Chronic Pain management Flashcards

1
Q

How can you evaluate chronic pain?

A
  • H&P
  • Psychological evaluation
  • electromyography
    • nerve conduction studies
    • muscle potentials
  • multidisciplinary approach
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2
Q

What is the chronic pain treatment continuum?

(picture)

A
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3
Q

What are some medications used for chronic pain managment?

A
  • NSAIDS/Acetaminophen
  • opioids
  • tramadol
  • antidepressant drugs
  • antiepileptic drugs
  • corticosteroids
  • muscle relaxants
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4
Q

How are Tricyclic antidepressants used to treat chronic pain?

How are they dose?

Side effects?

Example of drus?

A
  • Elevate mood, help with sleep
  • block reuptake of serotonin and norepinephrine at the neuronal membrane
  • potentiate narcotic analgesics
  • Dosing
    • use smaller doses than indicated for depression
    • must monitor drug levels
  • SE
    • anticholinergic (dry mouth, sedation, fatigue, orthostatic hypotension, arrhythmias)
  • Examples: amitriptyline, Doxepin
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5
Q

How are Anticonvulsant drugs used to treat chronic pain?

Uses?

Examples?

SE?

A
  • They alter the ion channels along the nerve fiber, thereby blocking pain stimuli by blocking the action potential
  • Used to treat neuropathic pain resulting from lesions to the Peripheral nervous system (DM, herpes) or CNS (stroke)
  • Examples: carbamazepine, phenytoin, gabapentin, and clonazampan
  • SE:
    • sedation
    • dizziness
    • ataxia
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6
Q

How are corticosteroids used to treat chronic pain?

Example?

A
  • Reduce inflammation and swelling, reducing inflammatory mediators
    • prevent release of prostaglandins
  • Ex: dexamethasone
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7
Q

What are some adjuvant medications used to treat chronic pain?

A
  • Muscle relaxants- reduce spasm
    • cyclobenzaprine, skelaxin, baclofen, carisoprodol
  • NMDA receptor antagonists
    • Ketamine and dextromethorphan
  • Alpha 2 agonist- inhibit nerve firing and release of substance P
    • Clonidine, dexmeditomidine
  • GABA agonists- inhibitory neurotransmitter which acts on spinal cord to prevent release of excitatory neurotransmitters
    • Baclofen
  • LAs
    • Mexiletine, Tocainide
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8
Q

How do epidural steroid injections work to treat chronic pain?

A
  • Provide high dose of steroid at the level of pathology to reduce swelling of the nerve root, block C-fibers, stabilize nerve membranes, and decrease ectopic discharges from inflamed tissue
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9
Q

What is a neurolytic block?

A
  • Permanent destruction of the nerve
  • Most common neurolytic blocks
    • lumbar sympathetic chain
    • celiac plexus
    • hypogastric plexus
    • ganglion impar (retroperitoneal plexus)
    • intercostal blocks
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10
Q

How is spinal cord stimulation used to treat chronic pain?

uses?

A
  • stimulating electrodes in the epidural space surrounding the entry level of the noxious input into the spinal cord
  • activates the descending modulating system and therefore inhibits sympathetic outflow
  • used for:
    • phantom limb pain
    • inschemic pain
    • PVD
    • spinal cord lesions
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11
Q

What are TENS?

A
  • Transcutaneous electrical nerve stimulation
  • hyperstimulation of the nervous system drowns out the pain
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12
Q

What is radiofrequency ablation?

A
  • A procedure where dysfuntional tissue is ablated using microwave energy
  • cryoneurolysis with cold-freeze
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13
Q

____-___% of cancer pain can be effectively treated with pharmacotherapy alone.

A

70-90%

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14
Q

____-____% of patients experiencing cancer-related pain do not receive effective analgesia.

A

40-50%

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15
Q

What is inadequate pain relief usually relataed to?

A
  • poor pain assessment
  • poor pain treatment plans
  • lack of knowledge of analgesics available
  • fear of addiction
  • fear of respiratory depression
  • side effects of pain treatment
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16
Q

What is the WHO analgesic ladder of pain management?

(picture)

A
17
Q

What are the medications that go along with the old WHO three step model?

(picture)

A