Pain Flashcards
Spiritual needs of pt in pain
Consideration that ots may be experiencing spiritual distress in ADDITION to pain (punishment belief)
FICA
F: Faith or Beliefs
I: Importance and influence
C: Community
A: Address the issue.
HOPE
H: Sources of hope, meaning, comfort, strength, peace, love and connection
O: Organized religion
P: Personal spirituality/practices
E: Effects on medical care and end-of-life issues
Questions relevant to spiritual care
Know when to refer to spiritual care.
Pg. 144 O’Brien text: “Has your illness affected your faith/belief system?
Do you pray?
What do you think the power of prayer means?
Is God or other power important to you?
How can I assist you in maintaining spiritual strength?
Are their religious rituals that are important to you now
Spiritual Care Matrix
Broad generalist spiritual care
- Atends to and accompanies a pt through presenting events or circumstances
Compassionate presence
Narrow generalist
-Responding to pt reuest
Do not offere spiritual or religious counsel
A ___________ of pain is considered the “gold standard” and as such is the single most reliable indicator of the existence and intensity of pain
patient’s self report
Nociceptive pain
Results from injury to tissues
Called somatic or visceral pain
Can respond well to opioids depending on tissue type (most tissues and organs)
Can respond well to NSAIDS or Tylenol (bone pain) or steroids if inflammation is a key player in the pain
Neuropathic pain
Results from injury to peripheral nerves
Responds poorly to opioids
Clinical apprpach to pain mangement ABCDE
Ask and assesss
Believe
Choose
Deliver
Empower and enable
Non-pharm techniques for pt management
Heat
Cold
Massage
Acupuncture
Art
Music
Distraction (Children)
Transcutaneous electrical nerve stimulation
Exercise
Cognitive techniques for pain managment
Distraction and Imagery
Hypnosis
Relaxation strategies (music, breathing, meditation, art)
Self management- conducted in groups with a focus on increasing daily pain management skills and decrease the negative consequence of social isolation.
Opioid analgesics
Opioids are narcotic substances that can produce numbness and stupor-like symptoms.
They are the drugs of choice for moderate to severe pain that cannot be controlled with other analgesics.
- Mod-severe pain
- Suppress cough and GI motility
- CNS depressants
Moderate pain opioids
Codeine
Tramadol/ Tramacet
Moderate-severe pain opioids
Hydromorphone
Morphine
Fentanyl
Methadone HCl (Dolophine): requires special prescribers with a license (will discuss more in a later class
Opioid receptors
specific cell surface receptors within the central and peripheral nervous system, which combine with naturally occurring opioid compounds (e.g. endorphins) to reduce pain and increase euphoria
Mu (1 and 2)
Kappa
Delta
Mu types one and two
Opioid receptors
Brain, spinal chord, peripheral nervous system, intestinal tract
produces analgesia, respiratory depression, euphoria, sedation, reduced GI motility
Kappa receptors
Opioid receptors
Brain, spinal chord, peripheral nervous system
produces analgesia, and sedation
Delta receptors
Opioid receptors
Located in the brain and peripheral nervous system
Analgesia, antidepressant effects
Morphine
Mechanism of action: binds to both Mu and Kappa receptors to produce profound analgesia
Used for relief of moderate and severe pain
Decreases the sensation AND emotional reaction to pain
- Resp depression
- Constipation
- Urinary retention
- Cough suppression
- Nausea/vomiting
- Dependence
Do opioids have similar effects
yes
Resp depression
- Constipation
- Urinary retention
- Cough suppression
- Nausea/vomiting
- Dependence
Why is fentanyl so dangerous
It is odourless and tasteless. You may not even know you are taking it.
It can be mixed with other drugs such as heroin and cocaine. It is also being found in counterfeit pills that are made to look like prescription opioids.
20-40x more potent than heroin and 100x more potent than morphine
Opioid agonist - Codeine
Codeine, is an opioid that naturally occurs in the opium poppy.
Found in cough syrups, tyloneol T1, T2, T3, T4
Once codeine enters your system, the body breaks it down and converts it into morphine. Codeine is classified as a depressant, which means it slows down your nervous system, including your breathing rate.
Normally taken PO, but can be injected or snorted
Opioid agonsist Oxycodone and (Percocet)
Oxycodone
a semi-syntheticopioidused medically for treatment of moderate to severepain
.highly addictive and a commonlyabused drug.
Oxycodone/paracetamol (Percocet),
acombination of the opioidoxycodonewithparacetamol(acetaminophen),used to treat moderate to severepain.
Hydromorphone
Indications
Moderate-to-severe pain (alone and in combination with nonopioid analgesics); extended-release product for opioid-tolerant patients requiring around-the-clock management of persistent pain. Antitussive (lower doses).
Action
Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Suppresses the cough reflex via a direct central action.
Tramadol
An opioid effective for both general and nerve related pain
It can cause dependence and use may be limited by side effects such as nausea and sedation.
Prescribed for Back Pain, Chronic Pain, Anxiety, Depression, Pain, Fibromyalgia, Obsessive Compulsive Disorder, Restless Legs Syndrome.
Toradol
NSAID (Cox1 and 2 inhibitors)
(kertolac) is a very strong NSAID that should only be considered for the short-term relief of acute, moderately severe pain that occurs following surgery.
