Pain Flashcards
Chronic pain is considered to be pain lasting over __________
12 weeks
Most people with LBP will have improvement in ________
4-6 weeks
Most people with LBP will have recurrence in _______
12 months
What is the aetiology of sciatica pain?
- most people have some sort of disc herniation -> nerve root irritation
- ruptured disc, or herniated disk is usually what causes this
What are the typical s/s of sciatic pain?
- intermittent shooting pain
- tingling or numbness
- loss of strength
- generally unilateral
- worse than the LBP
- numbess/tingling/pins and needles
- positive results on a straight leg raise tests
- weakness and reflux changes
With chronic pain, likely patients with be better within ______
3 months
What is a high pain intensity score often based on?
- suffering, helplessness and hopelessness
- when we use exogenous opioids, we sacrifice normal healthy motivational behaviours, socialization and coping
What are the goals of therapy in chronic pain?
- QOL
- exercise
- sleep
- decreased pill burden
What are the short term opioid AE?
- nausea, sedation, dizziness and cognitive impairment
What are the long term AE of opioids?
- constipation, dependence, tolerance, dental problems, hypogonadism, unintentional overdose, opioid therapy may paradoxically induce abnormal pain sensitivity, including hyperalgesia and allodynia
What is the opioid efficacy in neuropathic pain?
- not really a lot of efficacy in this space
- in chronic neuropathic pain, we should not be using opioids
Response to opioids is less likely if what?
- if there was minimal improvement after 2-3 dose increases
What are the non-pharm options for pain?
- heat
- massage
- yoga/tai chi
- exercise
- physio
- acupuncture
- behavioural therapy
What is the benefit of exercise with pain?
- exercise will not make sciatica go away, but it will make people lose wight and will help with mood
- exercise will help prevent recurrences in injury - help to increase strength and mobility- core strengthening and balance training
When is the only time muscle relaxants are warranted?
- if spasms are involved
Talk about dosing with cyclobenzaprine?
- high doses do not work better than low doses
- sedative may still be an issue in the morning
- effect within the first 4 days
- this drug likely only really helps people sleep**
- do not use beyond 2 weeks
What agents will help improve global effect?
- acupuncture
- chiropractic
- epidural injections
- non-opioid
- manipulation
What are the SE associated with corticosteroid injections?
- headache, nauseas, abscesses in the epidural space, paralysis
Does pregabalin work at all with sciatica?
- NO - no better than placebo
Is duloxetine much better than placebo?
- NO
- when placebo drops by 2 points, then duloxetine drops by 2.5 points
What are the main SE associated with TCAs?
- weight gain
- dry mouth
- sedation
- orthostatic hypotension
What are the main SE associated with gabapentin?
- drowsiness, dizziness, edema (caution in elderly, existing edema, fall risk)
What are the main SE associate with duloxetine?
- nausea
- increased BP
- dizziness (caution in HTN and bipolar disorder)
Does sedation as a SE last a long time?
no- sedation fades away over time
Naproxen is cardiovascular _____
neutral
Celebrex is cardio _______
neutral at 200 mg or less and as long as the person does not have heart failure
What are the efficacy monitoring points?
- an increase in general activity
- mood
- walking/activity
- normal work
- relations with other people
- sleep
What is a reasonable f/u time in pain?
2-4 weeks is reasonable
What is a reasonable f/u time with sciatica?
- back pain should be followed up in a 5-6 month time- should monitor then
