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Betty Miller is a 77-year-old female who has had right shoulder pain for 4 weeks. Through the case study, you will follow Betty through a visit to her primary care provider and pharmacist; a home health services for nursing, social services and physical therapy; and a primary care provider follow-up visit.
Catherine is a 46-year-old woman with Chronic Low Back Pain (CLBP), obesity, poorly controlled diabetes with peripheral neuropathy, and ankle pain on high dose opioids for past 4 years.
Charlie is a 17-year-old Caucasian male, accompanied by mother Sarah. He is about to undergo surgical extraction of maxillary third molars. . This case centers on the appropriate prescribing of opioids for post operative dental pain. It describes the role of the pharmacist in identifying suspected opioid misuse, abuse and diversion. Finally the case presents an example of opioid misuse and diversion and the consequences of such misuse.
This module follows Courtney, a now 19-year-old woman who underwent surgery to correct idiopathic scoliosis at 14. It discusses the appropriate approach to the management of pain with adolescents undergoing surgery for idiopathic scoliosis.
Mrs. Rose is an 89-year-old, widowed white female who has resided in a nursing home for the past 3 months. Admission was precipitated by inability to function independently, related to Dementia Alzheimer’s –type (DAT) and to widespread arthritic pain. Her mobility is severely limited.
‘Devon’s Disparate Dealings: Sickle Cell Disease and Pain’ presents the case of a 15-year-old black male with sickle cell disease who presents to the emergency department in severe pain.
Diana is a 19 year-old woman with pelvic pain and jaw pain since adolescence. She is seeing her provider for advice on how to manage her pain as it seems to be getting worse and is limiting the things she likes to do like dance and eat her favorite foods.
Donald Williams is a a 77-year-old veteran with osteoarthritis and an old football injury to his right knee. He has just undergone a right knee total arthroplasty 5 days ago.
Edna is a 70-year-old woman with chronic low back pain. After completing the course, you should be able to differentiate the weak link and the treatment targets in older adults with chronic low back pain, articulate realistic treatment expectations for chronic non-cancer pain, and describe a rational stepped care treatment approach for older patients with chronic low back pain.
Harold is an adult male with pain from trauma experienced in a car accident. This case covers assessing the aspects of the pain experience in a trauma patient with substance use disorder by integrating the health history into the treatment decision-making process, examining multimodal approaches to treat acute trauma across transitions of care, recognizing the biopsychosocial impact of the treatment of acute pain in patients with substance use disorder, and designing an appropriate treatment plan using case-based learning to address acute trauma related pain in patient with substance use disorder.
CA is a 48-year-old female patient who is status post left total knee replacement arthroplasty under a general anesthetic. Patient controlled analgesia was initiated in the post-anesthesia care unit. After transfer to the regular ward, the patient complains of worsening acute post-surgical pain coupled with chronic pain from inflammatory degenerative joint disease.
Joe is a graduate student with increasing headache frequency for the past 2-3 month. They occur daily and disrupt his coursework and studying. Some are severe with nausea and light sensitivity, while others are mild. In addition to his headaches, Joe experiences neck pain and muscle tension.
Margaret Andersen is an 85-year-old woman with limited communication who demonstrates changes in behavior two weeks after entering a nursing care facility.
Mary is a 74 year old woman with a history of breast cancer metastatic to the ribs, hypertension, and osteoarthritis. She complains of newly developed right-sided hip pain.
Melanie is a 15-year-old girl with jaw clicking with and without pain, and frequent headaches over the last three months. This course illustrates the foundational underpinnings of pain, pain assessment and pain management strategies using a longitudinal case of acute to persistent/chronic orofacial pain with mixed nociceptive and neuropathic phenotypes.
Recognizing medication overuse headache in patients presenting with chronic migraine. In this case study, we present a 39-year-old woman who has been experiencing near daily headache for the last 4 months and her successful treatment.
Mildred is 83 years old and suffers from chronic, constant knee pain that prevents her from doing things around the house. She recently moved next door to her son so he can provide the extra help she needs with grocery shopping, cooking, and doing heavier housework. An x-ray of her knee displays moderate to severe knee osteoarthritis.
This is a case of a fourteen year old girl with worsening headaches. The case covers four months, beginning with entries into her video diary ("vlog" or "video blog"). She explores several approaches to headache management in a series of encounters with health professionals.
Mr. Clark is an 80 year old, moderately overweight Caucasian male who awoke two nights ago with severe pain in his left foot. He has tried elevating his foot and has taken ibuprofen, with minimal pain relief. His wife states that he has some problems with his memory. She states that he has not been able to sleep, and asks the urgent care staff to give him something for the pain as well as something to help him sleep.