It carries a high risk of severe gastrointestinal side effects and can increase bleeding.
Treatment with Toradol should not exceed five days.
Opiod agonist methadone
a long-acting synthetic opioid medication that is used to reducewithdrawal symptomsin people addicted to heroin or other narcotic drugs, and it can also used as a pain reliever.
It reduces withdrawal symptoms and drug cravings without causing the “high” associated with the drug addiction.
Highly regulated med, must be watched during administration
Gabapentin
a medicine used to treat neuropathic pain (nerve pain). It works in different ways to stop seizures (epilepsy) and to block pain messages reaching the brain.
may make cause feel dizziness, sleepiness, or decreased alertness.
CAUTION - Gabapentin should be used with caution in patients with kidney disease
Medications for nerve pain
triculic antidepressants
Seritonin-norepinepthrine inhibitors
Opioid adminsteration key principals
Start low
Go slow
By mouth (Safest, least invasive)
By the clock (Regualr/fixed admin)
Plan for adverse effects (Anticipate, monitor and manage : START laxative proactively)
Plan for breakthrough pain
Why do we titrate doses gradually
to manage side effects
Why do we start opiods by mouth
Safest, least invasive
What does planning for breakthrough pain look like
use immediate release with breakthrough doses (BTD) until dose is stabilized to enable timely and effective titration.
What does managing by the clock imply
- Regular/fixed administration schedule, such as every 4 or 6 hours, rather than only “on demand”, including waking from sleep for a scheduled dose. Once pain control achieved, switch to long acting agents to improve compliance and sleep.
Key principles for opioid admin
Start with regular short-acting opioids and titrate to effective dose over a few days before switching to slow-release opioids.
* Once pain control is achieved, long-acting (q12h oral or q3days transdermal) agents are preferred to regular short-acting oral preparations for better compliance and sleep.
Titration
Use practice tools to monitor pain rating, adverse effects, and track patient goal attainment. A suitable numerical or descriptive pain rating scale should be used consistently.
Follow sedation levels using a tool such as the Pasero Opioid-Induced Sedation Scale, especially during titration of opioid doses.
Adjustment may require a dose adjustment of both the regular dose as well as the BTD.
It is common to combine an opioid with an analgesic for pain relief because it requires a ______of the narcotic (opioid).
smaller dose
POSS
Pasero Opioid induced sedation Scale
Tolerance
(a physical, not a psychosocial, response to a drug)
Increases doses to obtain same response
Cross-tolerance to other opioid agonists
Not the same as addiction!!!
Addiction
the continued use of a substance despite its negative health and social consequences
(1) a ‘high’, and
(2) the addicted person’s life is NOT improved by continuing the addiction!
Physical dependence
physically dependent clients attempt to discontinue the drug, they experience highly uncomfortable symptoms that make them want to continue use.
Methadone, buprenorphine, or Suboxone maintenance
Psychological Dependence
Addiction is a pattern of compulsive drug use characterized by a continued craving for an opioid and the need to use the opioid for effects other than pain relief (euphoria and psychological escape from life):
getting ‘high’ is the goal/drive
the addicted person’s family and/or social life is spiraling downwards as a result of this behavior
There is detrimental effects to key relationships in the addicted person’s life
Addiction is NOT a typical concern with opioid use in patients with persistent pain T or F
True
OD Signs
Resp depression, coma, pinpoint pupils
Opioid OD tx
Ventilatory support
Opioid antagonist – naloxone (NARCAN)
Naloxone- Narcan Naloxone - Canada.ca
Naloxone is a fast-acting drug used to temporarily reverse the effects of opioid overdoses. It is a competitive opioid antagonist.
It can restore breathing within 2 to 5 minutes.
Naloxone only works if you have opioids in your system.
Naloxone only works temporarily
- Effects of opioids are likely to outlast nalaxone, so another dose will be necessary
Non-opioid Analgesics
Acetaminophen (LFTs)
Non-steroidal inflammatory drugs (NSAIDS) - GI dysfunction, kidney funciton
Ibuprofen
Acetylsalicylic Acid
Naproxen
How to use of non-opioids
Weigh risks versus benefits
Start low to determin pt rxn
Adjuvant Analgesics:Indications
Often given with opioid analgesic agents to assist the primary agents with pain relief
NSAIDs (non-steroidal anti-inflammatories) – ie Ibuprofen
Antidepressants (TCAs, SSRIs) – ie Amitryptiline
Anticonvulsants (neuropathic pain) – ie Gabapentin
Corticosteroids (inflammatory pain)
Optimizing Adjuvant Medications for Analgesia: KEY Principles
The adjuvant analgesic with the greatest benefit and least risk should be administered as first-line treatment. Often this is an anticonvulsant such as gabapentin, or an antidepressant such as nortriptyline for treatment of cancer-related neuropathic pain.
Consider combination therapy with two or more drugs in the event of partial response to single drug therapy.
NSAIDs should be used cautiously in patients with a hx of _________ and always taken with food/ milk
GI Bleeds
Migraine tx
Begin w/ Acetaminphoen or NSaids
If unsuccessful, drug of choice is triptans (Constrict intercranial vessels)
Sumatriptan (constrict vessels, can cause coronary vasospasm)
