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CHRONIC PAIN MANAGEMENT Flashcards

1
Q

CUTE PAIN TRANSFORMATION
* ACUTE PAIN CAN BECOME CHRONIC IF IT LASTS
MORE THAN — OR THE TIME IT
WOULD TAKE CONNECTIVE TISSUE TO HEAL

A

3 TO 6 MONTHS

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2
Q

TEMPOROMANDIBULAR DISORDERS
(3)

A
  • MANY ARE MILD AND SELF-LIMITING
  • CHRONIC TMD PAIN SYNDROMES LAST AT MORE THAN 6 MONTHS
  • DEPRESSIVE SYMPTOMS AND CHRONIC MUSCULOSKELETAL PAIN
    HAVE A DIRECT CORRELATION
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3
Q

TMD MANAGEMENT
(6)

A
  • MEDICATIONS
  • SPLINT THERAPY
  • PHYSICAL THERAPY
  • ACCUPUNCTURE
  • PSYCHOTHERAPY
  • SURGERY
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4
Q

CHRONIC OVERLAPPING PAIN CONDITIONS (COPCS)
COMMON CO-EXISTING PAIN CONDITIONS:
(4)

A
  1. TMD
  2. FIBROMYALGIA
  3. HEADACHES (MIGRAINES, TENSION-TYPE, AND TAC’S)
  4. IRRITABLE BOWEL SYNDROME (IBS)
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5
Q

CAUSE HEAD & FACIAL PAIN:

A
  • MIGRAINE HEADACHE
    · TENSION HEADACHE
  • TAC’S
    · TEMPORAL ARTERITIS
    · EAR INFECTION
    · SINUS INFECTION OR TUMORS
    · TOOTH INFECTION
    · JAW JOINT SPRAIN
    · NEURALGIA
    · JAW JOINT DISK DISPLACEMENT *
    *MAY NOT BE PAINFUL
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6
Q

CAN CAUSE MALOCCLUSION:

A
  • ORAL CANCER
    · JAW JOINT TUMORS (I.E.
    OSTEOCHONDROMA)
    · DENTAL MALOCCLUSION ESPECIALLY
    SECONDARY TO OSTEOARTHRITIS OR
    RHEUMATOID ARTHRITIS
  • FACIAL MUSCLE SPASM
    JAW FRACTURE
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7
Q

ACETAMINOPHEN

A
  • PARACETAMOL (GENERIC IN SOME FOREIGN COUNTRIES)
  • APAP (ACETYL-PARA-AMINOPHENOL)
  • NO ANTI-INFLAMMATORY EFFECTS
  • MINIMAL INCREASED RISK OF BLEEDING
  • OVERDOSE: HEPATOTOXICITY
  • MAX DAILY DOSE: 4000 MG PER DAY IN DIVIDED DOSES EXCEPT
  • 3000 MG PER DAY IN DIVIDED DOSES FOR CHRONIC PAIN
    13
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8
Q

CETAMINOPHEN DOSAGE FORMS
* CAPLET, TABLET
(1)
* ELIXIR
(2)
* INJECTABLE (IV)
(1)
* SUPPOSITORY
(1)

A
  • 325MG, 500MG, 650MG EXTENDED RELEASE
  • 160MG/5ML
  • 500MG/5ML
  • 10MG/ML
  • 120MG, 325MG, 650MG
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9
Q

COMBINATION WITH OPIOIDS
* HYDROCODONE-ACETAMINOPHEN
(2)

A
  • NORCO 5MG, 7.5MG, 10MG/325MG
  • VICODIN 5MG, 7.5MG, 10MG/300MG
  • WATCH FOR CONCURRENT MEDICATIONS CONTAINING ACETAMINOPHEN ESPECIALLY OTC
    PRODUCTS.
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10
Q

COMBINATION WITH OPIOIDS
* OXYCODONE WITH ACETAMINOPHEN
(2)

