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1
Q

Strong psychological component of pain. Treamtent:

A

Pain medicine with anti anxiety

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2
Q

Why is Pain Management Important?

A

Common complaint - leads to frequent access to US healthcare system
Chronic pain affects more Americans than diabetes,cancer, heart disease, combined
Inadequate Management an numerous patient safety concerns - esp special populations
Untreated pain –> adverse sequelae

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3
Q

Groups with undertreated pain

A

Femail and minorities
Prevelant with African Americans and sickle cells

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4
Q

Pain Management Challenges

A

Failure to distinguish pain from anxiety
Lack of education with providers - nonpharmacologic
*inadequate discharge pain plans - return of admission
Physiologically unstable patient - least likely to receive standardized pain assessment
Stereotypes
Analgesia Shortage

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5
Q

Ketamine Subdissociate dose for pain

A

0.2-0.3 mg/kg

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6
Q

Pain is multidimensional T/F?

A

True - can be related to genetics, age gender socioeconomic culture, religion, etc

A patient’s response to prescribed pain treatment can be influenced by factors unrelated to actual pharmacological treatments.

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7
Q

Factors that affect patient perceptions

A

Perceived…
Effective communication
Responsiveness of team
Perceived empathy by treatment team

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8
Q

Females also are believed to ____ their pain more frequently and effectively than males.

A

express
Per Dr.C - men are more insensitive about their pain

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9
Q

Those with strong cultural and religious ties tend to have stronger support mechanisms for dealing with their pain.
T or F

A

T

Consider the impact of age, gender and ethnicity on pain assessment and management but beware of labeling or stereotyping - treat the individual patient!

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10
Q

Depression and pain often co-exist (____% of pain patients also report depression).

A

30 to 60 percent

Previous pain experiences can alter activity within certain brain regions responsible for pain processing resulting in persistent pain.
Additionally, mood disorders and other psychiatric disorders have been linked to the development of chronic pain

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11
Q

living in rural areas and who are of lower socioeconomic status tend to report higher levels of chronic pain, pain related disability, and depression.

T or F

A

T

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12
Q

What is pain catastrophizing?

A

an exaggerated cognitive response to an anticipated or actual pain stimulus and affects how individuals experience or express pain

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13
Q

Pain catastrophizing share similarities with what?

A

depression and anxiety

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14
Q

Different Types of Catastrophizing

A

Magnification: response that symptoms that can be or are greater than expected
Rumination: when an individual focuses repeatedly on attributes of an event that evoke a negative emotional response.Helplessness: the belief that there is nothing that anyone can do to improve a bad situation.

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15
Q

Intervention for Magnification
Ex: “I’m afraid that something serious might happen”

A

Intervention: Versed and Precedex

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16
Q

Intervention for Rumination
Ex: “I can’t stop thinking about how much it hurts“

A

Distraction

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17
Q

Intervention for Helplessness Ex: “There is nothing I can do to reduce the intensity of my pain”.

A

Gentle Truth

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18
Q

ultra-rapid metabolizers

A

of certain drugs such as codeine. This means they convert codeine to morphine more rapidly than other patients, resulting in potential supra-therapeutic dosing.
Hints: Review Home Meds: Long med list, previous anesthetics record
Increased analgesic requirements

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19
Q

“slow metabolizers” and do not efficiently metabolize codeine, and thus never achieve therapeutic levels.

A

Hints: Long PACU stay, sleepy for a couple days after anesthesia, previous anesthetics record
Decreased analgesic requirements

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20
Q

nearly 90% of certain ____(and_____) groups are fast acetylators.

A

Asians
Native Americans

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21
Q

Temporal nature refers to _____.

A

duration of pain

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22
Q

Nociceptive Pain is

A

result of direct tissue injury from a noxious stimulus.
can be somatic or visceral
ei bone fractures new surgical incision, acute burn injury

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23
Q

Inflammatory pain

A

result of release of inflammatory mediators that control nociceptive input and are released at sites of tissue inflammation.
appendicitis, rheumatoid arthritis, inflammatory bowel disease, and late stage burn healing.

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24
Q

Neuropathic Pain

A

leading to an alteration in sensory transmission.
can be central or peripheral in nature.
*Chronic
Examples include diabetic peripheral neuropathic pain, postherpetic neuralgia, chemotherapy induced pain, and radiculopathy.

