Chronic Pain Flashcards
Chronic noncancer pain: ______________________ condition that can have a significant impact on physical ability, emotional wellbeing, and QoL
heterogeneous physical and psychological
chronic noncancer pain may persist beyond ______, relate to chronic _______ disease or persistent ____ condition, and emerge/ persist ______ an identifiable cause
persists beyond normal healing time, relates to chronic degenerative disease or persistent neurologic condition, emerges and persists without an identifiable cause
T or F: dysfunctional pain has known structural nervous system lesions or acute peripheral inflammation
F- neither but still has spontaneous and stimulus dependent pain
who is chronic pain more likely to affect
older, women, indigenous, veterans, drug users
chronic pain RFs
psychological vulnerability (catastrophizing), anxiety/ depression, female, younger age (adults), genetic predisposition, inefficient diffuse noxious inhibitory control (DNIC), descending pathway of pain inhibition, nerve damage due to injury or surgery (neuropathic), hx of poor acute pain management, hx of poor response to analgesics
complications from chronic pain
deconditioning
hormonal SEs
neuropsychiatric sx
causes of chronic lower back pain
mechanical
nonmechanical spinal conditions- cancer, ifnections, inflammatory arthritis
visceral disease (nonspinal with referred pain)
T or F :majority of the time there is no identifiable cause of lower back pain
T
red flags for LBP
recent trauma
fever- infection/ cancer
sudden bilateral leg weakness, numbness, bladder dysfxn
4 Ps of pain management
prevention
psychological
physical
pharmaceutical
nonpharm tx for chronic pain
Activity, relaxation techniques, communication skills, modification of negative self talk or catastrophizing, education, sleep hygiene, stress management, CBT, physiotherapy, tai chi, music therapy
what are some secondary amine TCAs
nortriptyline and desipramine
which generation TCAs are better tolerated? why?
second gen- nortriptyline and desipramine due to less anticholinergic AEs
what are some tertiary amine TCAs
amitriptyline and imipramine
for TCAs, dose should be increased q____, adequate trial is _____
q1-2wks
2-4wks
TCA evidence for LBP and neuropathic pain
no evidence for LBP - unless neuropathic element
30% decrease in neuropathic pain
which TCA is tolerated better? amitriptyline or nortriptyline?
nortriptyline
which SNRI has NE activity at low doses?
duloxetine
which SNRI has only 5HT activity at low doses, but NE too at higher doses
venlafaxine
for SNRIs, allow ___ at each dose for tolerability, adequate trial ____wks at target dose
1 wk
2-4
SNRI evidence for LBP and neuropathic pain
duloxetine reduces LBP by 30-50%
some evidence for neuropathic pain
T or F: venlafaxine has more evidence for LBP and neuro pain than duloxetine
F
SNRI AEs
GI, nausea, dry mouth
Dizziness
Sleep disruption
Serotonergic PDyn
PK
venlafaxine and duloxetine are both ____ substrates and inhibitors
CYP 2D6
