The majority preferred physiotherapy and no surgery was the third most popular choice. Their preferences and choices evolved from previous experience. They did not perceive their pain as severe enough to require surgery. (Mitchell & Hurley). A revised regimen for Sid consists of 10 parts. These are a record of his general medical history for a total and comprehensive picture; the use of the four assessment tools mentioned earlier in this paper; his complete and updated pain history; instruction on chronic pain, opioids and opiate therapy; information about non-pharmacological treatment options for chronic pain; continuation of interrupted physiotherapy treatment sessions; conduct of training on self-management and pain control; warning about the risks of smoking; counseling on depression; matching preferences with evidence-based guidelines recommended for chronic pain; and hiring caregivers for himself and his wife.

General Medical History

This may reveal prior conditions, which may have led to chronic pain and thus underlies or contributes to it. It also provides a total picture on which to base a comprehensive approach to treatment.

Pain Assessment Tools - These include the Brief Pain Inventory, the McGill Pain Questionnaire and the Short-form McGill Pain Questionnaire, the Massachusetts General Hospital Pain Center's Pain Assessment form, and Neuropathic Screening Tools, as discussed in an earlier part of this paper.

Pain History - This should identify the location of the pain, its intensity, description,, the temporal aspects and possible patho-physiological and etiological features of the pain. Other information includes what relieves or aggravates it, its effects on daily physical and social functions, pain treatments and their positive or negative effects, feelings of depression, worry over pain condition and overall health and possible involvement in litigation or compensation process (Brevik et al., 2008).

Information Intervention - Chronic osteoarthritic pain is a nociceptive musculo-skeletal pain with a more predictable than neuropathic pain (Benedict, 2008). It is often treated with non-steroidal anti-inflammatory drugs or NSAIDs until healing occurs and the pain disappears. Most healthcare providers prescribe opiates for this pain. The 10 universal precautions on pain medicine and the Share-the-Risk Model address the controversies concerning the mis-use and abuse of opioids.

Non-Pharmacological Treatment Options - These are physiotherapy or physical therapy, hydrotherapy, homeopathic remedies, Chronic Behavior Therapy or CBT, transcutaneous electrical nerve stimulation or TENS, alternative medicine, self-management...

Homeopathic remedies include herbs. CBT includes biofeedback and relaxation strategies. Alternative medicine includes acupuncture, acupressure, reflexology and magnetic healing. Self-management of pain includes exercise, wearing appropriate and comfortable footwear, and weight control. Psychological interventions process one's perception of pain and change behavior towards it through relapse prevention techniques (Kroner-Herwig, 2009)These techniques have been reported to achieve long-term positive results (Kroner-Herwig).
Adherence to Evidence-Based Guidelines - Chronic pain patient treatment preferences have been found to mis-match these guidelines because of lack of resources and time pressure (Mitchell & Hurley, 2008). These recommend verbal and written information, self-management, physiotherapy and simple analgesics as first-line approach. These may be supplemented by opioids and NSAIDs if needed as second-line therapy. Surgery is resorted to only when these conservative treatments fail (Mitchell & Hurley).

Sid will resume physiotherapy sessions with a new schedule and program. He will be warned about the risks of smoking on his and his wife's overall health. They will receive counseling on depression. Caregivers and a live-out housekeeper will be assigned to help him in the care of his wife and of the house chores. #

BIBLIOGRAPHY

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