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K - Ameliorate Neuropathic Pain

Ideal Practice and Flow Diagram A systematic approach is important to diagnose and treat NeP. Figure 2.0 below illustrates a typical algorithm for this approach. First, a physician or other clinician, experienced in pain assessment and diagnosis, must assess the person. Once it is established that pain is present, it is important to differentiate whether the origin is nociceptive/ musculoskeletal or neuropathic, or both. This will help to guide investigation and treatment choices. Assessment includes ruling reversible causes for pain in or out (e.g., missed fractures, post-traumatic syringomyelia, peripheral nerve damage). Once NeP is identified, the treating team needs to negotiate goals with the individual, and select the measures used to appropriately assess response to treatment. There are a number of well-validated tools for baseline and follow-up assessment of pain and function. Treatment will generally be multimodal, and involve a combination of pharmacologic and non-pharmacologic options. Individual education is critical to treatment success, and surgical options are generally reserved for refractory cases. Figure 2.0 typical algorithm for A systematic aproach to diagnose and treat NeP. Physician assessment and diagnosis MSK vs NeP Tools: DN4, LANNS Rule out reversible causes of pain Nonpharmacologic treatments Team and patient set goals of pain management and outcome measures (e.g. decrease pain, increase function) Tools: BPI, VAS, Steep Scales, Pain Dairy Phamacologic treatments Patient education Tools: SCI-U, NeP patient guide • Acupuncture • TENS • Nerve stimulation • Biofeedback • Desensitization • Transcranial magnetic stimulation • CBT • Relaxation techniques • Biofeedback • Psychological support • Group pain program First Line meds • Pregabalin • Gabapentin Refractory treatments • Other medications • Specialty pain clinics • Invasive and surgival therapies 110 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


K - Ameliorate Neuropathic Pain
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