Ch 6- Pain Case Studies

A man, age 60 years, was recently diagnosed with trigeminal neuralgia. He presents in the clinician's office and claims his pain is "off the charts" and he "can't take it anymore." He said he read somewhere that trigeminal neuralgia is considered the "suicide disease." In this an example in which a patient is catastrophizing his condition? Why or why not? What can be done to help this individual?

This patient has real pain but is catastrophizing his condition since certain medications can help reduce the pain. It is a nerve disorder that causes a stabbing or electric shock like pain in parts of the face. Medications such as anticonvulsants, muscle relaxers, and TCAs can help reduce the pain rate of the attacks. Botulinum toxin A injections provide pain relief. Surgery can also be used to relieve the pressure on the nerve.

A woman comes to you upset because her other clinician recommended an antidepressant. The woman suffers from spinal nerve radiculopathy, and the clinician stated that some antidepressants help with pain management. The woman is coming to you because she feels the other clinician just wants to put her on antidepressants because he "prescribes them for everyone." What would you tell her?

Antidepressants are considered to be adjuvant medications which can be used along with analgesics to enhance their effects in people with nerve pain.

An injured athlete continues to exercise at a high intensity, causing further injury to his foot. The athlete claims he needs to work out for the "endorphin high." How would you explain the purpose of endorphins to the athlete? What suggestions could you give this athlete?

Endorphins are the body's natural pain relievers. They act on the opiate receptors in the brain, reducing pain and boosting pleasure. Exercise is not the only activity that produces an "endorphin high". Endorphins are also released when laughing, eating dark chocolate, hanging out with friends, creating music, or getting a massage

A woman, age 62 years, comes to the clinic wondering if she should get the "shingles vaccine." A friend recommended it, but the woman wonders if it is worth it or not. She asks you, "How bad can shingles be? Should I really get the vaccine?"

It is important to get the vaccine because shingles develop in older adults resulting in a linear rash along a nerve dermatome that causes excruciating pain. The rash will eventually subside but the pain stays persistent known as the post- herpetic neuralgia. Postherpetic neuralgia is difficult to treat, fewer than 50% of sufferers attain pain relief. To avoid shingles it is important to get vaccinated.

A woman, age 45 years, was diagnosed with fibromyalgia 7 years ago. Despite various treatment strategies, she claims her pain is worsening over time and she feels she cannot get out of bed, go to work, or have a "normal life." After assessing her responses over time, you begin to wonder if the patient has begun to catastrophize her pain. How would you handle this situation?

Patients should be screened for anxiety or depression related to their pain symptoms. Patients who catastrophize their pain may benefit from the use of pharmacological agents combined with non-pharmacological therapies. A recommendation for cognitive behavioral therapy would be useful for the patient to recognize and change their negative thoughts and behaviors.

An elderly gentleman has advanced metastatic cancer. Although he feels he was "strong" through the initial cancer diagnosis and treatments, he states he is suffering severe bone pain to the point that he cannot function at all. How can this level of pain be managed?

Severe pain is treated with the use of strong Opioids, in conjunction with physiotherapy and occupational therapy