A
  • ENDOCET, ROXICET
  • 5MG, 7.5MG, 10MG/ 325MG
  • PERCOCET
  • 5MG, 7.5MG, 10MG/ 325MG
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11
Q

COMBINATION WITH CODEINE
* TYLENOL WITH CODEINE NO.2
(1)
* TYLENOL WITH CODEINE NO.3
(1)
* TYLENOL WITH CODEINE NO.4
(1)

A
  • 300MG/15MG
  • 300MG/30MG
  • 300MG/60MG
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12
Q

COMBINATION WITH TRAMADOL
* ULTRACET
(2)

A
  • ACETAMINOPHEN/ TRAMADOL
  • 320MG/37.5MG
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13
Q

ADVANTAGES OF LONG-ACTING OPIOIDS
(5)

A
  • MORE CONSISTENT ANALGESIA
  • FEWER ADVERSE EFFECTS
  • MORE TOLERANCE TO ADVERSE EFFECTS
  • BETTER SLEEP ➔ BETTER DAYTIME FUNCTION
  • LESS EUPHORIA, ADDICTION, DIVERSION
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14
Q

OTC PRODUCTS CONTAINING ACETAMINOPHEN
* EXCEDRIN EXTRA STRENGTH, EXCEDRIN MIGRAINE
(2)

A
  • ACETAMINOPHEN/ ASPIRIN/ CAFFEINE
  • 250MG/ 250MG/ 65MG
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15
Q

OTC PRODUCTS CONTAINING ACETAMINOPHEN
* COMTREX
(2)

A
  • ACETAMINOPHEN/ DEXTROMETHORPHAN/ PHENYLEPHRINE
  • 325MG/ 10MG/ 5MG
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16
Q

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS)

A
  • ASPIRIN
  • IBUPROFEN
  • NAPROXEN
  • PIROXICAM
  • MELOXICAM
  • INDOMETHACIN
  • DICLOFENAC
  • KETOROLAC
  • CELECOXIB
  • ETODOLAC
  • NABUMETONE
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17
Q

NSAIDS
(3)

A
  1. ANTI-INFLAMMATORY EFFECTS
  2. ANALGESIC EFFECTS
  3. ANTIPYRETIC EFFECTS
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18
Q

NSAIDS
* AT LOW DOSE
(2)
* AT HIGHER DOSES
(1)

A
  • ANTIPYRETIC EFFECTS
  • ANALGESIC EFFECTS
  • MORE ANTI-INFLAMMATORY EFFECTS BESIDES MENTIONED EFFECTs
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19
Q

NSAIDS
* IBUPROFEN (MOTRIN®, ADVIL®)
(5)

A
  • OTC 200MG
  • RX 400MG, 600MG, 800MG
  • MAX DOSE: 3200 MG PER DAY IN DIVIDED DOSES
  • TOXICITY: GI ULCER
  • TO REACH ANTI-INFLAMMATORY EFFECTS MUST USE 1800MG-3200MG/DAY IN DIVIDED DOSES
20
Q

COMBINATION WITH OPIOIDS
* OXYCODONE/ IBUPROFEN
(2)

A
  • 5MG/ 400MG
  • MAXIMUM OF 4 TABLETS/DAY IN DIVIDED DOSES
21
Q

COMBINATION WITH OPIOIDS
* HYDROCODONE/ IBUPROFEN
(2)

A
  • 2.5MG, 5MG, 7.5MG, 10MG/ 200MG
  • MAXIMUM OF 5 TABLETS /DAY IN DIVIDED DOSES
22
Q

NSAIDS
* NAPROXEN (ALEVE® 220MG OTC)
(3)

A
  • MAX DAILY DOSE: 1500 MG PER DAY IN DIVIDED DOSES
  • TOXICITY: GI ULCER
  • COMBINATION WITH PPI ESOMEPRAZOLE TO MINIMIZE THE GI DAMAGE (BRAND NAME VIMOVO®)
23
Q

