Geriatrics - Chronic Pain

Question 1

List examples of acute pain?

Answer 1

trauma (fractures, falls), surgery

Question 2

List examples of chronic pain?

Answer 2

musculoskeletal, neuropathy, vascular, cancer

Question 3

Explain the difference between neuropathic and nociceptive pains?

Answer 3

neuropathic = primary lesion or dysfunction in the nervous system, nociceptive = injury to body tissues

Question 4

List the common descriptors of neuropathic and nociceptive pains?

Answer 4

neuropathic = burning, tingling, hypersensitivity to touch or cold; nociceptive = aching, sharp, throbbing

Question 5

List nonspecific signs/symptoms suggestive of pain?

Answer 5

frowning/grimacing/fearful expression/clenched teeth, bracing/guarding/rubbing, fidgeting/restlessness, striking out/agitation, eating/sleeping poorly

Question 6

What are non-pharm treatments for pain management in elderly?

Answer 6

physical activity, patient education, cognitive-behavioral therapies, adjuncts (heat/cold/massage/liniments/acupuncture/spirituality)

Question 7

What is treatment for mild pain in elderly? Moderate? Severe?

Answer 7

APAP +/- NSAIDs; APAP + opioid; opioid (all +/- adjuvant therapy PRN)

Question 8

How should pain medications be administered for chronic or long-term pain?

Answer 8

routinely/around-the-clock (NOT PRN)

Question 9

What is the TDD for APAP?

Answer 9

4 g/day

Question 10

What are absolute CIs for NSAIDs? (3)

Answer 10

PUD, CKD, HF

Question 11

What are alternatives to NSAID use in those elderly taking aspirin? (2)

Answer 11

PPIs, misoprostol

Question 12

Which TCAs are preferred for pain management in elderly?

Answer 12

secondary amines (nortriptyline)

Question 13

What are first-line treatments for neuropathic pain? (3)

Answer 13

alpha-2 ligands (pregabalin, gabapentin), SNRIs, TCAs

Question 14

What is second-line treatment for neuropathic pain? (2)

Answer 14

topical agents (lidocaine, capsaicin)

Question 15

When are steroids reserved for in pain management in elderly? (2)

Answer 15

those with pain-associated inflammatory disorders or metastatic bone pain

Question 16

What are AEs of opioids?

Answer 16

respiratory depression, lethargy/sedation, miosis, constipation, addiction/dependence

Question 17

Which opioids are preferred for pain management in elderly? (5)

Answer 17

morphine, hydrocodone, oxycodone, hydromorphone, fentanyl

Question 18

Which opioid is most potent when given orally? Intravenously?

Answer 18

hydromorphone, oxymorphone

Question 19

Which opioid is least potent when given orally? (2) Intravenously?

Answer 19

meperidine/tramadol, meperidine

Question 20

List medication classes for management of opioid-induced nausea/vomiting?

Answer 20

butyrophenones, phenothiazines, antihistamines, anticholinergics, serotonin antagonists, prokinetics, benzodiazepines

Question 21

List medication classes for management of opioid-induced constipation?

Answer 21

softening agents, stimulants, osmotics, saline solutions, opioid antagonists, lubricants

Question 22

What conditions are excluded from recent prescribing recommendations for opioids? (3)

Answer 22

sickle cell disease, cancer-related pain, and palliative or end-of-life care

Question 23

Explain the purpose of NYS law S8139/A10727?

Answer 23

limits opioid prescriptions from 30- to 7-day supplies and requires pharmacists to provide additional education/counseling to those receiving opioids