Pain Flashcards
Definition of pain:
An unpleasant sensory and emotional experience associated
with actual or potential tissue damage
How is pain classified?
Primary: not associated with illnesses
-Tension headache -> Stress (chronic or episodic)
-Migraine headache (with or without aura)
-Cluster headache
-Medicinal overuse headache
Secondary: symptoms of a condition
-sinus/congestion, head trauma, stroke, substance withdrawal/abuse, bacterial/viral diseases, the disorder of craniofacial structure
Location of headaches:
-Sinus: behind eyebrows and cheekbones
-Cluster: in and around one eye
-Tension: like a band on the forehead
-Migraine: on one side of the face
-temporomandibular joint: on the side (temple)
Patient presentation of tension headache
-Bilateral
-Gradual onset
-diffuse -> tight, pressing, compressing pain
-minutes to days
-Triggers: stress, emotional imbalance (anxiety, depression,
etc), lack of sleep
Patient presentation for Migraine:
-Pain unilateral, throbbing, and more severe than a tension headache
-Sudden onset
-with or without aura
-hours to days
-symptoms: nausea, vomiting, constipation, diarrhea, lightheadedness, light/sound/movement
sens
to remember: SULTANS
Patient presentation for Sinus headache:
- localized to the face, forehead, and periorbital areas
-Onset simultaneous with nasal symptoms
-Dull bilateral pain, pressure behind the eye or face
-last days resolves with sinus symptoms
-symptoms: nasal discharge; congestion, fever
Medication overuse:
-use of offending agent more than twice weekly
for ≥3 months
-Onset within hours of stopping agent
-Symptoms: continuous pain, upon awakening
-Potential causative agents: acetaminophen, aspirin, caffeine,
triptans, opioids, butalbital, and ergotamines
Pathophysiology of pain
Cell damage -> release of chemicals to depolarize nociceptors and prompt pain transmission
bradykinin, histamine, serotonin, prostaglandins,
potassium, substance P, calcitonin gene-related peptide
(CGRP)
When are patients referred? NO otc TREATMENT
-secondary headache except for sinus headache
-severe pain, severe symptoms (nausea, vomiting)
-a headache for more than 10 days
-severe infection (green/brown discharge, stiff neck)
- under 8 y of age
-significant liver problems or alcoholic consumption bc the liver doesn’t work to metabolize drugs
Exclusion by type of headache:
-if they have symptoms of migraine -> refer to check if it is a -migraine
-if it is ongoing
-if it is a cluster headache -> behind the eye (bc of severe pain excluded)
-medication overuse -> they have to stop the medication they are taking
What are the 3 types of systemic analgesics?
-Salicylates (Aspirin -> acetylsalicylic acid, non acetylsalicylics)
-Acetaminophen
-NSAIDS
-> refer to mild (1-3) and moderate (4-6)
What are the Non-Drug Treatment Approaches
Avoid stressors, aerobic, hot or cold compresses on forehead (trick pain pathway)
Which of the 3 analgesics has the longest Onset?
Aspirin with 1-2hr
Acetaminophen: 30 min
NSAID (ibuprofen and Naproxen) :15-30 min
What happens when a long-acting drug is given to an older person?
The drug will be in the system longer, which makes the dose higher
Why don’t want a long-acting drugs in kids?
Bc it takes so much time to get excreted, we don´t a lot of exposure of the drug to the kid -> least amount of drug for the shortest duration in kids and older people bc the kidney and liver decline
Which of the analgesics is eliminated in the Liver?
Acetaminophen
NSAIDS (Naproxen and Ibuprofen) and Aspirin (Acetylsalicylic acid) through kidney
Why is Aspirin as an irreversibly COX inhibitor concerning?
Because it blocks COX for the whole time it is present, meaning that it takes time for the body to excrete the drug before the positive effects of COX-I can be used (f.e. platelet formation)
-> Bleed risk is higher in Aspirin
What is special about Acetaminophen (Tylenol)?
It is secreted through the liver and it probably doesn’t target inflammation pain, this is why it may not work in every patient
-not for people with low LIVER function
-high dose can damage the LIVER
-but rare side effects: Hepatoxicity (nausea and vomiting), skin reaction, nephrotoxicity, Anemia
What is the max dose for Acetaminophen?
325-650mg every 4-6 hours, 1000mg ev 6 hr
3000mg a day
pediatrics: 10-15mg/kg/dose ev 4-6hr, 2.6g in 24 hr
What are the drug interactions of Acetaminophen (Tylenol)?
-Alcohol
-Anticoagulants (Warfarin), chronic use of APAP can increase bleedinmg risk -> anyone that is on a blood thinner is on Tylenol though
What are the Salicylates?
-Acetylated salicylates, Aspirin, ASA
-non-acetylated salicylates (Magnesium salicylate
Why might Aspirin be not the best choice to treat pain?
-Irreversible COX-I, II inhibitor and it acts anti-inflammatory only at high doses -> and at high doses, there are side effects: GI ulcer, nausea, vomiting, epigastric discomfort
-it is usually used for cardiovascular protection
For which patients is Aspirin avoided?
Aspiring allergy, prone to GI bleeding,
!! Renal insufficient patient bc cleared through kidney
children (viral infection) and young adults (< 16y) -> Reyes syndrome (neurological damage, deadly)
Ashtma (may be undiagnosed in kids, deadly), 3rd trimester pregnant (bleed risk when delivering)
Drug interaction for Aspirin?
-NSAIDs, anticoagulants -> Bleed risk
-Antihypertensive -> ASA may inhibit the effect of beta-blocker, ACE-I, vasodilators, diuretics
-Overdozed patients may experience: Tinnitus