Mr. Frank is an 80-year-old nursing home resident. Recent years have been marked by progressive cognitive decline attributed to Alzheimer’s disease. Two days prior to admission, the nursing home staff noted decreased oral intake and resistance to care but were able to dose usual medications. This progressed over the subsequent day with Mr. Frank noted to be agitated, resistant to care and uncharacteristically aggressive. Transfer to acute care facility was arranged after Mr. Frank fell from his chair.
Mr. Gateway is a 52-year-old male smoker with a history of substance abuse with recurrent laryngeal cancer who presents with increased throat and neck pain, dysphagia (pain with swallowing), and dehydration.
Follow 52-year-old Mr. Jones, 78-year-old Mrs. Hubbard, 38-year-old Mrs. Miller, and 45-year-old Mr. Nguyen as their care teams navigate opioid management for their acute pain once hospitalized.
This case presentation follows a 43-year-old farmer named Mr. Lane who injured his right arm after it got stuck in a combine. He was then air lifted to a tertiary care center. The case includes Mr. Lane's initial injury, acute pain, and the development of chronic pain and acute on chronic pain.
Mr. Monahan is a retired, community-dwelling, 81 year old Caucasian male who was a carpet installer for 50 years. He has a history of lower back pain, morbid obesity, hypertension, hypothyroid, occipital lobe stroke, bilateral knee arthroplasty, GERD and sleep apnea. You are seeing Mr. Monahan in his home.
Mr. Smith is a 46 year-old male with a history of HIV, hepatitis C cirrhosis, and substance abuse, presenting with bilateral hip pain.
Mr. Wakefield is a young Army veteran with chronic low back pain and depression. His physical exam demonstrates musculoskeletal pain and lumbar facet arthropathy (joint pain in his lower back).
Mrs. Christine Farley has been suffering from temporomandibular joint (jaw) and myofascial (muscular) pain, and you are asked to be part of her inter-professional team to advise on how to best help manage her pain.
Ms. Jackson is a 38-year-old, African American nurse who completed treatment for triple negative breast cancer 5 months ago. She opted for bilateral mastectomy, radiation, and chemotherapy. The patient is frustrated that she still experiences pain, states “it’s ruining my life."
Ms. Mondragon is a thin, 71-year-old, widowed Hispanic Spanish-Speaking woman whose son is serving as interpreter in the emergency department. Ms. M. fell this morning in her kitchen. She presents with upper back pain, groin pain, and left hip pain radiating anteriorly to the knee.
Ms. Rhodes is a 46-year-old woman with CPP: Stage IV endometriosis (cyclic component of pain treated with continuous oral contraceptives), abdominal and pelvic floor muscle pain, vestibulodynia, IBS with constipation, possible IC, anxiety and depression and sexual dysfunction.
Ms. Tatum is a 30 year-old woman with a history of opioid use disorder (heroin and fentanyl) who has been treated for 2 months with buprenorphine/naloxone (Suboxone) in a substance use disorder treatment program. 4 months after she transitioned her medications to her PCP, she was in a Motor Vehicle Accident and sustained multiple left-sided rib fractures as well as a jaw fracture. She has severe pain in the face, neck, and ribs and needs an acute pain management plan.
This foundational course covers terms and concepts of neuropathic pain, anatomical basis for neuropathic pain, clinical applications of aberrant nociceptive processing; general concepts of pharmacological treatment of neuropathic pain, anticonvulsants, anti-depressants and other neuromodulating agents; medical home models, treatment planning in the medical home context, motivating patients to participate in comprehensive care.
In this foundational module, learn more about the global challenge of pain care, applications of opioids globally, features of specific opioids available locally; opioids in context, definitions of tolerance and physical dependence, management of chronic non-cancer pain; safe management definitions: clear lines and gray areas, societal impact of prescription drug abuse, assessment and management of risk in the physician’s office.
Owen Jones is a 46-year-old man who presents for followup of low back pain with intermittent radicular symptoms and numbness which started ~ 2 years ago following a lifting related injury. He describes the pain as, "Sharp, pinching, and sore."
Pam is a 41-year-old woman diagnosed with breast cancer approximately one year ago. Pam underwent treatment including a bilateral mastectomy and subsequent breast reconstruction. Now she is experiencing pain that she feels should be improving.
Peter James is a 49-year-old veteran with phantom limb pain. While in the reserves he was injured by an IED in Afghanistan. His lower left leg was amputated at Walter Reed. He wants to better control his phantom limb pain so he can take on a farm management opportunity.
Sarah suffers whiplash following a car accident. She then goes on to develop widespread pain and associated fatigue. Her pain interferes with work and daily activities.
Sharee is a teenage girl coping with pain crises related to sickle cell disease (SCD). The case provides a history of the disease onset and progression from infancy though high school as seen from her perspective explained by case principals. The case then provides details of a pain crisis episode as she prepares to transition from high school to college.