Pain Management Guidelines

Introduction to Pain Management

• The British Journal of Sports Medicine and the World Journal of Emergency Surgery recommend a multimodal approach to pain management, including self-management education, exercise therapy, and medication, with the goal of reducing opioid requirements 1, 2
• The Annals of the Rheumatic Diseases and the Annals of Oncology suggest the use of interventional procedures, such as intra-articular corticosteroid injections and celiac plexus block, for specific conditions 3, 4

Medication Management

• The World Journal of Emergency Surgery and the British Journal of Sports Medicine recommend the use of acetaminophen and NSAIDs at the lowest effective dose for the shortest duration, as well as short-term opioids only when necessary, with careful consideration of risks and benefits 1, 2

Interventional Procedures

• The Annals of Oncology and the Annals of the Rheumatic Diseases recommend interventional procedures, such as celiac plexus block and intra-articular corticosteroid injections, for specific conditions, including joint pain and pancreatic cancer pain 3, 4

General Recommendations

• Established clinical guidelines, including those from the American Heart Association, the American College of Physicians, the Annals of the Rheumatic Diseases, the World Journal of Emergency Surgery, the British Journal of Sports Medicine, and the Annals of Oncology, consistently recommend evidence-based approaches to pain management, including education, exercise, medication, and interventional procedures 5, 6, 7, 1, 2, 3, 4
• The following interventions are recommended for pain management:
• Overhead pulley exercises should be avoided as they can worsen shoulder pain, while corticosteroid injections can provide superior short-term pain reduction compared to standard care, particularly when guided by imaging to verify joint pathology 5, 6
• Acupuncture may be a safe and effective adjuvant for hemiplegic shoulder pain, though evidence is limited 6
• Electrical stimulation, shoulder strapping/positioning devices, staff education, and avoidance of overhead pulleys are recommended for prevention of shoulder pain, as suggested by the American Heart Association 5, 6