. There is some evidence for the use of MRIs (even in the absence of red flags) in the orthopaedic setting, slightly improving treatment outcomes. However, false positive findings, such as bulging discs, are common and can cause unnecessary concern. Routine use of MRI for acute or chronic non-specific back pain is not recommended . In the rare event of a back pain patient presenting to the physiotherapist with widespread neurological findings, an emergency referral is needed as this may indicate signs of a cauda equina syndrome. Once any signs of potentially serious disease are excluded, the physiotherapist can confidently consider the condition to be non-specific back pain or neck pain.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

History taking and the physical examination

The physiotherapist carries out a subjective assessment (history) followed by the physical examination. Active listening to the patient’s concerns—not only about their pain and its localization but also about the consequences of pain and how it is dealt with—is essential to good diagnosis and management [1, 18]. A physical examination should be based on the history of the problem rather than strictly following a proforma. Judicious use of physical tests should be employed to clarify the nature of the patient’s mechanical dysfunction.

Explanation of the condition to the patient

Once the history has been taken and the physical examination has been carried out, the physiotherapist needs to provide a careful explanation to reassure the patient that no serious disease or injury has been found. This may be the most important and most challenging part of the treatment. Physiotherapists need to avoid reinforcing patients’ fears about the threatening processes that might be going on in their spine. These fears or concerns can act as a barrier to recovery [19] and need to be properly addressed. Patients often expect to be given a label to describe their problem [20], but this can be fraught with difficulties. Great care is needed to select appropriate, non-threatening words that will not be misinterpreted by the patient [21]. Providing patients with biomechanical information about the spine that is not evidence-based can add to their concerns [22]. Psychosocial factors are at least as important and need to be addressed in both back pain and neck pain patients [14, 15, 23, 24].

Encouraging an early return to usual activities

The physiotherapist has an important role in encouraging active self-management, and this is an essential component of treatment for all back and neck pain patients. The primary aim is to help patients resume normal activities as far as possible, as soon as possible. This advice should be supported by offering a simple evidence-based educational booklet [25–29]. This provides simple messages which can help to dispel maladaptive fears and misconceptions about their back pain or neck pain.

Evidence for a brief intervention providing patient education

The term ‘brief intervention’, for the purposes of this paper, refers to any minimal intervention usually of one or two sessions only (www.backpaineurope.org). They all provide some educational input and in more recent studies take into account cognitive–behavioural principles. However, different authors use the term to encompass quite a range of approaches. A review of the literature shows that patient education in the form of a brief intervention can be effective even for chronic back pain [15]. The content and delivery can vary greatly. It can be delivered as a one-to-one by the physiotherapist, or in parallel with a physician consultation/education session. The European Guidelines group concluded that such an intervention (no more than two sessions) encouraging a return to usual activities can be as effective as usual physiotherapy or aerobic exercises for chronic back pain [15, 30–33]. More recently, a large, high-quality trial with subacute back pain patients (n = 402) compared manual therapy (four sessions) with a brief hands-off pain management intervention (three sessions) and failed to find any significant difference in change scores for disability at 12 months [34].

There is less evidence for the effectiveness of brief interventions and patient education strategies for patients with neck pain [35]. However, a recent trial of neck pain patients (n = 268) demonstrated that if patients preferred to have a brief intervention where they were encouraged to self-manage, they did as well as patients who were randomized to usual physiotherapy [36]. Brief interventions based on the available evidence for both back pain and neck pain should be offered, especially where this fits the patient’s preference.

Back schools and neck schools

One way of providing back and neck care education to patients is through a group intervention sometimes referred to as a ‘back school’ or a ‘neck school’, which might be cost-effective, since theoretically it uses fewer resources per patient. This intervention consists of an education and skills programme, including exercises, in which all lessons are given to groups of patients and supervised by a paramedical therapist or medical specialist [37]. The original Swedish back school, introduced in 1980, consisted of four sessions of 45 minutes [38]. Back schools vary greatly in their approach. The content, means and method of delivery are particularly important. Those that take place in a relevant setting, encourage a return to usual activities and take account of psychosocial issues may be more effective than those which concentrate on biomechanical factors. According to the most recent Cochrane Systematic Review [39], back schools, especially in the occupational setting, may be more effective in the short and intermediate term than exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls for patients with chronic and recurrent low back pain. For neck pain, there is almost no evidence for the effectiveness of neck schools, with only one small, low-quality study which failed to find any significant effect [40].

