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445- Pain and Mental Health > Chronic Pain > Flashcards

Chronic Pain Flashcards

1
Q

Chronic noncancer pain: ______________________ condition that can have a significant impact on physical ability, emotional wellbeing, and QoL

A

heterogeneous physical and psychological

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2
Q

chronic noncancer pain may persist beyond ______, relate to chronic _______ disease or persistent ____ condition, and emerge/ persist ______ an identifiable cause

A

persists beyond normal healing time, relates to chronic degenerative disease or persistent neurologic condition, emerges and persists without an identifiable cause

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3
Q

T or F: dysfunctional pain has known structural nervous system lesions or acute peripheral inflammation

A

F- neither but still has spontaneous and stimulus dependent pain

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4
Q

who is chronic pain more likely to affect

A

older, women, indigenous, veterans, drug users

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5
Q

chronic pain RFs

A

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

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6
Q

complications from chronic pain

A

deconditioning
hormonal SEs
neuropsychiatric sx

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7
Q

causes of chronic lower back pain

A

mechanical
nonmechanical spinal conditions- cancer, ifnections, inflammatory arthritis
visceral disease (nonspinal with referred pain)

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8
Q

T or F :majority of the time there is no identifiable cause of lower back pain

A

T

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9
Q

red flags for LBP

A

recent trauma
fever- infection/ cancer
sudden bilateral leg weakness, numbness, bladder dysfxn

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10
Q

4 Ps of pain management

A

prevention
psychological
physical
pharmaceutical

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11
Q

nonpharm tx for chronic pain

A

Activity, relaxation techniques, communication skills, modification of negative self talk or catastrophizing, education, sleep hygiene, stress management, CBT, physiotherapy, tai chi, music therapy

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12
Q

what are some secondary amine TCAs

A

nortriptyline and desipramine

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13
Q

which generation TCAs are better tolerated? why?

A

second gen- nortriptyline and desipramine due to less anticholinergic AEs

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14
Q

what are some tertiary amine TCAs

A

amitriptyline and imipramine

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15
Q

for TCAs, dose should be increased q____, adequate trial is _____

A

q1-2wks
2-4wks

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16
Q

TCA evidence for LBP and neuropathic pain

A

no evidence for LBP - unless neuropathic element
30% decrease in neuropathic pain

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17
Q

which TCA is tolerated better? amitriptyline or nortriptyline?

A

nortriptyline

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18
Q

which SNRI has NE activity at low doses?

A

duloxetine

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19
Q

which SNRI has only 5HT activity at low doses, but NE too at higher doses

A

venlafaxine

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20
Q

for SNRIs, allow ___ at each dose for tolerability, adequate trial ____wks at target dose

A

1 wk
2-4

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21
Q

SNRI evidence for LBP and neuropathic pain

A

duloxetine reduces LBP by 30-50%
some evidence for neuropathic pain

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22
Q

T or F: venlafaxine has more evidence for LBP and neuro pain than duloxetine

A

F

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23
Q

SNRI AEs

A

GI, nausea, dry mouth
Dizziness
Sleep disruption
Serotonergic PDyn
PK

24
Q

venlafaxine and duloxetine are both ____ substrates and inhibitors

A

CYP 2D6

25
Q

venlafaxine is a ____ substrate

A

3A4

26
Q

duloxetine is a ____ substrate

A

1A2

27
Q

minimum gabapentin effective dose

A

900mg/d

28
Q

gabapentinoids evidence in pain and disability in chronic LBP

A

may not improve pain, can actually increase chance of opioid related death

29
Q

gabapentinoids
Titrate ____as tolerated until at eff dose
Allow ____ to assess benefit and tolerability
Adequate trial ____ on adequate dose

A

q3-7d
1-2 wks
3-4wks

30
Q

gabapentinoid AEs

A

Dizziness
Somnolence
Weight gain (pregabalin >gabapentin)
euphoria/ abuse (gabapentin >pregabalin)
↑HF (dose dep peripheral edema)

31
Q

which has more weight gain? pregabalin or gabapentin

A

pregabalin

32
Q

which has more abuse potential? pregabalin or gabapentin?

A

gabapentin

33
Q

what is important to check for before starting gabapentinoids

A

renal function

34
Q

how often should you increase topiramate dose

A

qwk

35
Q

topiramate evidence on LBP

A

may improve in short term- very limited evidence

36
Q

topiramate AEs

A

Drowsiness, dizziness, fatigue
Ataxia, tremor
Paresthesia
Difficulty word finding
↓concentration
Other nonCNS AEs

37
Q

naproxen antiinflammatory dose

A

500mg BID

38
Q

ibuprofen antiinflam dose

A

600mg po TID

39
Q

what is recommended as first line for chronic LBP

A

NSAIDs

40
Q

how long should acetaminophen be used to assess for efficacy

A

4wks

41
Q

for acetaminophen, consider _____ if LT
_____ in EtOH abuse/ cirrhosis

A

≤3.25g/d
≤2.6g/d

42
Q

T or F: acetaminophen is effective for chronic LBP

A

F- not effective but can still try as part of multimodal strategy

43
Q

T or F: acetaminophen is generally not recommended for neuropathic pain

A

T

44
Q

T or F: opioids are first line for chronic pain

A

F

45
Q

how should you trial opioids?

A

screen + discuss R/B and goals
increases must be after min 2 days but pref 2wks
adequate trial = 3-6mths

46
Q

3 strong opioids

A

morphine, hydromorphone, oxycodone

47
Q

tramadol MOA

A

mu opioid agonsit + inhibitor of 5HT and NE reuptake

48
Q

trial period for tramadol

A

4wks

49
Q

tramadol AEs

A

increase in seizure risk, hypoglycemia risk
serotonin syndrome
QTc prolongation

50
Q

buprenorphine MOA

A

partial mu agonist, k receptor antagonist

51
Q

T or F: buprenorphine has a lowered risk for repiratory depression

A

T

52
Q

fentanyl should not be used in those that

A

have acute pain or are opioid naive

53
Q

25mcg/hr patch of fentanyl = ____ MEDD

A

60-134

54
Q

fentanyl is a substrate for

A

3A4

55
Q

why should one not use a heat pad with a fentanyl patch for pain

A

causes faster release = increased risk of overdose

56
Q

5As for opioid monitoring

A

analgesia
activities
AEs
aberrant drug behaviors
accurate documentation

445- Pain and Mental Health (21 decks)

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