Acute Pain

Question 1

Neuropathic pain

Answer 1

Pain caused by lesion/dysfunction of nervous system
- pathological changes in pain pathway
-usually occurs after injury
Inflammatory: cancer, regional pain syndrome, herpes
Noninflammatory: postherpetic neuralgia, stump pain, trigeminal neuralgia

Question 2

Pain assessment

Answer 2

Description: throbbing, dull, achy, crushing, shooting
Timing: started, duration, onset, exacerbating/alleviating, frequency, accompanying signs
Localization

Question 3

Pain measurement

Answer 3

Numerical scale (0=no, 10=worst imaginable)
Faces scale (kids

Question 4

Acute pain

Answer 4

Occurs as direct result from tissue damage,

Question 5

Physiological effects of pain

Answer 5

CV: HTN, tachycardia, dysrhythmias, MI
Pulmonary: atelectasis, V/Q mismatch, pneumonia
Endocrine: protein catabolism, hyperglycemia, fluid retention
Immune: impaired functioning
Coag: hypercoagulstion, platelet aggregation
GI: ileus
GU: urinary retention

Question 6

Acute pain treatment

Answer 6

Opioids & nonopioids

Question 7

Opioid rotation

Answer 7

Using different opioids interchangeably
Organ damage can decrease dose needed to achieve pain control
Essential to use lower than equianalgesic dose
Oral/parenteral doses are different
Itching? -> naloxone and Benadryl

Question 8

Codeine/acetaminophen

Answer 8

Tylenol #2 (15/300)
Tylenol #3 (30/300)
Tylenol #5 (60/300)

Question 9

Hydrocodone/acetaminophen

Answer 9

Norco (5, 7, 10/325)

Vicodin (5/500, 7.5/750)

Question 10

Oxycodone/acetaminophen

Answer 10

Percocet (2.5-10/325-650)

OxyContin (no Tylenol 5-30)

Question 11

Opioid side effects

Answer 11

N/V
Allergic reaction
Respiratory depression
Pruritis 
Delirium
Constipation
Sedation

Question 12

PO administration of analgesia

Answer 12

Not optimal for immediate post op pain

Opioids commonly combined with cox inhibitors

Question 13

SC/IM administration for analgesia

Answer 13

Less desirable (pain and erratic absorption)
Cyclical periods of sedation -> analgesia

Question 14

IV administration of analgesia

Answer 14

Requires close respiratory monitoring

Common in pacu, ICU, units

Question 15

Patient controlled analgesia (PCA)

Answer 15

Allows patient to self-administer opioids with push of button
- set dose and time period between doses

Question 16

Normal pain mechanism

Answer 16

Periphery: nociceptors -> brain
Nociceptors present in skin,muscles, and joints
- stimulated by mechanical, chemical, or thermal stimuli
- bradykinins, cytokines, PG sensitive nociceptors to pain
Somatic pain: musculoskeletal (dermatomes)
Visceral pain: organs (bladder, bowel, ovaries)