Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical 2 (Part B) > 17 - Neuropathic Pain > Flashcards

17 - Neuropathic Pain Flashcards

1
Q

For a 70 year old with painful diabetic neuropathy (PDN), what drugs do you want to avoid?

A
  • drugs that cause orthostatic hypotension or dizziness/unsteady on her feet
  • maybe things that cause sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the DN4 questionnaire

A
  • If score greater than or equal to 4, test is positive
  • 83% sensitivity
  • 90% specificity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 areas to target neuropathic pain?

A
  • spontaneous ectopic activity (peripheral)
  • central sensitization
  • disinhibition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do Gabapentinoids work?

A
  • mostly on the calcium channel

- work on central centization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do TCA’s work?

A
  • NE/5-HT receptor
  • work on disinhibition
  • also working on yellow guys on the spontaneous ectopic activity (sodium channels)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do SNRI’s work?

A
  • NE/5-HT receptor

- prob disinhibition ?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does Tramadol work?

A
  • bit of an SNRI or TCA and works on disinhibition

- also works on opioid receptor so central sensitization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does Lidocaine work?

A

-fits on peripheral part, working with sodium channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the weight of evidence for pain meds by neuropathic pain type (greatest to least evidence)

A
  • Painful Diabetic Neuropathy
  • Post-herpetic neuralgia
  • Mixed neuropathies
  • Peripheral Nerve Injury (ex. post-amputation)
  • Central Pain (ex. post-stroke, MS, SCI)
  • HIV Neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is tramadol an exception to opioids for PDN ?

A

Is it unique?
-MOA weak m-opioid receptor agonist activity & inhibition of NE/5-HT reuptake

Although tramadol has a lower potential for abuse compared with other opioids, given these safety concerns, it is not recommended for use at first or second-line agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pain decrease does not equal increased QOL or functioning.

A

Of 26 studies in neuropathic pain, showing a meaningful decrease in pain, only 11 reported a significant improvement in QOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Notable side effects of TCA’s

A
  • anticholinergic (dry mouth, constipation, sedation)
  • weight gain
  • orthostatic hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cautions with TCA’s

A
  • elderly
  • dementia
  • glaucoma
  • urinary retention
  • cardiac disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Notable side effects with Gabapentin, pregabalin

A
  • dizziness
  • imbalanced
  • sedation
  • peripheral edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cautions with gabapentin, pregabalin

A
  • elderly
  • existing edema
  • fall risk
  • abuse potential
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Notable side effects of SNRI’s

A
  • nausea
  • increase BP
  • dizziness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cautions with SNRI’s

A
  • HTN?

- bipolar disorder (NE can flip bi-polar patients into hypomania)

18
Q

Notable side effects of Tramadol

A
  • nausea
  • constipation
  • sedation
  • dizziness
19
Q

Cautions with tramadol ?

A
  • opioid dependence/addiction risk

- seizure risk

20
Q

What type(s) of pain do we have good non-pharms for? What about bad non-pharms?

A
  • With back pain we have lots of non-pharms that are maybe more effective than meds
  • With neuropathic pain, we don’t have that many
21
Q

Does exercise improve neuropathic pain?

A
  • exercise does not help
  • no evidence that it improves neuropathic pain
  • may be a distraction technique
22
Q

Does exercise help fibromyalgia?

A

yes

23
Q

What are non-pharms for neuropathic pain?

A
  • Behavioral, psychosocial, physical & other therapies (ex. music) are essential for successful long-term management
  • Interdisciplinary intervention may decrease drug requirements
  • Pain reduction and improved function, not pain elimination, is the goal of drug therapy. Those with CNCP must be helped to refocus on positive, incremental gains. Dedicated therapists and/or CNCP programs are helpful
24
Q

look at slide 19

A

ok

25
Q

Describe the fast track approach to neuropathic pain meds

A

increase dose by 50-100% q3d

26
Q

Describe the cautious driver approach

A

increase dose by 50-100% q1w

27
Q

What are some practicalities of dosing neuropathic pain meds?

A

Always start low & go slow - this is a chronic condition:

  • There is no rush
  • Not worth risking harm to the patient
  • Side effects may result in a loss of a viable option in the mind of the patient

*Higher doses have a low likelihood of resulting in greater benefit and are more likely to result in greater harm

28
Q

What PDN drug will help with depression/anxiety ?

A
  • TCA

- SNRI

29
Q

What PDN drug will help with insomnia ?

A
  • Gabapentin, pregabalin ?

- TCA

30
Q

What PDN drug will help with osteoarthritis ?

A
  • duloxetine
  • tramadol ?

*not great studies

31
Q

What PDN drug will help with most other types of neuropathic pain?

A
  • SNRI
  • TCA
  • gabapentin
  • pregabalin
  • tramadol ?
32
Q

Which PDN drug is not covered by Pharmacare?

A

Tramadol

33
Q

What are we monitoring for?

A

Efficacy:

  • Pain level
  • Functioning
    • Mobility
    • Exercise tolerance
    • Sleep
    • Socialization
    • Psychological status

Side Effects

Monitor for SE in a week, efficacy will not show up in a week

34
Q

When are we monitoring?

A

Depends on:

  • Rate of titration desired
  • Self-management abilities of patient
35
Q

see slide 25

A

ok

36
Q

Describe the results of the trial with gabapentin + opioid vs gabapentin

A

NNT = NNH

  • you’re essentially harming the same number of people you’re treating
  • with concerns of long-term opioid use
37
Q

Topical Neuropathic Pain Med:

Describe Lidocaine

A
  • 5% plaster or patch most studied - modest benefit in low quality, short-term trials
  • ointment compounded at some local pharmacies - equally effective ??
  • applied TID - QID

-1st or 2nd line in several guidelines for PHN

Advantage:

  • Onset immediate
  • Minimal systemic absorption
38
Q

Topical Neuropathic Pain Med:

Describe Capsaicin

A
  • 0.075% gel - insufficient data to draw conclusions
  • 8% patch (NNT = 11) not available in Canada
  • just adds more burning, doesn’t really work
39
Q

Topical Neuropathic Pain Med:

Describe Ketamine Alone

A

Case series supporting pain relief vs. placebo

40
Q

Topical Neuropathic Pain Med:

Describe Amitriptyline + Ketamine

A

questionable

41
Q

What are some patient counselling points?

A
  • NNT, % response
  • When is a reliable benefit likely to be seen?
  • Side effects (likelihood of them happening)
  • Approximate costs
42
Q

Avoid creating what type of patients?

A

1) Always wanting more - minimize drug-centricity

2) Stuck, but not knowing how to get free - minimize pharmacological messiness

Clinical 2 (Part B) (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions