Medical Management of Pain

Question 1

top 3 meds for the multimodal approach to acute pain managmenet

Answer 1

1. acetaminophen: foundational post op management: antipyretics, analgesic, and non-antiinflammatory meds
2. naproxen/NSAIDS or ibuprofen
3. opioids.

Question 2

top 3 meds for neuropathic pain

Answer 2

1. anticonvulsant (gabapentin/carbamazepine)
2. TCAs
3. SNRIs

Question 3

osteoarthritis, headache abortive. Risks: hepatic risk, accidental overdose

Med?

Answer 3

acetaminophen

Question 4

arthritis, fibromyalgia, headache abortive. Risks: GI bleed, cardiovascular health-MI and stroke increase, renal disease.

chronic pain med?

Answer 4

NSAIDS

Question 5

MOA and risks and type of chronic pain you should use TCA and Antidepressants for

Answer 5

Inhibits NE reuptake. Used for neuropathic, central or migraine pain.
Risks; anticholinergic– dry mouth and dysgeusia, dry eyes, constipation, confusion, drowsiness, sexual dysfunction, balance and increased risk of fall.

Question 6

Type of chronic pain you should use SNRi’s for. Risks.

Answer 6

SNRIs (antidepressants): Duloxetine and venlafaxine. Used for neuropathic, central or migraine pain by inhibited serotonin or NE
reuptake. Risks: sleep disturbance, activation/stimulation (occasionally drowsiness), sexual dysfunction, diaphoresis.

Question 7

Risks for using anticonvulsants as a long term chronic pain therapy

Answer 7

Anticonvulsants (gabapentin, pregabalin, topiramate, carbamazepine). Used for neuropathic pain, central pain, trigeminal neuralgia,
migraine prophylaxis.

• *Risks: ataxia, risk of fall, word finding, drowsiness, cognitive impairment, weight gain (weight loss with
  topiramate) **
  a. Often you give a 2-3 month trial.

Question 8

When would you use muscle relaxants for chronic pain management

Answer 8

Muscle Relaxants: cyclobenzaprine, baclofen, pinaverium. Used for cramping, IBS, spasm–ex> in MS, lower motor neuron disease, upper MN disease. Risks: GERD, drowsiness, risk of fall.

Question 9

T/F opioids are good for chronic neuropathic pain

Answer 9

ffalse. opioids demonstrated less than 30% actually helped with pain releif.

Question 10

t/f opioisd are good for long term chronic lower back pain relief

Answer 10

false. opioids seem to have a short term analgesic efficacy for chronic back pain. Long term effectiveness has not been shown

Question 11

T/F opioids are good to treat long term fibromyalgia

Answer 11

false. patients with FM receiving opioids have poorer outcomes than patients receiving nonopioids

Question 12

outline the hormonal effects of long term opioids use

Answer 12

myoclonus, hormonal effects (direct pituitary and hypothalamic effects, direct hormone effects like elevated prolactin, ACTH, ADH, and decreased TSH, FSD, LH, GH, cortisol and testosterone), mood dysregulation, opioid use disorder, poisoning/death

• *When prescribing opioids:**
• Prescribe short dispensing interval sinitially
• *- Co-prescribe naloxone**
• Urine drug screen at baseline and randomly at least annually.
• Opioid “agreement,” not a contact.

Question 13

T/f tramadol, tapentadol are equivalent to morphine

Answer 13

false.

Question 14

Tf oxycodone is the same potency as hydromorphone

Answer 14

false. oxycodone is doubly as potentn as morphine, and hydromorphone is 5 times as potent as morphine