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Phar 507 > Chronic pain management > Flashcards

Chronic pain management Flashcards

1
Q

What is acute pain, subacute/post-acute, chronic

A

Time limited (up to 7 days after an injury), Up to 6-12 weeks following a severe injury and/or major surgery, pain that last beyond normal expected time of tissue injury

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2
Q

What is the most common type of chronic pain

A

Back pain

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3
Q

T/F: Chronic pain and mental health are usually tied together

A

True

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4
Q

What are the causes of chronic pain

A

nociceptive, neuropathic (nerve damage or abnormal functioning), mixed

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5
Q

T/F: SSRIs such as escitalopram are apporved for neuropathic pain

A

False: SNRI, duloxetine, is approved for neuropathic pain

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6
Q

The analgesic action of antidepressants occurs under what conditions

A

Even if patient is not clinically depressed, sooner and at lower doses than doses required to treat depression

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7
Q

What are the first line agents for Neuropathic pain

A

Secondary amine tricyclic antidepressants (despiramine and nortriptyline), Duloxetine, gabapentin, pregablin

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8
Q

What is the second line of neuropathic pain, concern, other

A

Tramadol, increased abuse potential for chronic pain and a risk factor for long-term opiod use, licdocaine patch

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9
Q

What is the third line, caveat

A

Immediate release opiod, effective in the short-term while titrating antidepressants and/or anticonvulsants to optimal dosages

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10
Q

T/F: For treating pain start low and go slow when titrating

A

True

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11
Q

If partial pain relieft is present and side effects are tolerable what should be done, problematic, pain relief is INADEQUATE

A

Increase the dose, add a first line agent with a DIFFERENT mechanism of action, adding or switching to a first line agent with a different mechanism of action

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12
Q

What is the symptom duration of acute back pain, subacute, chronic

A

Greater than 4 weeks, 4 to 12 weeks, greater than 12 weeks

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13
Q

What physiological changes usually causes acute or subacute back pain

A

Release of inflammatory mediators, muscle spasm in surrounding tissue

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14
Q

What is the first line treatment of acute or subacute lower back pain, second line

A

Remain active and education/ application of heat, NSAID, spinal manipulation and acupuncture

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15
Q

What are limited use treatment for select patients only

A

Exercise therapy, skeletal muscle relaxants (acute LBP only), opiods (CAUTION)

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16
Q

What treatment is not recommended for LBP, insufficient evidence

A

Acetaminophen, SNRI and gabapentinoids

17
Q

What is the MOA of anitspasticity agents, what are they

A

Act directly on skeletal muscle or in spinal cord to improve muscle hyertonicity and involuntary spasms/ Baclofen and Dantrolene

18
Q

What are the antispasomadic agents

A

Cyclobenazaprine, carisoprodol, metaxalone, methocarbamol

19
Q

What drugs are antispasmodic and antispasticity

A

Diazepam and Tizanidine

20
Q

T/F: Evidence supports a modest benefit of skeletal muscle relaxants for short-term (less than one week) for treatment of acute and is associated with faster functional recovery in LBP

A

False: Evidence dose support a modest benefit of skeletal muscle relaxants for short term for treatment of acute LBP BUT IS NOT associated with faster functional recovery/ NO STUDIES SUPPORT LONG TERM USE IF SKELETAL MUSCLE RELAXANTS

21
Q

What is the first-line treatment for chronic LBP

A

Remain active, exercise, education that includes coping with a long term health problem, cognitive behavioral therapy

22
Q

What is the first line treatment or adjunctive option for chornic LBP

A

Spinal manipulation, massage, acupuncture, yoga, stress reduction, rehab, NSAIDS, SNRI (small at best), Tramadol (kinda)

23
Q

What is not recommended for LBP, insufficient evidence

A

Acetaminophen/ application of heat and skeletal muscle relaxants

24
Q

When would gabapentionids be used in chronic LBP

A

Painful conditions with nerve pathology (sciatica, failed back surgery syndrome)

25
Q

What are NSIADS first line for

A

Osteoarthritis, rheumatoid arthritis, back/neck/shoulder pain, inflammatory pain

26
Q

What are the three types of side ffects for NSAIDs

A

Gastrointestinal (Hearburn, GI bleeding), Cardiovascular (MI and stroke, heart failure), Renal (AKI)

27
Q

`What patients should NSAIDs be avoided in

A

Recent myocardial infarction, unstable angina, poorly compensated heart failure, CKD (3 or worse), Volume depleted

28
Q

What disease states are associated with opiod-tolerant patingts recieving agents, which agents

A

Cancer pain and chronic upain unresponsive to nonopiod treatments. transdermal fentanyl patch and methadone

29
Q

What is the indication for trnasdermal fentanyl patch

A

Opioid-tolerant patients with pain severe enough to require daily, around the clock, long term opioid treatment

30
Q

Where and how is the fentanyl patch applied

A

Chest, back, upper arm or flank/ press patch firmly in place for about 30 seconds

31
Q

What are the kinetics of the fentanyl patch, mininum and maximum effect, steady state

A

Simple diffusion with delayed onset and offset of effect 12 hours. 24 hours, 3 to 6 days

32
Q

The patient should continue oral opioid for 12-24 hours after

A

True

33
Q

After the patch is removed how long does it take to for plasma levels to fall by 50%

A

24 hours (must monitor for a day if oversedation/respiratory depression is seen)

34
Q

What is patient education for fentanyl patches

A

DO NOT CUT patch or use altered patch, avoid exposing application site to direct heat, remove old patch once new patch is placed

35
Q

What metabolizes methadone, adverse effects

A

CYP 3A4 and CYP2B6, QT prolongation

36
Q

What are the risk factors of abusing opiods

A

Family history of substance abuse, personal history of substance abuse, age between 16- 45 years, psycholoigcal disease, history of preadolescent sexual abuse

37
Q

The CDC guideline for prescribin poiods for chronic pain dose not include which patients

A

Active cancer treatment, acutesickle cell pain crisis, acute pain after surgery

38
Q

T/F: Patients should be tapered off opiods in order to lessen withdrawl symptoms

A

True

Phar 507 (33 decks)

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