Chronic non cancer pain Flashcards
describe acute pain
<2weeks
palys a functional role in bodys defenses and resolves with tissue recovery
describe chronic pain
no function role, doesnt resolve with tissue recoery and can be a primary diagnosis
involves complex cns signaling that can be amplified bystressors
increased excitatory mechanisma dn decreased inhibitory
what is sensitization
increased excitability of nerve cells in dorsal horn of spinal cord (central)
or increased excitability of nociceptor terminal and decreased threshold for actiovation by stimuli (peripheral)
what is allodynia
normally nn painful stimulus percieved as pain
what is hyperalgesia
increased pain intensity in response to the same noxious stimulus
on a scale of 1-10 how much do most agents improve chronic non cancer pain
1
NNT for 50% improvement =5
on a scale of 1-10 how much do most agents improve function
none or .5
6 A’s of opioids hterapy
analgesio activity adverse effects affect accurate records aberrant behaviour/abuse risk
efficacy of opioids in chronic low back pain
not great outcomes
min effect on disability
no placebo RCT to support the effectiveness and safety of long term opioid therapy
short term may be ok
ways to minimize abuse and diversion risk
form from the start
visit doesnt mean arefill
inform patient of exit strategy if goals arent achieved
use dpin or echart
small fills at shorter duration
urine drug screen
use opioid risk assessment tool or opioid contract
what do we do with results from the opiod risk tool
low risk 0-3 safe to give
moderat 4-7 give limited amount
high >8 dont use opioids
evidence for benefit of chronic low back pain for which non drug measures
heat cbt acupuncture physio massage yoga exercise multidisciplinary programs
what to move from passive modalities to
active rehabilitation
what is multimodal care
behaviourl, physical and integrated medical approaches
primary goal of reducing pain related distress, disability, and suffering
describe exercise prescriptions
therapy options such as biking, walking, yoga
dose options in minutes
frequency in # of days per week
does dose escalation reduce pain or increase function
not proven
short term opioid AE
nausea sedation dizziness cognitive impairment eventually goes away
long term opioid AE
constipation tolerance, dependence, abuse dental problems due to dry mouth hypogonadism (erectile dysfunction) may paradoxially induce abnormal pain sensitivity
at what doses of opioids do we start to see serious effects
> 100mg MEQ daily
shouldnt need to get close to these doses in chronic non cancer pain
an adequate therapeutic trial
codiene or tramadol x 2weeks
if no/min improvement then can stop all together or consider a short trial fo a strogn opioid
describe the graded analgesic response
patient expereinces the great benefits at lower doses and plateauing of analgesic response at higher doses
response less likely if min improvement after ____
2-3 dose increases
patients who receive high opioid doses and remain incapacitated by pain should be
considered treatment failures
even if it takes the edge off the pain
why do opioid tapering
eliminate source of abuse
reduce withdrawal mediated pain at higher doses
reduce hyperalgesia
healthier perception of pain experience due to improved mood and energy
how fast should we taper opioids
decrease 10% of original dose every 1-2 weeks
once 1/3 of original dose is reached may slow to taper to half of the previous rate
how often should we see an opioid patient
every1-2 week withsimilar dispensing interval
what should we monitor with opioid tapering
pain
withdrawal symptoms (sweating, diarrhea, agitation)
beenfits - improved mood and energy