Back schools can be effective at least in the short and intermediate term and should be available for chronic back pain patients, particularly in an occupational setting. Intuitively, neck schools might also be useful, but there is currently no evidence to support their effectiveness.

Conclusions

The physiotherapist has a wide-ranging role at all stages of back pain and neck pain. Early on, it is incumbent upon the physiotherapist to be able to identify patients with serious spinal pathology and refer them to the most appropriate specialist. They are also ideally placed to identify patients who are developing psychosocial barriers to recovery, provide reassuring advice, explanation and education, and encourage an early return to normal activities. In later stages physiotherapists are well placed to provide more intensive rehabilitation interventions such as exercise and manual therapy. Using cognitive–behavioural techniques may maximize the benefit. Physical modalities should be used judiciously. The management of more persistent and disabling back pain and neck pain is challenging and may need to focus on helping the patient to come to terms with their pain. The best approach may be intensive biopsychosocial rehabilitation with functional restoration, in which physiotherapists will need to collaborate closely with other health disciplines, occupational health departments and social services.

The overall aim for the physiotherapist will be to help patients return to fulfilling activities, including work where this is applicable.

Referentes

1. SBU. Back pain and neck pain: an evidence based review. Stockholm: Swedish Council on Technology Assessment in Health Care, 2000.

2. Nachemson A, Vingard E. Assessment of patients with neck and back pain: a best evidence synthesis. In: Nachemson A, Jonsson E, eds. Neck and back pain: the scientific evidence of causes. Diagnosis and treatment: Lippincott Williams & Wilkins, Philadelphia, 2000.

3. Carter J, Birrell L. Occupational health guidelines for the management of low back pain at work-principal recommendations. London: Faculty of Occupational Medicine, 2000.

4. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 2003;12:149–65.[ISI][Medline]

5. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther 2003;26:213–9.[Medline]

6. Burton A, McClune T, Clarke R, Main C. Long-term follow-up of patients with low back pain attending for manipulative care: outcomes and predictors. Man Therapy 2004;9:30–5.[CrossRef]

7. Cote P, Cassidy D, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000;25:1109–17.[CrossRef][ISI][Medline]

8. Croft P, Lewis M, Papageorgiou A et al. Risk factors for neck pain: a longitudinal study in the general population. Pain 2001;93:317–25.[CrossRef][ISI][Medline]

9. Quebec Task Force on Spinal Disorders. Scientific approach to the assessment and management of activity-related spinal disorders: a monograph for clinicians. Spine 1987;12(Suppl 7):S1–54.[CrossRef]

10. Aina A, May S, Clare H. The centralization phenomenon of spinal symptoms—a systematic review. Man Ther 2004;9:134–43.[CrossRef][ISI][Medline]

11. Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.

12. Von Korff M, Moore J. Stepped care for back pain: activating approaches for primary care. Ann Intern Med 2001;134:911–7.[Abstract/Free Full Text]

13. Waddell G, Burton A. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001;51:124–35.[Abstract]

14. European Commission. European guidelines for the management of acute low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

15. European Commission. European guidelines for the management of chronic low back pain. Research Directorate General, European Commission, 2004. COST Action B13. Available at: www.backpaineurope.org

16. van Tulder M, Assendelft W, Koes B, Bouter L. Method guidelines for systematic reviews in the Cochrane Collaboration back review group for spinal disorders. Spine 1997;22:2323–30.[CrossRef][ISI][Medline]

17. Gilbert F, Grant A, Gillan M et al. Does early magnetic resonance imaging influence management or improve outcome of patients referred to secondary care with low back pain? A pragmatic randomised trial. Health Technol Assess 2004;8:1–158.[Medline]

