Pain Flashcards
Pain that persists beyond the usual course of an acute disease or after a reasonable time for healing to occur?
- ___ may be a predictor of transition to chronic pain.
- Emotional and psychosocial component.
Chronic Pain
-Poorly controlled acute pain
- Imbalance of neuromodulation controls?
- Attenuated or absent ___ response
- Decreased levels of ___ and ___
- Predominance of ___
- Associated with Chronic Inflammation in the ?
- Chronic Pain
- neuroendocrine
- endorphins and serotonin
- C-neuron stimulation
- Periphery
*Pain caused by cancer?
-___ is most common cause of cancer pain
-___ is #2 cause
•Pain due to treatment
•___ effects - worse due to loss of sleep, appetite, nausea and vomiting
•___ effects - heightened anxiety, feelings of loss, low self-esteem, changes in life goals, disfigurement
*Cancer Pain
-Tumor invasion of bone
-Tumor compression of peripheral nerves
Physical
Psychological
A syndrome of sustained burning pain, allodynia, and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and motor dysfunction and later trophic changes?
Causalgia
An unpleasant abnormal sensation, whether spontaneous or evoked?
Dysesthesia
Diminished pain in response to a normally painful stimulus?
Hypoalgesia
Increased sensitivity to stimulation, excluding the special senses?
Hyperesthesia
1) Pain due to a stimulus that does not normally provoke pain?
2) Increased pain from a stimulus that normally provokes pain?
3) Pain in the distribution of a nerve or nerves?
1) Allodynia
2) Hyperalgesia
3) Neuralgia
Management of Postoperative Acute Pain:
Preoperative Evaluation
•___ = Pain history - Physical exam - Self report measurement scales - Medications for pain - Document
•___ = Adjustments and/or continuation of meds
•Develop ?
Evaluate Pain
Preparation
Plan
Pain Management: Control of postoperative pain allows for:
–Reduction of the ___ –Shorter times to ___, shorter ___
–Improved ___ function –Earlier return of ___
–Early ___, decreased risk for ___
–Early discharge
–Reduction in sensitization, neuroplasticity, wind-up phenomenon, and transition to chronic pain
- stress response
- extubation, ICU stay
- respiratory
- bowel function
- mobilization, DVTs
Blockade of noxious stimuli response with the extension of this block into the postoperative period?
•Reduces postoperative pain and accelerates recovery
•Thought to attenuate (stop) ___ and ___ and ___ to pain and therefore the development of chronic pain.
Preemptive Analgesia
peripheral and central sensitization and hyper-excitability
*___ = Principle: Control postoperative pain and attenuate the perioperative stress response through the use of regional anesthetic techniques and a combination of analgesic agents (?)
•An extension of “clinical pathways” into effective postoperative ___
Multimodal Approach
(multimodal analgesia)
rehabilitation pathways
Benefits of the Multimodal Approach: •Pain control •Early \_\_\_ •Early \_\_\_ nutrition •Attenuate the \_\_\_ •Minimize side effects •Earlier discharge •Improve patient satisfaction
mobilization
enteral
stress response
Mode of Administration:
- ___ = preferred administration of postop opioid therapy
- Subcutaneous
- Intramuscular
- Oral
- Sublingual
- Rectal
- Buccal
- Intranasal
- Transdermal patch
-Intravenous
- Gold standard in pain management?
- Exert their analgesic effect through __ and __ __ receptors in the CNS
- No analgesic __
- Disadvantages include SIDE EFFECTS (esp. __ and __, nausea/ vomiting, sedation, pruritus, urinary retention), VARIABILITY, and TOLERANCE
- Opioids
- mu and kappa opioid receptors
- ceiling
- respiratory depression and hypotension
All examples of ? •Morphine Sulfate •Fentanyl •Sufentanyl •Alfentanil •Remifentanil •Hydromorphone •Meperidine
Opioids
PCA Systemic Opioids: *Features
- __ and __ controller
- Button pushed by patient = Demand (bolus), Lockout interval, Continuous, background infusion
- Most common drugs used?
Reservoir and Infusion
morphine sulfate and hydromorphone
PCA Systemic Opioids - Advantages: –Cost-effective –Higher degree of \_\_\_ –Total drug consumption is \_\_\_ –Harder to \_\_\_ self –Prevents the \_\_\_
- Patient satisfaction
- less
- over-medicate
- “pain/ no pain” cycle
NSAIDS = Exert their analgesic effect through inhibition of ___, preventing the synthesis of ___
-Used in ___ and pain related to ___ conditions
•Useful adjunct to ___
•As a result, the nociceptive response to ___ is attenuated, both peripherally and in spinal cord
cyclooxygenase (COX) prostaglandins mild to moderate pain inflammatory conditions opioids inflammatory mediators
NSAIDS - Side effects:
- Decreased ___ = ___ dysfunction, Inhibition of ___
- ___ and ___ dysfunction
- GI ___
- Effects on ___
-Hemostasis platelet thromboxane A2 -Renal and Liver -Hemorrhage -bone healing/osteogenesis
Examples of \_\_\_: *Given PO, PR, IV, IM •Ketorolac (Toradol) •Piroxicam (Feldane) •Nabumatone (Relafen) •Indomethacin (Indocin) •Celecoxib (Celebrex) •Parecoxib •ASA •Acetaminophen
NSAIDS
Examples of \_\_\_: •Ketamine •Tramadol (Ultram) •Nalbuphine (Nubain) •Methadone •Gabapentin •Celebrex
Adjuvant Drugs
Single injection or continuous infusion of local anesthetic applied at a peripheral nerve site?
-Can be used intraoperative or as an adjunct to postop anesthesia
•Limit the path of ___
•Superior ___
•Few side effects
•Can have analgesia for up to ___ after single injection
Peripheral Nerve Blocks
- nociceptive impulses
- analgesia
- 24 hours
*Examples of ??? Catheters can be placed in all of these sites except? –Brachial plexus blocks –Lumbar plexus blocks –Femoral nerve blocks –Sciatic-popliteal nerve blocks –Paravertebral blocks –Intercostal blocks –Intrapleural blocks –Intra-articular blocks
Peripheral Nerve Blocks
Lumbar plexus
Paravertebral
Intra-articular
Neuraxil Analgesia - Benefits:
•Provide superior analgesia compared with ?
•Reduced ___
•Facilitates return of ___
•Decrease incidence of ___
•Decreased incidence of ___ adverse events
systemic opioids stress response GI motility pulmonary complications coagulation-related
- Sole or adjuvant analgesic
- Intrathecal or epidural
- Opioid selection depends on degree of lipophilicity vs hydrophilicity
Single-Dose Neuroaxial opioids
Neuraxial Opioids:
- Hydrophilic opioids - Name 2 examples?
- Tend to ___
- Onset of action?
- Duration?
- ___ CSF spread
- ___ of side effects
Morphine and Dilaudid
- remain within CSF
- Delayed
- Longer
- Extensive
- High incidence
Neuraxial Opioids:
- Lipophilic opioids - Name 2 examples?
- Onset of action?
- Duration?
- ___ CSF spread
- ___ of side effects
- Fentanyl and Sufentanil
- Rapid
- Shorter
- Minimal (due to segmental analgesic effect)
- Less occurrence
