Chronic Pain Management Flashcards
when does acute pain become chronic
if it lasts more than 6 months or the time it would take for the connective tissue to heal
many TMJ disorders are ____ and ______
mild and self limiting
how long do CHRONIC pain syndromes last
more than 6 months
depressive symptoms and _____ pain have a direct correlation
chronic musculoskeletal pain
_____ increases the patients self reporting of pain especially skeltal muscle pain
anxiety
________ approach is best for management of TMD
multi modality
what are the multi modality approaches to TMD management
- medications
- splint therapy
- physical therapy
- acupuncture
- psychotherapy
- arthrocentesis or surgery
what are the common co existing pain conditions
- TMD
- fibromyalgia
- headaches (migraine, tension type, and TACs)
- IBS
team approach for chronic pain has best treatment outcome involving multi specialities such as:
- orofacial pain
- PT
- pain psychologist
- rhuematologist
- neurologist
what other diagnoses can cause head and facial pain
- migraine headache
- tension headahce
- trigeminal autonomic cephalgias
- temporal arteritis
- ear infection
- sinus infection or tumors
- tooth infection
- jaw joint sprain
- neuralgia
- jaw joint disk displacement
- may not be painful
what diagnoses can cause malocclusion
- oral cancer
- jaw joint tumors (osteochondromas)
- dental malocclusion especially secondary to osteoarthritis or rheumatoid arthritis
- facial muscle spasm
- jaw fracture
what is the PT for TMD chronic pain
- treat 2 times per week for 12 sessions
- add CC
- add diagnoses
- add tx recommendations such as:
- ultrasound to masseters
- massage jaw muscles
- mandibular mobilization to increase range of mouth oepning
- evaluate pressure
what are the txs for mild-moderate pain
- NSAIDs, muscle relaxants
- mixed analgesics
- class III narcotics
what is the tx for severe pain
- steroids, muscle relaxants
- sleep medications, antidepressants, neuropathic pain medications
- mixed analgesics, class II narcotics
what types of acetominophens are given what are the effects and overdose effects
- paracetamol (generic in foreign countries)
- APAP (acetyl- para- aminophenol)
- no anti inflammaotry effects
- minimal increased risk of bleeding
- overdose: hepatotoxicity
what is the max daily dose for acetominophen
4000 mg per day in divided doses except in chronic pain: 3000 mg per day in divided doses
what is the dosage for caplet, tablet of acetominophen
325mg, 500mg, 650mg XR (lasts 8 hours
what is the dosage for an acetominophen elixir
160mg/5mL
- 500mg/5mL
what is the dosage of the injectable acetominophen
10mg/mL
what is the suppository acetominophen dose
120mg,325mg, 650mg
what is the acetominophen combination with opioids
- hydrocodone- acetominophen
- norco 5mg, 7.5mg, 10mg/ 325mg
- vicodin 5mg, 7.5mg, 10mg/300mg
- endocet, roxicet 5mg,7.5mg, 10mg/ 325 mg
- percocet: 5mg, 7.5mg, 10mg/ 325mg
- watch for concurrent medications containing acetominophen especially OTC products such as sleep aids
what is the max dose for acetominophen (tylenol) for select pts and what is the risk
3-4g/day
- hepatic failure/toxicity
what is the max dose ibuprofen (motrin)
3.2g/day
what is the max dose for aspirin
4g/day