TOPICAL ANALGESICS: LESS LIKELY THAN SYSTEMIC
ANALGESICS TO PRODUCE SIDE EFFECTS & CAN TREAT A
VARIETY OF PAINFUL DISORDERS
 USED FOR MUSCLE OR TMJ PAIN
 (I.E. ARTHRITIS)
 NSAIDS: COMPOUNDED
(4)
 USED FOR MUSCULOSKELETAL PAINS
 NSAID WITH MUSCLE RELAXANTS
(3)

A

 10% OR 20% INDOMETHACIN
 10% OR 20% IBUPROFEN
 10%, 15% OR 20% KETOPROFEN
 3%, 5%, OR 10% DICLOFENAC

 1% FLEXERIL WITH10% KETOPROFEN/10% IBUPROFEN
 1% DICLOFENAC SODIUM GEL(VOLTAREN) RX OR OTCThis Photo by Unknown Author is licensed under CC BY-SA

24
Q

NSAIDS
* CELECOXIB (CELEBREX®)
(3)

A
  • SELECTIVE COX 2 INHIBITOR
  • 100MG OR 200 MG TWICE DAILY
  • AVOID IF PATIENT HAS SULFA ALLERGY
25
ACETAMINOPHEN, NSAIDS * THESE ANALGESICS HAVE --- EFFECT * HAS A LIMIT IN RELIEVING THE PAIN (2) * MORE TOXICITY * NO --- HAPPEN WITH THESE ANALGESICS * TAKE NSAIDS WITH FOOD TO LOWER -- ADRs
CEILING * ABOVE THE LIMIT * NO MORE ANALGESIC EFFECT TOLERANCE OR DEPENDENCE GI ADRS
26
ORAL OPIOIDS MU RECEPTOR AGONISTS (6)
* HYDROMORPHONE 7.5MG * OXYCODONE 20MG * MORPHINE 30MG * HYDROCODONE 30 MG * CODEINE 200MG * MEPERIDINE 300MG
27
CURES (2)
* CURES (CONTROLLED SUBSTANCE UTILIZATION REVIEW AND EVALUATION SYSTEM) IS A DATABASE OF CONTROLLED PRESCRIPTIONS DISPENSED IN CALIFORNIA * CURES IS COMMITTED TO THE REDUCTION OF PRESCRIPTION DRUG ABUSE AND DIVERSION WITHOUT AFFECTING LEGITIMATE MEDICAL PRACTICE OR PATIENT CARE
28
OPIOIDS * NO --- EFFECT * --- * USE DISORDER AND DEPENDENCE * --- SUBSTANCES
CEILING * NO LIMITATION IN RELIEVING THE PAIN WHEN ESCALADE THE DOSE TOLERANCE * NEED FOR DOSE INCREASE CONTROLLED
29
OPIOIDS ADRS (7)
* RESPIRATORY DEPRESSION * NAUSEA/ VOMITING * SEDATION * DIZZINESS * CONFUSION * PRURITUS * CONSTIPATION
30
TRAMADOL (4)
* BINDS TO CNS OPIOID RECEPTORS AND INTERRUPTS WITH NOCICEPTIVE TRANSMISSION * INHIBITS THE REUPTAKE OF SEROTONIN AND NOREPINEPHRINE * DOSE TITRATION IS NEEDED * ABRUPT D/C IS NOT RECOMMENDED
31
NEUROPATHIC PAIN PERIPHERAL DAMAGE (3)
* DIABETIC NEUROPATHY * POST-HERPETIC NEUROPATHY * IMMUNOSUPPRESSANT THERAPY FOR CANCER TREATMENT
32
NEUROPATHIC PAIN CENTRAL DAMAGE (5)
* POST- STROKE * SPINAL OR OTHER CNS DAMAGE - TRAUMA - MALIGNANCY - MULTIPLE SCLEROSIS- CAN LEAD TO TRIGEMINAL NEURALGIA
33