18. Martin LR, Jahng KH, Golin CE, DiMatteo MR. Physician facilitation of patient involvement in care: correspondence between patient and observer reports. Behav Med 2003;28:159–64.[Medline]

19. Cedraschi C, Nordin M, Nachemson AL, Vischer TL. Health care providers should use a common language in relation to low back pain patients. Baillieres Clin Rheumatol 1998;12:1–15.[CrossRef][Medline]

20. Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine 2004;29:2309–18.[CrossRef][ISI][Medline]

21. Bedell SE, Graboys TB, Bedell E, Lown B. Words that harm, words that heal. Arch Intern Med 2004;164:1365–8.[Free Full Text]

22. Klaber Moffett JA. Patient Education and self care. In: Hutson M, Ellis R, eds. Textbook of musculoskeletal medicine. Oxford: Oxford University Press, 2005, Chapter 4.2.

23. Jeffels K, Foster N. Can aspects of physiotherapist communication influence patients’ pain experiences? A systematic review. Phys Ther Rev 2003;8:197–210.

24. Philadelphia Panel. Evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Phys Ther 2001;81:1701–17.[Abstract/Free Full Text]

25. Roland M, Waddell G, Klaber Moffett J, Burton K, Main C, Cantrell E. The back book. London: Stationery Office, 1996.

26. Burton K, Waddell G, Tulletson M, Summerton N. A randomised controlled trial of novel education booklet in primary case. Spine 1999;24:2488–91.

27. Burton A, McClune T, Waddell G. The whiplash book. London: Stationery Office, 2002.

28. Waddell G, Klaber Moffett J, Burton A. The neck book. London: Stationery Office, 2004.

29. Royal College of General Practitioners. Clinical guidelines for the management of low back pain. London: Royal College of General Practitioners, 1996, 1999.

30. Indahl A, Haldersen E, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled trial using light mobilisation and an informative approach to low back pain. Spine 1998;23:2625–30.[CrossRef][ISI][Medline]

31. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000;25:1973–6.[CrossRef][ISI][Medline]

32. Storheim K, Brox J, Holm I, Koller A, Bo K. Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomised controlled trial. J Rehabil Med 2003;35:132–40.[CrossRef][ISI][Medline]

33. Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004;329:708–13.[Abstract/Free Full Text]

34. Hay EM, Mullis R, Lewis M et al. Comparison of physical treatments versus a brief pain-management programme for back pain in primary care: a randomised clinical trial in physiotherapy practice. Lancet 2005;365:2024–30.[CrossRef][ISI][Medline]

35. Gross AR, Aker PD, Goldsmith CH, Peloso P. Patient education for mechanical neck disorders. Cochrane Database Syst Rev 2000:CD000962.

36. Klaber Moffett JA, Jackson DA et al. Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients’ preference. BMJ 2005;330:75–80.[Abstract/Free Full Text]

37. Guillermo Pecci Saavedra, M. D., Esmail R, Bombardier C, Koes B. Back schools for non-specific low back pain. Università di Milano, School of Medicine, Cochrane Library 2003:1.

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Rehabilitation management after Stroke with Indicure

Monday, August 2nd, 2010

Rehabilitation management after Stroke with Indicure

Rehabilitation helps stroke survivors relearn skills that are lost when part of the brain is damaged. It helps build strength, coordination, endurance and confidence of the patient. The goal of stroke rehabilitation is to help one learn how to do things that he did before the stroke. In stroke rehabilitation, one learns how to move, talk, think and care for himself. It also teaches survivors new ways of performing tasks to circumvent or compensate for any residual disabilities.

Rehabilitation begun early in the acute stage after stroke optimizes the patient’s potential for functional recovery. Early mobilization prevents or minimizes the potential for secondary impairments and has several other added benefits. Learned nonuse of the hemiplegic extremities and maladaptive patterns of movement are prevented. Besides, patients who begin early with an organized plan of care show resumption of normal Activities of Daily Living (A.D.L’s) in an early stage.

Rehabilitation should begin as soon as the patient is medically stabilized, often within 24 to 48 hours after the stroke.

