5b: Pain Management

Question 1

4 requirements of NSAIDs

Answer 1

1. decrease inflammation
2. relieve mild to moderate pain
3. reduce fever
4. decrease risk of blood clotting

Question 2

mechanism of NSAIDs

Answer 2

they work by inhibiting the COX enzyme, which is an enzyme that produces prostaglandins

Question 3

when does production of prostaglandins increase?

Answer 3

when a cell has undergone trauma

Question 4

are aspirin and acetaminophen NSAIDs?

Answer 4

aspirin – yes
acetaminophen – no

Question 5

roles of prostaglandins

Answer 5

inflammation, increasing sensitivity of pain receptors, and promoting fever

Question 6

which COX enzyme should be inhibited for best clinical results?

Answer 6

COX-2

Question 7

What is the primary and oldest NSAID?

Answer 7

aspirin

Question 8

uses for aspirin

Answer 8

to manage MSK and joint pain, post surgery pain, prevent clots, treat fever, prevent chance of developing cancer

Question 9

side effects of NSAIDs

Answer 9

GI hemorrhage or ulceration, increased BP, liver or kidney dysfunction, Reye syndrome

Question 10

why should aspirin not be taken after a fracture?

Answer 10

it can inhibit bone healing

Question 11

COX-2 selective drugs compared to non-selective COX inhibitors

Answer 11

(Celebrex) less gastric irritation but more upper respiratory tract infections / associated with heart attack and increased CVA risk

Question 12

rehab implications for NSAIDs

Answer 12

stomach discomfort is a concern, and patients may ask about different types of pain medications

Question 13

two goals of drug treatment for RA

Answer 13

decrease joint inflammation and decrease/stop progression of the disease

Question 14

three categories of drugs to treat RA

Answer 14

NSAIDs, glucocorticoids, and DMARDs

Question 15

difference between NSAIDs and glucocorticoids in treating RA

Answer 15

NSAIDs have fewer side effects but glucocorticoids reduce inflammation to a greater extent

Question 16

why is acetaminophen not recommended for RA?

Answer 16

it does not affect the inflammation aspect of RA

Question 17

why take glucocorticoids and DMARDs together for RA?

Answer 17

DMARDs take a few weeks to take effect, so glucocorticoids can help control pain and inflammation until then (or may be combined throughout entire disease process)

Question 18

side effects of glucocorticoids

Answer 18

osteoporosis, muscle wasting and weakness, HTN, aggravation of diabetes, glaucoma, cataracts, increased risk of infection

Question 19

types of DMARDs

Answer 19

antimalarials, gold compounds, nonbiological, biological, tumor necrosis factor inhibitors

Question 20

reason for combining DMARDs

Answer 20

optimal benefits with 2 or more drugs, lower dose of each, and may provide best results

Question 21

nutrients in the diet that can benefit RA

Answer 21

fish oil, omega-3 fatty acids, and antioxidants (fruits and vegetables)

Question 22

nutrient in the diet that can harm RA

Answer 22

meat/protein

Question 23

is pharmacology the focus of treatment for OA?

Answer 23

No – should focus on nonpharmalogical treatment (PT, weight loss, joint replacements), NOT joint inflammation

Question 24

rehab implications of RA drugs

Answer 24

glucocorticoids: watch for damage to bone, tendon, muscle, skin breakdown

DMARDs: infection control