Chronic Pain Flashcards
is pain a normal part of growing old?
No
is pain more common as you get older
yes
if it is chronic pain how should it be dosed?
by the clock so pain is more steady
are most patients under or over treated for pain?
under
what are manifestations of pain
clenched teeth
grimacing
splinting
posturing
what drug shouldn’t be used due to ataxia, dizziness, increased risk for falls
propoxyphene
what drug shouldn’t be used due to tremor, myoclonus, seizures
meperidine
if you are using COX 2 + aspirin or NSAID what else should they recieve
PPI
Should you begin treating pain with the lowest level on the analgesic ladder then slowly work your way up to opioids?
No, The initial choice of agents is based on the characteristics of the pain, the pain intensity, and the individual patient
0-3 on pain scale is ____ pain
mild
7-10 on pain scale is ____ pain
severe
4-6 on pain scale is ____ pain
moderate
What pain drug should be prescribed with opioid analgesia to ensure a combination with maximum efficacy?
Acetaminophen and NSAID
Non pharm treatment of pain
Physical activity and exercise
Distracting measures
Heat, ice, stretching, massage, US, acupuncture
When do you choose acetaminophen for pain?
mild to moderate pain
MSS (OA, LBP)
What should you use if you are taking NSAIDs for GI protection?
PPI or misoprostol
Side Effects of Opiod
respiratory depression sedation falls constipation N/V delirium
What 2 opiods should you not use for pain?
propoxyphene (increases risk of falls, dizziness, sedation, drowsiness, confusion, constipation)
meperidine (tremors, myoclonus, delirium, seizures)
Stage of OA? Fibrillation and erosion of the cartilage surface develop, with subsequent release of proteoglycan and collagen fragments into the synovial fluid
stage 2
Stage of OA? Proteolytic breakdown of the cartilage matrix occurs
Stage 1
Stage of OA? Breakdown products of cartilage induce a chronic inflammatory response in the synovium, which in turn contributes to further cartilage breakdown
Stage 3
For OA: Stiffness during _____ (gelling) may develop, with morning joint stiffness usually lasting for less than _____
rest; 30 minutes
Does OA have erythema or warmth over affected joints?
Not usually
What joints does OA affect?
DIP, but also PIP and joints at base of thumb
Pain >3 months
Trouble concentrating
Low energy level
Trouble sleeping
chronic pain
2 types of nociceptive pain
somatic
visceral
arising from skin, bone, joint, muscle, CT. It is described as well localize, constant, throbbing, aching, stabbing. Nociceptors are the pain receptors. (ex: arthritis, bone mets, fracture, acute post-op).
Somatic pain
arises from viscera of internal organs (large intestines and the pancreas, renal colic, bowel obs) abnormal processing of sensory input by the peripheral or central nervous system. Poorly localized, diffuse, referred pain, dull, colicky, deep. Associated with N/V, diaphoresis.
Visceral pain
PNS or CNS cause. Burning, tingling, shock-like, shooting, prickling, squeezing, abnormal DTRs, impaired motor function, paresthesias. (cervical or lumbar radiculopathy, postherpetic neuralgia, trigeminal neuralgia, diabetic neuropathy, post-stroke syndrome, herniated intervertebral disc)
Neuropathic Pain
Source of pain is not understood, widespread MSS pain, stiffness, weakness. Myofascial pain syndrome, somatoform pain disorders.
Undetermined Pain
Somatization and hysterical reactions
Psychological
What is the PAINAD?
Pain Assessment In Advanced Dementia
What is the procedure of PAINAD?
Observe 3-5 min with movement (bathing, turning, transferring).
- For each item select the score (0, 1, 2) that reflects the current state of the behavior.
- Add the scores. Total scores range from 0 to 10 (0= “no pain” to 10= “severe pain”).
Always compare the score to a previous score. An increased score suggests pain is increased, while a lower score suggests pain is decreased.
What are the 5 types of scoring for PAINAD?
Breathing Negative vocalization Facial expression Body language Consolability
What are treatments for neuropathic pain?
antidepressants, anticonvulsants, opioids, topical anesthetics
What are treatments for undetermined pain?
antidepressants, anti-anxiety, psychological therapy.
Risk Factors of OA
Age- strongest risk factor F>M Obesity Lack of osteoporosis Occupation Previous injury Muscle weakness Genetic elements (COL2A1 mutation)
What is hallmark of OA?
cartilage degeneration
OA stiffness in affected joints for ___ minutes
<30; gelling phenomenon (resolves with motion, recurs with rest)
What are the 2 types of nodes of OA?
Bouchard's nodes (PIP) Heberden nodes (DIP)
What is the clinical choice to diagnose OA?
Xray
1st drug to try for OA
Acetaminophen
