E3: Pain Management Flashcards
How is tramadol, tapendatol, hydrocodone, and oxycodone administered?
Oral
How is oxymorphone immediate release, morphine, and hydromorphone administered?
Oral or IV
What are the side effects of opioids?
Constipation, N/V, pruritis, dry mouth ,AMS, respiratory depression, tolerance, and dependence
What is pseudo addiction?
Undertreated pain resulting in red flag behaviors
What are the 3 different types of pain?
- Nociceptive
- Neuropathic
- psychogenic
- etiology of pain dictates treatment
What is nociceptive pain?
-Caused by injury to the tissues and activation of peripheral pain receptors, somatic or visceral
What is the recommended treatment of Nociceptive pain?
- Short term NSAIDs
- Tylenol
- Corticosteroids
- Oral/topical opioid pain medication
- Parenteral pain medications
- PT
- TENS unit
- muscle relaxants
What is neuropathic pain?
Results from damage to or dysfunction of nerves, spinal cord or brain
what is the recommended treatment of neuropathic pain?
- Gabapentin
- Pregabalin
- Amitriptyline
- Cymbalta
- Tramadol
- Nucynta
What are the options for interventional pain management?
- Epidural steroid injection
- Joint injection
- Intrathecal pump implant
- spinal cord stimulator implant
- peripheral nerve blocks
- sympathetic nerve blocks and neurolysis
What kind of nerve block can treat pain of the UE, chest, head, neck, breast, and thorax?
Stellate ganglion
What kind of nerve block can treat pancreatic, gastric, hepatic, or biliary tree pain?
Celiac plexus
What kind of nerve block can treat lower abdominal pain and lower extremity pain?
Lumbar sympathetic
What kind of nerve block can be used to treat pain of the entire pelvis with exception of the ovaries?
Superior hypogastric
What kind of nerve block can be used to treat pain of the perineum and rectum?
Ganglion of Impar
What is psychogenic pain?
Persistent pain typically with evidence of psychologic disturbance
-No evidence of disorder that could account for the pain or its severity
What is the treatment of Psychogenic pain?
- Biofeedback/distraction techniques
- encourage exercise
- psychologic/psychiatric evaluation and therapy
What are the treatment options for muscle spasm pain?
- NSAIDs
- Possible muscle relaxant
- Trigger point injections
- Medrol dose pack
- Ice/heat
You are treating a patient for muscle spasms and on their 1-2 week follow up, they are not having any improvement. What should you consider?
- PT
- imaging
- may repeat trigger point injection if they were effective short term
- TENS unit
You are converted a patient from a short acting opioid to a long acting opioid for pain. What should you consider for breakthrough pain?
Low dose opioid- should not be more than 20-25% of daily long acting dose
What medications should you consider for diabetic neuropathy?
- Gabapentin
- Pregabalin
- Cymbalta
- topical compounded cream
- TENS unit
How should you dose Gabapentin for diabetic neuropathy?
-Titrate slowly up, 100mg-300mg, start qd, then BID, then TID over weeks to months
How should you dose Pregabalin for diabetic neuropathy?
Titrate slowly up, 25mg-50mg, start QD, then BID, then RID over weeks to months
What is the treatment for fibromyalgia?
- Encourage physical activity (#1 treatment)
- Support and counseling
- Pregabalin or Gabapentin
- Cymbalta for pain control
- AVOID OPIOIDS
What is PCA?
- Patient controlled analgesia
- used most often for severe post operative pain and intractable cancer pain
- Can be used short term for patients on chronic, high dose opioids outpatient that are suddenly NPO
What is the PO to IV conversion of morphine?
Typically 3:1, but patient dependent
What is the main risky side effect of methadone?
-Risk of QT prolongation, get baseline EKG and check EKG annually thereafter
What is Tramadol commonly used for?
- Consider for neuropathic pain
- Fibromyalgia if absolutely necessary
What pain medications should be avoided in ESRD?
- Avoid morphine, Demerol, hydrocodone, and codeine
- EXTREME caution with hydromorphine and oxycodone
What is the DOC in ESRD?
- Fentanyl (patch or parenteral)
- Methadone
