drug in rehab setting Flashcards
what is pain
Physical/electrical input comes from the body and is combined with historical and contextual factors in the brain. If the threat seems real enough, there will be pain
what is central sensitivation
Body has pathophysiological changes in the nervous system that makes it more responsive to input that typically would be nonpainful
pain threshold is lower than usual
overactive system alarm
pain lasting for longer than 3 month
how does nerve adapt in central sensitization
increase their resting levels of excitement -> continue inflamation response, continuing stress response
what repeated pain experience cause to system
sensitized
nervous system become more sensitized -> original pain threshold decrease = experience pain at decrease levels of activity
how does NSAID work
Suppress inflammation by inhibiting the enzyme cyclooxygenases (COXs)
Cyclooxygenase (COX-1protects stomach lining from harsh chemicals and COX-2 is produced when joints are injured/inflamed)
Good at treating pain caused by slow tissue damage, such as arthritis
T/F NSAID is typically not used more than 10 days for pain unless doctors say it ok
T
how does acetaminophen work
Blocks pain by inhibiting the synthesis of prostaglandin (a natural substance in the body that initiates inflammation) in the CNS (brain) but not in the peripheral system
Reduces pain signals
Acts as an analgesic and reduces fever but has NO anti-inflammatory or antiplatelet properties
Does not cause GI irritation so often is used as a replacement for aspirin
can you use ibuprofen and acetaminophen together
yes
best to take them 2-4h apart
when will it be a better option to use topical NSAID
Direct application to painful site to produce local pain-relieving effect which avoids whole body distribution of the drug at physiological levels
Penetrates the skin, can be absorbed by the blood and transported to site to inhibit COX enzymes
More superficial painful conditioning such as sprains, strains, muscle and tendon soreness and not deep visceral pain or headaches
benefit of corticosteroid injection
Widely used to help decrease inflammation and pain by delivery of potent anti-inflammatories
Concerns include length of benefits and safety concerns that limit the frequency of use
T/F Studies have shown that prolonged use of CS have a detrimental effect on articular cartilage and accelerate the progression of OA
T
Higher doses of corticosteroid for longer treatment durations were associated with
chondrotoxicity
Physicians typically limit 3-4 injections/year to a joint
T/F Recommendation for use recognizes that CS are indicated for short term use
T
what is the goal of muscle relaxant
Goal is to normalize muscle excitability without a profound decrease in muscle function
Can be used in conjunction with therapeutic techniques (can be synergetic relationship)
Type of medication to help reduce increased muscle tone and spasticity
Neuromuscular blocker (often used in surgery, ICU, emergency)
Spasmolytics used more in physical therapy community
Over the counter Robaxin (methocarbamol)
Flexeril cyclobenzaprine **most studied muscle relaxer with strong evidence for effectiveness
indication for muscle relaxant
Indicated for SHORT TERM use…therefore should be used in conjunction with multiple modalities (example: physical therapy) to have lasting effects
benefit of cannabidiol
rest better (improve sleep latency, sleep continuity, subjective sleep quality and reduce nightmares and insomnia)
reduce their stress and feel better in the face of challenges (anxiolytic and antidepressant)
can deflate their muscles after damage caused by physical exertion (anti-inflammatory)
reduce pain caused by high physical demands
what are opioid
Broad group of pain relieving drugs that work by interacting with opioid receptors in your cells
Made from poppy plant or Synthesized in a lab
Topical NSAID is absorbed where
blood
where is acetamoniphen processed
liver
where is ibuprofen processed
through kidney
what is often use in remplacement of aspirin since it doesn’t cause GI irritation
acetaminophen
what will you want to use if you want to reduce clotting action
NSAID -> aspirin
is Tylenol a NSAID
no -> pain reliever
is CBD accept among professional athlete
yes
risk factor of opioid use
Caucasian race, contact sports, postretirement unemployment, and undiagnosed concussion
how to complete a pain management plan
Individualized education- talk to your patient!
- High Risk Factors
- Diversion programs
- Overdose management (co-prescribing Naloxone to at risk patients)
- Proper disposal**
Realistic expectations and goals
3-7 day supply limit
Lowest effect dose
Non-Opioid alternatives
Physician re-evaluation
Refill policies