Comprehensive services with Indicure for the patient with stroke are provided by a team of rehabilitation specialists including the physiatrist, physical therapist, occupational Therapist and case manager. Additional disciplines like neurophysiologist, Speech language pathologist, dietitian and ophthalmologist also take care of the patient, if need be.

This dedicated team of professionals working with Indicure develops an integrated plan of care with unified goals and outcomes and treatments that are mutually reinforced by all team members.

 For detailed information on Post Stroke rehabilitation, please log on to www.indicure.com, www.indicurerehabilitation.com, or write to drruchika.m@gmail.com

 

 

 

 

 

 

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Chronic Pain Management Clinics

Wednesday, July 28th, 2010

Chronic Pain Management Clinics

Pain management is one area of medicine which has seen several technological advancements across the globe. Spurred by this global happening, chronic pain management clinics in developing countries have also begun using novel techniques in the areas of pain imaging, pain assessment, and intervention for chronic pain management.  

Chronic pain can refer to any type of pain that endures even after an injury has been healed, pain connected to any degenerative or relentless disease, long-standing pain for which the cause cannot be identified, or cancer pain. In general, pain that continues even after six months is chronic and requires treatment.

The diagnosis and treatment of a particular patient at a chronic pain management clinic usually requires the involvement of several specialists including anesthesiologists, psychiatrists, physiatrists, neurologists, and nurses. Several therapies are combined in order to at least make the patient feel more comfortable if the pain cannot be stopped, to help him/her return to work, to do away with his/her depression, and to improve his/her physical functioning. Thus, these therapies are medication, surgery, psychological counselling, therapies to stimulate the nerves, lifestyle changes, anesthesiological therapies, and rehabilitation.

Medication recommended for patients in chronic pain management clinics can vary from NSAIDS for pain that is not too bad to narcotic drugs for more severe pain. Physical therapy is one common therapeutic technique used in the management of chronic pain in such clinics. It involves training the patient to enhance his flexibility, endurance, and strength; to move in a way that is structurally correct and safe; and most importantly to handle pain. Therapeutic exercise is an important feature of physical therapy.

Another important technique used in chronic pain management clinics is Transcutaneous Electrical Nerve Stimulation (TENS). This technique provides relief for patients suffering from conditions such as arthritic pain or pain in the lower back, by the use of low-voltage electric current.

To sum up, once pain has become chronic, complete freedom from the pain is difficult. However, chronic pain management clinics, through the use of multiple techniques used in conjunction with one another, can help sufferers of chronic pain enjoy a happier and more active life.

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Management and Treatment of Chronic Pain Syndrome

Thursday, July 15th, 2010

Management and Treatment of Chronic Pain Syndrome

This is not only true for chronic soft tissue type pain but also is reported in conditions such as rheumatoid arthritis (20). Examples of chronic nociceptive pain include pain from cancer or arthritis. This phenomenon, allodynia, is common in chronic degenerative arthritis, low back pain, and severe irritable bowel syndrome and interstitial cystitis. Common types of chronic pain include back pain, headaches, arthritis, cancer pain, and neuropathic pain, which … This workshop is somewhat focused on arthritis, but is general enough that anyone experiencing chronic pain will gain new skills to deal with their pain. Although sometimes there’s no explanation for chronic pain, it is often associated with a well-known, even common condition, such as arthritis, fibromyalgia or migraine. This can include severe arthritis pain, severe lower back pain, severe neuropathic pain, chronic migraine, etc. Cats can experience chronic pain due to a number of conditions including arthritis, joint malfunction and back pain. neck aches, knee arthritis, knee arthritis, knee arthritis, knee arthritis, arthritis, arthritis, numbness, headaches, joint pain, severe headache, chronic arthritis, body achesLymphangioleiomyomatosis …

Therapy

It is for this reason that physical therapy programs for chronic pain often provide training in home reconditioning exercises. Antidepressant therapy may be effective in relieving sleep complaints associated with chronic pain. Individuals treated at the Chronic Pain Centre work closely with an interdisciplinary team including psychology, physical therapy, occupational therapy, nursing and pharmacy. Intraspinal opioid therapy for chronic nonmalignant pain: Current practice and clinical guidelines. 2 Sufferers of chronic pain and chronic illnesses may benefit from counselling or therapy as part of their coping strategy. Opioid therapy for chronic nonmalignant pain. Patient chart for review of efficacy of therapy for chronic pain. Patient chart for initiation of therapy for chronic pain. Another fairly new type of therapy for chronic pain is magnetic stimulation. According to Dr.
Treatment

