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PSYC 302 > Lecture 2: pain treatment and pain research > Flashcards

Lecture 2: pain treatment and pain research Flashcards

1
Q

What was the treatment of pain ins antiquity

A

-trephination
-pain was thought to be caused by eveil spirits in the brain so they had to let them out
-made holes in people’s skulls
-also used theriac

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2
Q

when was Theriac used and what is the main active ingredient

A

-in antiquity
-OPIUM

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3
Q

how was pain treated in 1500 AD

A

-willow bark made into tea
-opium poppy

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4
Q

what was the first pharmaceutical company

A

Merk KGaA in germany

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5
Q

what did the first pharmaceutical companies do in the 1500’s

A

-they knew we could take opium and make it into morphine
-but were unable to make the same dosage
-they came up a process to always have the same dosage
-all about control dosage

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6
Q

what is the greatest advance in medecine

A

anasthesia in 1846
before we had no anesthetic only analgesic

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7
Q

what is the ether dome

A

it is a surgical amphiteater in Boston
-it showed that “ether” existed aka ether puts you to sleep and that it was hard to die from it

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8
Q

Equianalgesic dosing, compared to 10 mg IM morphine: Codeine

A

-IM: 130
-PO: 200
-Half-life: 2-3
-Duration of action: 2-4
-Comments: usually combined with a nonopiod

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9
Q

Equianalgesic dosing, compared to 10 mg IM morphine: oxycodone

A

-IM: 15
-PO: 20-30
-Half-life: 2-3
-Duration of action: 2-4
-Comments: combined with a nonopiod or as a controlled release tablet

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10
Q

Equianalgesic dosing, compared to 10 mg IM morphine: : propoxyphene

A

-IM: 100
-PO: 50
-Half-life: 2-3
-Duration of action: 2-4
-Comments: usually combined with nonopiod, norproxyphene toxicity may cause seizure

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11
Q

Equianalgesic dosing, compared to 10 mg IM morphine: morphine

A

-IM: 10
-PO: 30
-Half-life: 2-3
-Duration of action: 3-4
-Comments:multiple routes of administration available. controlled release availabke

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12
Q

Equianalgesic dosing, compared to 10 mg IM morphine: Methadone

A

-IM: 1-3
-PO: 2-6
-Half-life: 15-190
-Duration of action: 4-8
-Comments: since it has a longer half life it is less adictive
plasma accumulation may lead to delayed toxicity

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13
Q

Equianalgesic dosing, compared to 10 mg IM morphine: fentanyl

A

-IM: it depends on what you give aka patches or IV
-PO:
-Half-life:
-Duration of action: 48-72
-Comments: lasts so much longer

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14
Q

routes of drug administration

A

-subcutaneus (end of dermal layer)
-intramusculat aka IM
-intravenous
-transdermal aka on the epidermis
-implantation aka pumps right into the dermis

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15
Q

why is transdermal kinda lit

A

-long lasting
-lower dose
-lower side effects

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16
Q

what are the major differences between the routes of drug administration

A

matter of time and where it needs to go

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17
Q

what is pharmacodynamics

A

what drug does to the body

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18
Q

what is pharmacokinetics

A

what body does to the drug

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19
Q

what is ADME

A

-absorbtion
-distribution
-metabolism
-elimination

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20
Q

rue or false: when a med is broken down either the metabolites become eliminated or they are active

A

true

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21
Q

what is an example of a med that the metabolites are active

A

codeine becomes morphine

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22
Q

which organ absorbs the drugs

A

small intestines

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23
Q

what is PCA

A

-patient controlled analgesia
-people consume less morphine that way because they have more control

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24
Q

opiate side effects

A

-constipation up to 80%
-nausea or vomiting : 15-30
-sedation 20-60%
-confusion or hallucinations
-myoclonic jerks
-respiration depression
-xerostomia aka dry mouth
-urine retention

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25
Q

what is the best selling drug class

A

over the counter analgesics

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26
Q

examples of oral otc analgesics

A

-acetaminophen
-aspirin
-ibuprofen
-naproxen sodium
-dextromethorphan: cough

27
Q

what does acetaminophen cause

A

liver damage

28
Q

the who analgesic ladder for cancer pain

A

-pain: non-opioid +- adjuvant
-Pain persisting or increasing: opioid for mild to moderate pain, +- non-opioid, +- adjuvant
-freedom from cancer pain: opioid for moderate pain tp severe pain, +- non-opioid, +- adjuvant

29
Q

other analgesic categories

A

multipurposes:
cortistereoids ex: pregabalin
antidepressants ex: SNRIs ex: duloxetine
alpha 2 adenergic agonists

neuropathic
-nmda receptor agonists mixed opioids and snri
-anticonvulsants
-oral local anesthetics ex: botox
-cannabinoids

