Opioids in practice

Question 1

How do psychological factors impact on pain?

Answer 1

people who are in pain expect to be in pain so they feel pain, so difficult to come off opioids

Question 2

Define allodynia

Answer 2

Feeling pain as a result of a non-painful stimulus

Question 3

Define hyperalgesia

Answer 3

the amount of pain felt is disproportionate to a weakly painful stimulus

Question 4

What are the two different types of sensitisation to pain?

Answer 4

allodynia

hyperalgesia

Question 5

What are our pain receptors called?

Answer 5

Nocioceptors

Question 6

In terms of nerve fibres describe what Abeta, Adelta and C fibres do

Answer 6

Abeta - touch, pressure and vibration
A delta - quick acute pain
C fibres - slow pain, burns and dull aches

Question 7

Describe the pathophysiology of tolerance

Answer 7

make new receptors, so need more to get the same effect

Question 8

What happens in chronic pain eg back pain?

Answer 8

damage to nerves changes the way they relay pain signals

Question 9

How would explain management of chronic pain to a patient in primary care

Answer 9

• explain that it may take time to find a successful treatment regimen
• pacing yourself
• distraction techniques
• expectation of being in pain makes pain worse
• manage expectation - pain may never go away

Question 10

What are the negative effects of opioids?

Answer 10

• Gastrointestinal : nausea and constipation
• Respiratory: sleep disordered breathing eg sleep apnoea
• Cardiovascular: MI, heart failure
• CNS effects: dizziness, sedation lead to falls, hyperalgesia (if chronic use)
• Musculoskeletal System: falls leading to fractures
• Immune system: reduced immunity and pneumonia
• Addiction and Misuse: drug taking behaviours: asking for more meds before the prescription ends, reluctant to consider lowering the dose, stockpiling on opioids, reluctant to find other methods of managing the pain

Question 11

Which patients are at higher risk of resp depression with opioids?

Answer 11

sleep apnoea
COPD
pregablin/gabapentin
renal impairment

Question 12

List some side effects of opioids

Answer 12

tolerance, withdrawal, irregular periods, erectile dysfunction, hyperalgesia, depression, dependence, addiction, reduced immunity, osteoporosis and constipation.

Question 13

What are the non-pharmacological ways of managing pain?

Answer 13

• physical - weight loss, smoking cessation, exercise, yoga, physiotherapy,
• Psychological - counselling, CBT, music, medication, relaxation
• complementary therapy - massage, reflexology
• occupational - work based review

Question 14

Name some non-opioids analgesics

Answer 14

paracetamol, ibuprofen, aspirin

Question 15

Name some opioid analgesics

Answer 15

Weak: codeine, dihydrocodeine, tramadol

strong: morphine, oxycodone (2x as strong as morphine)
others: fentanyl, buprenorphine, methadone

Question 16

Name some adjuvant analgesics

Answer 16

antidepressants eg amitryptilline
anticonvulsants - pregablin, gabapentin
lidocaine pataches

Question 17

What are the signs of opioids abuse or dependency?

Answer 17

• Use of pain medications other than for pain treatment
• Impaired control (of self or of medication use)
• Compulsive use of medication
• Continued use of medication despite harm (or lack of benefit)
• Craving or escalation of medication use
• Stealing or diverting medications
• Calls for early refills / losing prescriptions
• Reluctance to try nonpharmacologic interventions.

Question 18

What are the risk factors for opioid dependency?

Answer 18

• younger age
• unemployed
• non-white ethinicty
• poor general health