Pain
Chronic Pain Flare Management
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Chronic Pain Flare Management
, Chronic Pain Flare
See Also
Chronic Pain
Chronic Pain Management
Chronic Pain Management with Physical Therapy
Definition
Chronic Pain Flare
Flares are same pain type and same location with an increase in intensity
Protocol
Rule out serious new or progressive underlying condition
Flares are an increase in the same pain type at the same location
Recognize obvious triggers (e.g. overuse, stress, acute medical illness)
Tolerance to medication therapy occurs early in course
After first few months of pain management baseline dose should be stable
Evaluate new pain or red flags (e.g. neurologic deficit, fever or other systemic symptoms)
Help the patient manage the flare and cope with the crisis
Reassure patient that flares are increase in same pain and not a new serious condition
Manage contributing factors
Specific exacerbating factors (e.g. cough exacerbating thoracic pain)
Manage comorbid
Insomnia
,
Anxiety Disorder
, and
Major Depression
Eliminate barriers to flare improvement
Chemical Dependency
needs to be treated
Develop coping skills and reduce stressors
Reset reasonable expectations for pain management
Flares have clearly defined endpoints and limited duration (days to a couple of weeks)
Pain management returns to baseline after flare
Flare management is the patient's responsibility and they need to develop a toolkit
Medication dose increase protocol
See below
Patient establishes management strategy for next pain flare
See management below
Patient is in control of their flare management (maximize the toolkit - see below)
Active self management is critical
Practicing techniques with each flare is important to longterm management
Mnemonic: BUMS
Behavioral (e.g. breathing techniques, relaxation, pacing activity)
Unloading (e.g. Chiropracter,
Splinting
and
Assistive Device
s)
Movement (e.g. Tai Chi, Pool
Exercise
s)
Stimulation (e.g. Heat therapy or
Ice Therapy
,
TENS
unit, Massage, Acupressure)
Management
Relaxation Technique
s
Breathing techniques
Imagine body as hollow
Imagine breathing-in fills a hollow body and breathing-out empties the hollow body
Muscle
Relaxation Technique
s (e.g.
Shoulder
shrugs, head circles,
Shoulder
rolls)
See
Progressive Relaxation in Hypnosis
(can be adapted for general relaxation)
Music therapy
Management
Local pain management
See
Chronic Pain Management with Physical Therapy
(also covers energy conservation)
Local Cold Therapy
Local Heat Therapy
Contrast Bath
s
TENS
Unit
Acupressure
Ball Therapy
Management
Pharmacologic Therapy
See
Acute Pain Control
No more than 30 doses per month
Additional
Opioid
to <2 week duration
Maximize non-
Opioid
medications that are specific for flare type
Muscle
relaxants
Antiinflammatory medications (e.g.
NSAID
s)
Neuropathic pain agents (e.g.
Gabapentin
)
Consider
Antidepressant
s and possibly a short course of
Anxiolytic
References
Belgrade (2009) UMN Internal Medicine Review, Minneapolis
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