Chronic Pain Flashcards
definition and prevalence of pain
- Definition – pain lasting > 3 months
- Prevalence: 100M patients, 20% of office visits, 12% of prescriptions, $100B
tolerance
patient needs an increasing dose of medication to achieve the same/desired effect
Dependence
an adaptive state with a withdrawal syndrome upon cessation of drug; requires tolerance
Addiction
uncontrolled, compulsive engagement in rewarding stimuli despite adverse consequences
Pseudo-addiction
drug-seeking behavior reminiscent of addiction, but tend to have genuine pain that has been under-treated. Unlike true addiction, behaviors tend to stop when pain is adequately treated
Abuse
the use of substances in a manner outside sociocultural conventions (not as prescribed)
labs for pain
- Blood
- Imaging
- Neuro
- Psych
treatment categories of pain
- Pharmacology
- Physical Medicine
- Behavioral Medicine
- Neuromodulation
- Interventional
- Surgical
- Current modalities average about 30% pain reduction – important to set appropriate expectations
Neuropathic pain
accurate diagnosis, relieve nerve compression or medication effects.
Rx for neuropathic pain
consider antidepressants and Ca++ channel agents (Gabapentin and pregabalin). Also consider carbamazapine, esp for trigeminal neuralgia.
Nociceptive pain
pain: Pain not from direct trauma on nerves but carried through peripheral nocicpetors.
Rx for Nociceptive pain
Acetaminophen, NSAIDs, Tramadol, opioids, antidepressants
*”Muscle relaxants” MOA – CNS Depression
Opioid misuse and monitoring
- Establish clear boundaries and “rules”
- Pain contracts
- Regular visits
- Pill counts
- Urine drug testing
- Prescription monitoring programs (CURES)
- Five A’s: analgesia, ADL, addiction, ADE, adherence
- Testing for DOA – know what test you’re using
- CURES/PDMP
CURES
Controlled substance Utilization Review and Evaluation System (CURES) is a database containing information on Schedule II through IV controlled substances dispensed in California. It is a valuable investigative, preventive, and educational tool for the healthcare community, regulatory boards, and law enforcement.
The California Prescription Drug Monitoring Program (PDMP) maintains the CURES database. The PDMP allows authorized users, including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards, to access patient controlled substance history information maintained in CURES. The PDMP is committed to assisting in the reduction of pharmaceutical drug diversion without affecting legitimate medical practice or patient care.
Through online access to CURES, authorized prescribers and pharmacists can quickly review information via Patient Activity Reports (PAR) in an effort to identify and deter drug abuse and diversion through accurate and rapid tracking of Schedule II through IV controlled substances.
CURES stores Schedule II, III, and IV controlled substance prescription information reported as dispensed in California. CURES contains the following information: patient name, patient date of birth, patient address, prescriber name, prescriber DEA number, pharmacy name, pharmacy license number, date prescription was dispensed, prescription number, drug name, drug quantity and strength, and number of refills remaining.
adjuvant modalities
- Physical Medicine
- Behavioral Medicine
- Neuromodulation
- Interventional
- Surgical