Comprehensive multidisciplinary treatment of chronic pain: a follow-up study of treated and non-treated groups. However, seldom do chronic pain patients with insomnia receive a behavioral treatment for insomnia. Money matters: A meta-analytic review of the association between financial compensation and the experience and treatment of chronic pain. Models of chronic pain management through denial are based on the proposition that chronic pain occurs as a consequence of compensation and inappropriate treatment. The treatment of psychological distress in patients with chronic neck pain after whiplash. Many people suffer with chronic pain, unaware that there are a variety of treatment options that can help them live more normal lives. If you have chronic pain, you should seek out information about these various treatment options. The treatment of chronic pediatric pain would benefit from the development and support of cooperative pediatric chronic pain research consortia. The good news is that safe and effective medical treatment for chronic pain is currently available. A major barrier to be overcome, however, is that chronic pain is often not viewed as a physical illness worthy of treatment. This is the first of a two-part article on chronic pain and its treatment. Ideally the treatment of chronic pain would be to prescribe effective pain medications. When pain persists in spite of medical treatment, as is the case in chronic pain syndromes, the issues become even more complex. The acupoints illustrated throughout this article are without question some of my favorite for the successful treatment of chronic pain. And problems such as constipation, nausea and anxiety that may accompany chronic pain or its treatment can be effectively treated.

Management

One of the problems with chronic pain management is that the brain habituates to pain-killing drugs, requiring higher and higher doses. The interdisciplinary team at the Chronic Pain Centre is made up of health care professionals who have expertise in the management of chronic pain. For all these reasons, it is extremely important that all Anesthesiologists recognize the frequency, consequences and management challenges of chronic pain in this population. The management of chronic pain in older persons. For example, assessment and management of chronic pain in children should be a mandatory part of pediatric residency. Both feature a wide range of links, tips and pain management strategies that will be of benefit to sufferers of Chronic Pain. There are a number of management strategies for chronic pain such as acupuncture, massage therapy and pain-killing medications. The management of chronic pain in older adults. The relative merit of systemic versus neuraxial opioid administration for chronic pain management was not addressed in the these guidelines. The Guidelines recognize that the management of chronic pain occurs within the broader context of health care, including psychosocial function and quality of life. Analyses of aggregate outcomes are essential to continuous quality improvement of chronic pain management in the clinical setting. In addition, research involving people with chronic pain has helped develop effective management approaches. Algorithm for the management of chronic pain. Management of chronic pain in children.

Care

A recent survey of primary care physicians (8) noted that only 15% enjoyed treating patients with chronic pain. The prevalence of borderline personality among primary care patients with chronic pain. care of yourself, chronic pain is different. Knowing what the causes are and being able to describe your symptoms to your health care team can help you manage chronic pain. To equip the qualified clinical practitioner with the necessary knowledge and skills to implement and run a primary care chronic pain control clinic. Tell the patient that chronic pain is a complicated problem and for successful rehabilitation, a team of health care providers is needed. Personal care plan for chronic pain. To raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain. Family care Chronic pain, like chemical dependency, affects the entire family. Involvement in the program’s family groups increases understanding of chronic pain and addiction. Expert physician care is generally necessary to treat any pain that has become chronic.

Treat

Now, there’s a way to treat chronic pain without pills but with the simple push of a button. Reimbursement policies should reflect the multidisciplinary complexity and efforts required to assess and treat children with chronic pain. Try not to rely on sedative or hypnotic medications to treat the fear many chronic patients show of activity or fear of increased pain. Interventional techniques refer to procedures that are performed in an attempt to diagnose and treat chronic pain.

