CHRONIC PAIN MANAGEMENT 24 Flashcards by sophie rosen

ACUTE PAIN TRANSFORMATION
*ACUTE PAIN CAN BECOME CHRONIC IF IT LASTS
MORE THAN

6 MONTHS OR THE TIME IT WOULD
TAKE CONNECTIVE TISSUE TO HEAL

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TEMPOROMANDIBULAR DISORDERS
* MANY ARE …
* CHRONIC TMD PAIN SYNDROMES LAST MORE THAN – MONTHS
* — SYMPTOMS AND CHRONIC MUSCULOSKELETAL PAIN HAVE
A DIRECT CORRELATION
* — INCREASES THE PATIENT’S SELF REPORTING OF PAIN
ESPECIALLY SKELETAL MUSCLE PAIN

MILD AND SELF-LIMITING
6
DEPRESSIVE
ANXIETY

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MULTI-MODALITY APPROACH IS BEST FOR
MANAGEMENT OF TEMPOROMANDIBULAR
DISORDERS
(6)

MEDICATIONS
SPLINT THERAPY
PHYSICAL THERAPY
ACCUPUNCTURE
PSYCHOTHERAPY
SURGERY

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

TMD
FIBROMYALGIA
HEADACHES (MIGRAINES, TENSION-TYPE,
AND TAC’S)
IRRITABLE BOWEL SYNDROME (IBS)

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TEAM APPROACH FOR
CHRONIC PAIN HAS BEST
TREATMENT OUTCOME
* INVOLVE MULTI-SPECIALTIES SUCH
AS:
(5)

OROFACIAL PAIN
PHYSICAL THERAPY
PAIN PSYCHOLOGIST
RHEUMATOLOGIST
NEUROLOGIST

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CAUSE HEAD & FACIAL PAIN:

MIGRAINE HEADACHE
· TENSION HEADACHE
TRIGEMINAL AUTONOMIC CEPHALGIAS (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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CAN CAUSE MALOCCLUSION:

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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PAIN
Mild/Moderate
(4)

NSAIDs, muscle
relaxants

Mixed analgesics,
Class III narcotics

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PAIN
Severe
(4)

Steroids, muscle relaxants

Sleep medications, antidepressants,
neuropathic pain medications

Mixed analgesics,
Class II narcotics

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ACETAMINOPHEN
* Other name
* Other name
* NO — EFFECTS
* MINIMAL INCREASED RISK OF —
* OVERDOSE: —
* MAX DAILY DOSE: — MG PER DAY IN DIVIDED DOSES EXCEPT
* CHRONIC PAIN — MG PER DAY IN DIVIDED DOSES

PARACETAMOL (GENERIC IN SOME FOREIGN COUNTRIES)
APAP (ACETYL-PARA-AMINOPHENOL)
ANTI-INFLAMMATORY
BLEEDING
HEPATOTOXICITY
4000
3000

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ACETAMINOPHEN DOSAGE FORMS
* CAPLET, TABLET
(3)
* ELIXIR
(2)
* INJECTABLE (IV)
(1)
* SUPPOSITORY
(3)

325MG, 500MG, 650MG EXTENDED RELEASE (LASTS 8 HRS.)

160MG/5ML
500MG/5ML
10MG/ML
120MG, 325MG, 650MG

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COMBINATION WITH OPIOIDS
* HYDROCODONE-ACETAMINOPHEN
(3)

NORCO 5MG, 7.5MG, 10MG/325MG
VICODIN 5MG, 7.5MG, 10MG/300MG
WATCH FOR CONCURRENT MEDICATIONS
CONTAINING ACETAMINOPHEN
ESPECIALLY OTC PRODUCTS SUCH AS
SLEEP AIDS

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COMBINATION WITH OPIOIDS
* OXYCODONE WITH ACETAMINOPHEN
(2)

ENDOCET, ROXICET
5MG, 7.5MG, 10MG/ 325MG
PERCOCET
5MG, 7.5MG, 10MG/ 325MG

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COMBINATION WITH CODEINE
* 300mg/— Tylenol with codeine
No.2
* 300mg/— Tylenol with codeine
No.3
* 300mg/— Tylenol with codeine
No.4

15mg
30mg
60mg

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COMBINATION
WITH
TRAMADOL

ULTRACET
ACETAMINOPHEN/
TRAMADOL
320MG/37.5MG

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ADVANTAGES OF LONG-ACTING OPIOIDS
(5)

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

OTC PRODUCTS
CONTAINING
ACETAMINOPHEN
(2)

Excedrin Extra
strength, Excedrin
Migraine
Acetaminophen/
Aspirin/ Caffeine
* 250mg/ 250mg/
65mg

Comtrex
Acetaminophen/
Dextromethorphan/
Phenylephrine
* 325mg/ 10mg/
5mg

NON-STEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS)

*ASPIRIN
*IBUPROFEN
*NAPROXEN
*PIROXICAM
*MELOXICAM
* INDOMETHACIN
* DICLOFENAC
* KETOROLAC
* CELECOXIB
* ETODOLAC
* NABUMETONE

NSAIDS
Effects (3)

ANTI-INFLAMMATORY EFFECTS
ANALGESIC EFFECTS
ANTIPYRETIC EFFECTS

NSAIDS
At low dose
(2)
At higher doses
(1)

Antipyretic effects
Analgesic effects
More anti-inflammatory effects
besides mentioned effects

NSAIDS
* IBUPROFEN (MOTRIN®, ADVIL®)
* OTC —MG
* RX (3)
* MAX DOSE: — MG PER DAY IN DIVIDED DOSES
* TOXICITY: —
* TO REACH ANTI-INFLAMMATORY EFFECTS MUST USE —DAY IN DIVIDED DOSES

200
400MG, 600MG, 800MG
3200
GI ULCER
1800MG3200MG/

COMBINATION
WITH OPIOIDS
27
Oxycodone/ Ibuprofen
mg
max
Hydrocodone/ Ibuprofen
mg
max

5mg/ 400mg
Maximum of 4 tablets/day in
divided doses
2.5mg, 5mg, 7.5mg, 10mg/ 200mg
Maximum of 5 tablets /day in
divided doses

SELECT A LONG LASTING NSAID
* NAPROXEN (ALEVE® 220MG OTC)
* MAX DAILY DOSE: — MG PER DAY IN DIVIDED
DOSES
* TOXICITY:
* COMBINATION WITH — TO
MINIMIZE THE GI DAMAGE (BRAND NAME VIMOVO®)

1500
GI ULCER
PPI ESOMEPRAZOLE

CELECOXIB (CELEBREX®)
SELECTIVE …
— OR — MG TWICE DAILY
AVOID IF PATIENT HAS — ALLERGY

COX 2 INHIBITOR
100MG 200
SULFA

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 (3)

 10% OR 20% INDOMETHACIN  10% OR 20% IBUPROFEN  10%, 15% OR 20% KETOPROFEN  3%, 5%, OR 10% DICLOFENAC  NSAID WITH MUSCLE RELAXANTS  1% FLEXERIL WITH10% KETOPROFEN/10% IBUPROFEN  1% DICLOFENAC SODIUM GEL(VOLTAREN) RX OR OTC

ACETAMINOPHEN, NSAIDS These analgesics have ceiling effect (4) No --- happen with these analgesics Take NSAIDs with --- to lower GI ADRs

* Has a limit in relieving the pain * Above the limit * No more analgesic effect * More toxicity tolerance or dependence food