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25
Somatic Pain
known as musculoskeletal pain, is pain that occurs from injury to skin, muscle, bone, joint, connective tissue and deep tissues. Typically pain is well-localized, sharp and worse with movement. Skin superficial Laceration, fractures, pelvic pain Rx: LOCAL anesthetic
26
Visceral Pain
internal pain and typically occurs from internal organs or tissues that support them. Pain is usually poorly localized and described as vague deep aches, colicky, and/or cramping.clude appendicitis, peptic ulcer disease, diverticulitis, endometriosis, and ureteral stones. RX: Opioids, po or IV constipation - add bowel regimen
27
Difference between acute or chronic pain
Acute pain is defined as lasting less than 3 months and is a neurophysiological response to noxious injury that should resolve with normal healing. Chronic pain is defined as lasting more than 3 months or beyond the expected course of an acute disease or after complete tissue healing. Chronic pain extends beyond the time of normal wound healing with the development of multiple neurophysiological changes in the central nervous system.
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Numeric Score
28
What is acute on chronic pain?
refers to times of acute exacerbations of a chronic painful syndrome or new acute pain in a person suffering from a chronic condition. Examples include a sickle cell exacerbation
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Functionality
1. How is pain affecting the current level of function? 2. Is the patient working? 3. How is a patient coping with pain?
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Caution in _____ + opioids w extended release bec resp depression
sleep apnea Additionally Benzos/Gabapentin - can cause oversedation
32
Fentanyl will have a ___ UDS
negative because syntehtic opioid
33
OPQRST Stands for?
O - onset P - Provocation and palliation of symptoms Q- quality R- Region and radiation S- Severity T- Timining
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Provocation and Palliation Questions
is it better or worse with.. activity, position, adjuvant - types of medications or alterbatuve treatment that makes it better
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Socrates
Site Onset Character Radiation Associations Time course Exacerbating/Relieving factors Severity
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QISS TAPED
Quality Impact Site Severity Temporal Aggravating and alleviating Past response and preferences Expectations and goals Diagnostics and physical exam
37
Who can assist with pain history?
PCP
38
Physical Assessment with Pain
Note the patient’s vital signs as they can provide a clue to pain severity An elevation in blood pressure and heart rate can occur secondary to pain and inadequate control of pain. However, normal vital signs should not negate a patient’s reported pain. Always review vital signs.
39
Perform a focused assessment with Pain
40
Patients will often assume a position of comfort. Induce them then move them over , give pre-movement analgesic
Ketamine > Fentanyl
41
Pain for Different Populations
Adults- numeric Defense and Veterans Pain Rating Scale 2.0, Pediatrics - faces Elderly- Non-verbal chronic and cancer-related pain may require more complex evaluation tools. only stick to ONE, do not use two
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Toradol
Renal function alters platelet --> increased bleeding ceiling effect 15 mg
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49
Intranasal Medications Which drugs?
Intranasal Ketamine and Precedex Use concentrated solution Fast because highly vascular in face with increased absorption, and some of drug may be inhaled which is also very vascular surface area
50
Ketamine pharmacology
Blockade of N-methyl D-aspartate (NMDA) receptors, peripheral Na+ channels and μ-opioid receptors providing sedation, (retro/antegrade) amnesia, and analgesia. -highly lipid soluble
51
Ketamine Dosing
Low dose- sub-disacciotive 0.1-0.3 mg/kg Mod dose- procedural sedation 0.5-1.0 mg/kg High dose - excited delirium 1mg/kg
52
Ketamine? Worry about and give?
Give them a drying agent: benadryl, glycopyrrolate
53
Think of nonpharmacologic management as your “base coat” or “primer” before applying additional coats of analgesic treatment. With the right base coat foundation, you have a better chance of painting a patient’s symptoms a more tolerable and long-lasting new color.
54
One of the most common mistakes made in pain management is ...
failure of reassessment after an intervention Pain level should be reassessed after an intervention, such as medication administration, and once the intervention has had time to exert its effect.
55
PO and IV assessment
consider reassessing pain level 30 minutes after IV and 60 minutes after PO administration of a medication.
56
Consequences of unrelieved acute pain
Psychological Impacts The psychological impact of untreated pain can include post-traumatic stress disorder, anxiety, catastrophizing, and depression. Chronic pain syndromes Chronic pain syndromes can develop as a consequence of untreated acute pain mechanisms including spinal cord hyper-excitability. Mortality and Morbidity Increased mortality and morbidity can result from unrelieved acute pain. This can occur through increased oxygen demand, increased metabolic rate, cardiovascular and pulmonary complications, and impaired immune function.
57
Most pain happens in the_____ post op, may complain of pain month after
first 12-24 hours
58
Patients often take ___ weeks to experience pain reduction after an acute injury!
4-6
59
PDMPs (prescription drug monitoring programs) and opioid legislation.
have to attest you have reviewed drug monitoring log before Rxing an opioid
60
You notice the patient to be playful and interactive, but not using his right arm. Although the child is attempting his normal behaviors (such as playing), he is doing so through _____. This is confirmed via his caregiver stating that he has been favoring his left arm.
compensation
61
It is important to recognize that patients who have taken the same prescription opioids for significant period of time may need an increase in dose T/F
T
62
Chronic pain is a potential outcome __________
of untreated acute pain.
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