Page 14 - CASA Bulletin 2019 Vol 6 No 4

CASA Bulletin of Anesthesiology

and eliminate need of opioid. In addition, it may be more cost-effective in a long run.

While in physical therapy, patients often are given instruction on home exercise program.
Anyone can benefit from engaging in regular exercise. Groups of women with Fibromyalgia had
reported decreased pain, fatigue and disease severity when they involved themselves in bouts’
of physical activity for no less than 10 minutes, 5 days a week.

Per our experience, opioids are not effective on chronic pain. Patients may have been
on opioids for long time, but their function level and physical activities have hardly been
improved, and could even get worse. As a matter of fact, patients may experience various

symptoms beyond the commonly known side effects such as constipation and sedation. They
may suffer fatigue, muscle waste, and decreased sexual drive due to long term use of opioids.
There may be a link between hypogonadism, hypocortisolism and chronic opioid use. Once
pain becomes “chronic”, the best management should take the comprehensive biopsychosocial
approach. Again, opioid should be avoided. Alternative treatment includes other medications
such as NSAID, antidepressants, anti-seizure medications, steroid, forms of local application,
electronic and mechanic devices, limited use of braces, all should be sought.

In addition to physical therapy, Yoga, Taichi, and Acupuncture can be therapeutic. They

have been proven to be effective to treat pain and improve physical mobility and function.
Chiropractic care and massage can be utilized in some cases. Deep massage with tension release
maneuver can be extremely effective treating muscle pain with trigger points.

When question of musculoskeletal type of pain vs. neuropathic pain is in place, or when
there is clinic indication that neurological condition maybe the etiology resulting in the pain,
electromyographic (electromyograph and nerve conduction EMG/NCS) study can be done to
help with diagnosis and assist with subsequent treatment. Consultations to the other specialties
such as neurology, pharmacy, radiology, neurosurgeon can be very helpful. Psychology
counseling for chronic pain and cognitive behavior therapy should be considered for patients
with significant psycho-social stressors. Interventional “pain procedure” may be able to offer

effective pain control. For spine-related back pain, neurosurgeon evaluation for spine surgery
may be necessary in some cases, such as when patient has a large disc herniation not responding
to medical treatment, severe spinal stenosis causing pain unrelieved by conservative measures,
spine instability evidenced on X-rays, and when spinal cord involvement is suspected.

Patients scheduled for elective surgeries should be offered physical therapy to work on their
balance, flexibility, range-of-motion, endurance, strength, gait, posture, safety awareness, etc.
to promote overall fitness. We know pre-operative health status has direct impact on how well
and fast the patient will recover, which will in turn determine the need of pain medication and

further medical management.

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