c pain

Question 1

c pain def

Answer 1

has the characteristics of a disease state

disease of our pain sensing mechanisms

chronic pain has no cure,, its chronic

Diet, exercise, sleep, mood, coping strategies are critical many times, more so than medications.

Question 2

pain mx

Answer 2

Multimodal:
Self management
Psychological
Medications: Opioids, NSAIDS & Adjuvants, nerve blockade, interventions
Cognitive Behavioural : distraction, music, biofeedback
Physical: heat/cold massage, TENS

Question 3

sleep hygiene

Answer 3

have a routine, go to bed at same time and wake up same time, tell yourself a story, repetition will help

limit day time naps to 20-30 mins

less water, caffeine, nicotine and stimulants 2 hours before bedtime

steering clear of food that can be disruptive right before sleep. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people.

no exercise 2 hours before but need daily exercise or 4-5 times a week 20 minutes a day

save bedroom only for sleep and sex, if can sleep, get up and do something to promote sleep, yoga, meditation, book

Question 4

how often and how much to wean off opioids

Answer 4

10% every week - month depending on patients ability

Question 5

1st line tca for ch pain

next?

Answer 5

Amitriptatine first line of TCA – 200 for antidepressants, 10mg up for 50mg for sleep

has anticoholingeric effects, if hangover s/s, take earlier like at 7, so sleep through the hangovers/s, can use

cymbalta (SNRI, both are in pain pathway)

Question 6

only SNRI approved for FM

anticonvulsants?

Answer 6

Duloxetine - cymbalta

lyrica

Question 7

Muscle relaxants for?

SE - 3

Answer 7

non-specific low back pain.
Not recommended for chronic use.

QT prolongation &; increased intraocular pressure – cyclobenzaprine
Anticholinergic effects

Question 8

tramadol

Answer 8

Tramacet®, Ralivia®, Tridural®, Zytram XL®
Works on opioid (mu receptors) and has an effect of serotonin and norepinephrine receptors
Effective for neuropathic pain **

Question 9

preferred opioid

preferred opioid in renal patients

Answer 9

morphine

hydromorphone

Question 10

addiction - definition

4 cs

Answer 10

effects brain reward pathways

chronic disease/condition of brain reward, motivation, memory and related circuitry

4 C’s

1. impaired Control over drug use
2. Compulsive use
3. Continued use despite harm
4. Cravings

Question 11

opioid agreement plan 5

Answer 11

Only 1 prescriber for opioids and adjunctives

Only 1 pharmacy to be used for medications

A complete list of all products ( prescribed, OTC, herbal, online etc ) be created/disclosed
medications to be kept in a safe secure spot

Medications will not be shared, sold or given to any one else

Random Urine drug testing will be performed

Question 12

first line for addiction

2nd line

3rd?

how long for tx

Answer 12

1 Suboxone – naloxone/buprenorphine - partial agonist

• higher affinity to opioid receptors, therefore bumps the high off receptor – precipitated withdrawal
• has ceiling effects 6x safer than methadone

2 Methadone - full agonist - others heroin, morphine
No precipitating withdrawal, can use right away, easy to initiate, More SE than suboxone, arrhythmias and QTc prolongation

Full opioid blocker/antagonist

• Naltrexone/narcan
• Oral doesn’t have good retention

tx generally recommended for at least 1 year before tapering off the medication slowly over the course of months.