ANTIDEPRESSANTS * INITIATION OF ANALGESIC EFFECTS IS --- DURATION THAN TIME NEEDED FOR ANTIDEPRESSANT EFFECTS: * --- DOSES EFFECTIVE FOR ANALGESIC EFFECTS THAN DOSES FOR ANTIDEPRESSANT EFFECTS
SHORTER 3-10 DAYS VS 2-4 WEEKS LOWER
34
TRICYCLIC ANTIDEPRESSANTS (TCA’S) * MOA (5)
* INHIBITION OF NOCICEPTIVE PATHWAY * INHIBITION OF NOREPINEPHRINE AND SEROTONIN REUPTAKE * INCREASE THE SYNAPTIC CONCENTRATIONS OF 5HT3 & NE * POTENTIATE THE ANALGESIC EFFECTS OF OPIOIDS * SODIUM CHANNEL BLOCKING EFFECTS (LIKE LOCAL ANESTHETICS)
35
TCAS ADVERSE DRUG REACTIONS * ANTICHOLINERGIC EFFECTS (4)
* URINARY RETENTION * CONSTIPATION * DRY MOUTH (XEROSTOMIA) * ORTHOSTATIC HYPOTENSION
36
OTHER COMMON ADVERSE DRUG REACTIONS (ADRS) (4)
* ORTHOSTATIC HYPOTENSION * COGNITIVE DYSFUNCTION * SEDATION * WEIGHT GAIN
37
TRICYCLIC ANTIDEPRESSANTS (TCAS) (5)
* DESIPRAMINE * NORTRIPTYLINE * AMITRIPTYLINE * DOXEPIN * IMIPRAMINE 45
38
SELECTIVE SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) (5)
* INHIBIT SEROTONIN AND NOREPINEPHRINE REUPTAKE * LOWER DOSES NEEDED FOR NP THAN DOSES IN DEPRESSION TREATMENT * DULOXETINE (CYMBALTA) * VENLAFAXINE (EFFEXOR) * DESVENLAFAXINE (PRESTIQ)
39
SNRIS ADRS (3)
* XEROSTOMIA * NEW ONSET OR WORSENING OF BRUXISM, (MORE COMMON WITH SSRIS: PAROXETINE: ANTIDEPRESSANTS) * INCREASE IN BLOOD PRESSURE
40
ANTICONVULSANTS (4)
* GABAPENTIN (NEURONTIN) * PREGABALIN (LYRICA) * CARBAMAZAPINE * OXCARBAZEPINE
41
ANTICONVULSANTS ADRS (7)
* PERIPHERAL EDEMA * ATAXIA * DIZZINESS * SOMNOLENCE * FATIGUE * INCREASE APPETITE, WEIGHT GAIN * BLURRED VISION
42
NTICONVULSANTS (ADVERSE EFFECTS) (5)
* RASH * N/V * XEROSTOMIA * SIADH - HYPONATREMIA
43
MUSCLE RELAXANTS (3)
* MUSCLE RELAXANTS FREQUENTLY ARE USED AS ADJUNCTIVE MEDICATION IN THE TREATMENT OF ACUTE LOW BACK PAIN. THEIR USE IN CHRONIC PAIN IS MORE LIMITED * ALL MUSCLE RELAXANTS CAN CAUSE DIZZINESS AND SEDATION * DIFFERENT AGENTS HAVE DIFFERENT MECHANISM OF ACTION
44
MUSCLE RELAXANTS (9)
* CYCLOBENZAPRINE * CARISOPRODOL * METAXALONE * METHOCARBAMOL * TIZANIDINE * CLONIDINE * BENZODIAZEPINES - DIAZEPAM - LORAZEPAM
45
ACUPUNCTURE
Recommend 1-2 times/week for 6-8 weeks to decrease jaw pain or headaches

DMOP (15 decks)

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