Chronic pain Flashcards
Meds for neuropathic pain
Pregabalin
Gabapentin
SNRI
Capsaicin
How to mitigate diversion/ abuse when prescribing meds w/ potential for this
limit doses
document reasons
check for double doctoring
Use written treatment contract with realistic consequences
limiting prescribed quantities or carries
when pt breaches contract, manage your own emotions, address impact on staff, apply or judiciously amend contract
Indication for cannabis
Refractory severe neuropathic pain or palliative pain, has tried >3 neuropathic pain meds
CI to cannabis
<25y/o
Fam hx psychosis
Cannabis or SUD
CV/ resp dz
Pregnant
Safety education for cannabis
No driving 6 hrs after smoking, 8hrs after ingestion
Vaporizer preferred
SE: drowsy, memory impairment
Sign drug agreement
Dosing for cannabis
100-400mg of 9% THC daily
What to consider when providing analgesia for acute pain
Dose appropriately based on narcotic naivete and renal function
consider addiction risk
consider metabolic responses (codeine in pregnant/ breastfeeding pts)
Inform pt not to use OTC drugs from same class
Use non-pharmacological treatments to control pain and manage function
Recognise transition to chronic pain
Management of trigeminal neuralgia
Carbamazepine
Gabapentin
Pregabalin
Phenytoin
Lamotrigine
Valproic Acid
Tricyclic Antidepressants
Baclofen
Difference between Trigeminal Neuralgia and Herpes Zoster
Trigeminal Neuralgia and Herpes Zoster are both unilateral presentations; however Trigeminal Neuralgia will usually have a normal physical and sensory examination while Herpes Zoster is usually accompanied by either allodynia, numbness and has an associated rash and/or occular involvement if involving the face.
Indications for marijuana
palliative pain, neuropathic pain, N/V post chemo, spasticity w/ MS
Opioid guidelines for chronic non cancer pain
max new start 50mg MED, taper to 90mg MED if currently higher
When to use opioids?
When TCAs, nabilone, NSAIDs, CBT, exercise, PT, self management
Guidelines for opioids + elderly
Rx should only be for 3d, max 1w. Slow taper
Managing sx of withdrawal: pain
rx w/ neuropathic or NSAIDs
Managing sx of withdrawal syndrome
clonidine if BP >90/50 + pulse >50