30
Q

what are the four main categories of pain treatment choices basically

A

-surgical: but the evidence that it works is mid ex: you cut where the nerve is
-anesthesiological ex: nerve blocks, epidural blockade lidocaine
-psychological: pain management, sensory discrimination, training
-ther like acupuncture and PT

31
Q

what is the name for the western default medicine

A

allopathic

32
Q

Complementary and alternative medecine for pain

A

-individual practices like spiritual or movement based
-systems of medicine like homeopathy, osteopathy, naturopathy, prayer eyc
-world medicine systems like native amerixcan healing, traditional Chinese medicine, herbal medicine, ayurvedic medicine

33
Q

why is it hard to prove that alternative medicine works

A

control for tests: placebo? like peopel already think it work s

34
Q

true or false: when you swear you feel less pain and with music too

A

true

35
Q

why do some patients push back on the idea of pain self management

A

you come to someone for management and they tell you to just do it on ur own and that if you fail it is your fault

36
Q

analgesia for babies

A

-sugar
-breatfeading
-kangaroo care

37
Q

are opioates a vibe for babies?

A

no
opioids, analgesics, acetaminophen and aspirin are all and for babies

38
Q

what was the name of the dude that came up with the idea for multidisciplinary pain clinics

A

-john J bonica
-wrote the first pain book: the management of pain

39
Q

what is a part of multidisciplinary clinics

A

-primary care physician
-psychological therapied
-educational programming
-advice, appropriate medications
-appropriate medical procedures
-PT, structured & alternatives movement therapies

40
Q

when do we switch from curative intent to palliative care

A

-when they will die soon and you wanna make them as confy as they can be
-switch them to an hospice care or a palliative facility

41
Q

pain the fifth vital soign

A

-now nurses are required to write down the pain levels since if there is a repid change it is a really and thing
pulse
temperature
-blood pressure
respiratory rate
pain

42
Q

why did people not like pain as the fifth vital sign

A

pain is not objective measure
-measure pain= augmentation to treat it=over treatment

43
Q

evidence based medecine the lil pyramid top to bottom of how I can trust that

A

-systematic reviews and meta analysises
-randomized control double blind studies aka RTCS
-case control studies
-case studies: whole series of published patients
-case reports: doctors wrote down what happened to a patient
-expert opinion: aka your doc
-personal opinion aka tiktok

44
Q

what is the cochrane collaboration

A

-the best way to make meta analysis

45
Q

why are meta analysis kinda mid

A

because they always get to mid comclusions like yes this affects this but like we also saw that this affects that

46
Q

explain RTC

A

mmm

47
Q

what are common exclusion criteria for pain trials

A

-if you already have treatment
-haven’t have pain for long enough
-co morbidities that you have

48
Q

does it really matter that we say why did someone quit a trial

A

yeah we need to know why

49
Q

what are the 2 types of inteversions usually in a trial

A

the treatment aka the drug and the placebo

50
Q

what are the 3 types of RTC design

A

-parallel design; you can also add the active control which is the control that people use now
-crossover design
-enriched design

51
Q

what is an advantage of crossover design

A

-participants like it more because they can get the drug either ways
-you can use A WITHIN SUBJECT DESIGN AS OPPOSED TO A WIDE SUBJECT design and a within is more statistically relevant

52
Q

what is the potential confound of crossovermethod

A

-it matters when the drug us give
-we dunno if the washout period will 100% wash out the effects of the medication

53
Q

what is one measure of protection that pharmaceutical companies have to put so that they can prove that their drug works

A

they put like a thing that says like our drug works if the patients have a 50% reduction in pain

54
Q

explain odds ration and what would the column and row labels be for an analgesic study

A

mmam

55
Q

plots you can have in meta analysis

A

-forest plots
-l’abbe plots

56
Q

what does the number needed to treat works + how to calculate it

A

how much an extra advantage does the drug give to the population 1/ (numbve of people got the treatment and worked/people who got the treatment minus people who got control and got smth/ people who got control

57
Q

true or false: NNTs will depend on the medication and the needs of the population

A

true

58
Q

most common pain medication of neuropathic pain

A

gabapentin/ pregabalin and TCAs

59
Q

why is gabapebtin so common

A

because pfizer put a lot of money in there

60
Q

true or fakse: are antidepressabts good for painful diabetic neuropathy compared to triple therapy for peptic ulcers

A

false they are less good because the NNT is lower than the triple therapy

61
Q

what is number needed to harm

A

whate side effects are we gonna overlook
usually opioids have a lower NNH

62
Q

where does the perfect analgesic reside

A

top left aka high NNH and low NNT

63
Q

true or false: we only care about NNT

A

false we also care about
-effect size
-tolerability and safety
-cost and resource allocation
-strenght of recommendation

64
Q

whats is the name for the pain association

A

the inernational association for the study of pain
publishes in journals like pain and pain reports

PSYC 302 (10 decks)

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