Research

Research has shown that the chance of people with chronic pain becoming addicted to pain-relieving drugs is extremely small. …my research with patients with chronic pain and other chronic illnesses in…enormous success. Targeted government and private funding for research in pediatric chronic pain should be augmented. Current research should soon yield ways of formulating and delivering NMDA receptor-blockers that will ease most chronic pain syndromes without causing such adverse effects. The research evidence is strongest for these patients regarding the risk factors for chronic pain. But for chronic pain, research has shown that they tend to make pain worse, causing the patient to need larger and larger doses. Of the little research done on chronic pain, researchers had previously focused on damaged nerve fibers as pain conduits.

System

With chronic pain, the pain signals keep firing up the nervous system for months, even years, either continually or as flare-ups. Recent animal studies have shown that remodeling within the central nervous system causes the physical pathogenesis of chronic pain. In chronic pain the nervous system may be sending a pain signal even though there is no ongoing tissue damage. Much of the identifiable findings in chronic pain patients will be referable to the peripheral nervous system.

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Juvenile Justice And Detention Management Software – 5 Big Benefits

Tuesday, July 6th, 2010

Juvenile Justice And Detention Management Software – 5 Big Benefits

When children are in the juvenile detention system they need to be monitored closely for a wide variety of reasons. The main focus is for a successful rehabilitation and it is very important to make sure that details are not forgotten, no information slips through the cracks and a proactive approach is taken with each aspect of the behavior correction and healing processes.

Is There a Correlation Between Good Software and Improved Outcomes?

There is a direct correlation on how a good information management platform for juvenile justice and detention agencies helps the clients and children that agencies and centers serve. Specifically, for detention centers that serve youth and children – a solid case management platform helps caseworkers take control of all of the information that is coming in daily, make real-time sense of it and enable them to make the right decisions that help the children get back on their feet.

Here are five benefits that both case workers and children in the juvenile detention system receive when a solid, web-based information tracking platform is integrated.

A good juvenile detention information platform can track an extensive variety of services that are available to juveniles. These services include support for emotional and physical demands, such as:

Track a wide range of services that support the juvenile’s physical, emotional, and social development.

Track therapeutic interventions designed to address offense specific needs for juveniles committed for longer periods of time.

Progress reporting and court updates can be generated in a timely fashion.

Casenotes can be entered at any time during the youth’s stay.

They also help connect children with the groups that can help them adjust socially with a new perspective.

When data on the children can be monitored in real-time it is easy to make notes on their achievements and setbacks. On a simple level – this type of information is important for making the proper adjustments and giving the proper rewards for the correct behaviors. At a higher level – aggregate information helps identify new trends as they occur and improves decision making at the caseworker and agency director levels. Juvenile detention management software helps track those notes and make them available for case workers and other pertinent people to review. In addition bed checks can be confirmed through bar-coding scanning devices. Speed, convenience, accuracy – can determine the overall effectiveness of the program.

It is easy to communicate with the court systems quickly and efficiently. The information is electronic; the information can be shared securely and does not fall through cracks as in a paper-based process. Probation officers, court managers and judges all have the ability to connect via a laptop or “smart phone” as needed – and it’s very convenient. P.O.’s can pull up client information while they’re waiting for their case to be heard in court. Judges could have direct access to a child’s record right from the bench. The result is that the children in juvenile detention are having their needs and considerations attended to efficiently. In actual application, this provides the ability for juvenile detention management staff to focus less on paperwork and administration and more on the needs of the children.

Juvenile detention management software can track and monitor the interventions and needs of juveniles that are going to be in the system for a long period of time. This provides an invaluable tool for evaluation and determining needs of children’s whose lives are being significantly altered due to past problems. When they leave the juvenile detention system it is going to be a very different world than it was when they entered. It is the job of juvenile detention management workers to ensure that these children are equipped with the proper life skills to rejoin society.

The right software makes it easy for juvenile detention facilities to create reports that help in monitoring, tracking, budget building, and showing results. Facilitiescan report on the following programs and services (at a minimum): intake, medical and health care, orientation, education, recreation, visitation, census reports, progress reports, counseling and treatment provided, supervision, bed checks / barcode scanning, food service/USDA reporting, daily shift logs, incident reports.

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