Canine V: Comprehensive Pain Management for the Rehab Patient
A minimum of one elective is required for all participants.
Prerequisites
Participant must:
- Participant must be a veterinarian, veterinary technician, physical therapist, physical therapist assistant, occupational therapist or an actively enrolled student in on of these fields.
Course Description:
"Pain is inevitable, suffering is optional. It is the therapist's job
to relieve the suffering from pain as well as re-building function and
strength in the physiotherapy patient. Attempting physiotherapy without
breaking a patient's pain cycle sets the patient and the therapist up
for failure."
"This two-day course will review the fundamentals of pain physiology and
the traditional categories of pain, as well as introducing newer
vocabulary for describing and understanding pain. The importance of a
multi-modal approach to pain will be explored and emphasized.
Participants will learn how to 'build' a pain management pyramid - - and
how to disassemble it once the patient is comfortable."
Seminar Outline
Day 1:8:00 - 8:30am - Registration
8:30am - 9:00am - Introductions & Overview of Pain Management Module
9:00am - 10:00am - Overview of Pain #1
Who we are and what we do
Pain myths and misconceptions
Pain physiology overview
Traditional categories/definitions of pain
Nociception
Acute to chronic / Adaptive to maladaptive
Why is pain important?
Why is treating pain important?
Why is treating pain early important?
10:00am - 11:00am - Overview of Pain #2
Introduction to the concept of multi-modal therapy
Introduction to the concept of targeted therapy
What areas of the nervous system can we influence and how do we get there?
AAHA/AAFP Pain Management Guidelines for Dogs and Cats
Pain assessment instruments overview
VAS
CSU pain scales - acute & chronic
Pain assessment/scoring - - KISS (RD)
11:00am - 12:00pm - Pharmacology Plus - Acute Pain
Principles of pre-emptive perioperative pain management
Pre-op, induction, and post-op options
Benefits of multi-modal perioperative analgesia
Preventing "windup"
Options to supplement systemic medications
Nerve blocks
Epidurals
"CRI's for Dummies"
The role of physical medicine, modalities, and nursing care in perioperative pain
12:00pm - 1:00pm - Lunch
1:00pm - 3:00pm - Pharmacology - Chronic/Maladaptive Pain #1
Importance of a complete diagnosis
Laying the foundation for long-term care
Creating a plan and managing client expectations
Tools in the pharmacologic toolbox:
NSAIDs
Gabapentin
Amantadine
TCA's & pain
Tramadol
PSGAGs
3:00pm - 5:00pm - The Multimodal Model in Chronic Pain Management
Taking a "whole-istic" approach
Breaking the maladaptive pain cycle
Weight loss/management
Nutritional support tailored to the patient
Omega-3 FA's (specifically EPA)
Leveraging rehabilitation techniques
Therapeutic exercise
Assisted
Controlled
Balance work
Strength-building
Day 2:
8:00am - 9:00am - Overview of Physical Medicine Modalities & Pain
Thermal therapy - heat and cold
Low-level LASER therapy
Therapeutic ultrasound
TENS
NMES
Extra-corporeal shock wave therapy
Hydrotherapy
Whirlpool
Swimming
UWT
9:00am - 10:00am - Physical Medicine Techniques & Pain
Acupuncture
Medical massage
Tissue manipulation - trigger point therapy
Joint mobilizations
Tissue mobilizations
Stretching
10:00am - 11:00am - Homework - Engaging the Pet Owner
Why is owner participation important?
Keeping a daily diary for the pain patient
Managing multiple meds, etc.
Teaching the client techniques to perform at home
Ice/heat therapy
Massage/Tui Na
PROM/AAROM
Therapeutic exercise
Stretching
11:00am - 12:00pm - Miscellaneous Special Cases
Cancer pain
Bisphosphanates
Opioids
Hospice/end-of-life patients
Adipose-derived regenerative cell therapy
Q & A
12:00pm - 1:00pm - Lunch
1:00pm - 2:00pm - Building the Pain Management Pyramid - Acute/Post-op Pain
Step by step approach to perioperative pain
What to do first, second, third, etc.
Creating a comprehensive plan from pre-op to discharge from the hospital
Pain assessment and reassessment
Disassembling the pain management pyramid/plan - after the procedure is over and the patient goes home
Home care
Representative cases/examples
2:00pm - 3:00pm - Building the Pain Management Pyramid - Chronic/Maladaptive Pain
Step by step approach to the chronic pain patient
What to do first, second, third, etc.
Creating a comprehensive pain plan - every patient is different!
Pain assessment and reassessment
Intervals for pain reassessments and metabolic updates with chronic use medications
When to introduce "full-bore" physiotherapy
Disassembling the pain management pyramid
Removing medications/modalities
Home care
Representative cases/examples
3:00pm - 4:00pm - Git 'er Done - Maximizing Compliance for the PT Pain Patient
Overview of the compliance study results (2003 & 2009)
What clients want
Obstacles to appropriate compliance
Practical steps for delivering what the pain patient needs and deserves
4:00pm - 5:00pm - Putting it All Together for the Pain Patient
Interactive case scenarios (examples only)
Young dog orthopedic surgery - - ACL, elbow incongruity
Middle-age, older dog orthopedic surgery - - THR, FHO
Acute IVDD w/ surgery
Chronic OA - - hips, stifles, facets, spondylosis
Chronic IVDD - - mobile, paresis, paralysis
Learning Objectives:
- Understand the complex nature of pain as disease
- Be able to articulate key differences between nociceptive & inflammatory pain versus maladaptive & dysfunctional pain
- Recognize the diverse techniques and modalities that may be applied to the painful patient
- Understand the application of multi-modal pain management strategies to acute and chronic/maladaptive pain patients
- Recognize essential elements of a comprehensive approach to pain management and how to coordinate among professionals to help the patient
- Understand the importance of assisting clients/pet owners in their efforts to remain compliant with therapist recommendations
- Be able to assemble, adapt/modify, and then disassemble pain management plans for various types of pain patients
