Pain Control Flashcards
Musculoskeletal Pain
NSAIDS
COX-2
Example NSAID
Ibuprofen
naproxen
Example of COX-2
diclofenac
celecoxib( celebrex)
Neuropathic Pain
Anticonvulsants 1st line and Analgesics THEN TCA anticonvulsants 2nd line SSRI Anti-arrhythmic agent
Example anti-convulsants 1st line- neuropathic
Gabapentin (neurontin)
Example Analgesics anti-convulsants-neuropathic
PREGABLIN
Example TCA-neuropathic
amitriptyline (Elavil)
nortirptyline (Pamelor)
imipramine (Tofranil)
desipramine (Norpramin)
Example Anti-convulsants 2nd line - neuropathic
Phenytoin (Dilantin)
Carbamazepine (Tegretol)
Valporic Acid (depakote)
Example SSRI- neuropathic
Fluoxetine (Prozac)
Sertaline (Zoloft)
Paroxetine (Paxil)
Duloxetine (CYmbalta)
Example Anti-arrhythmic - neuropathic
Lidocaine
Nociceptive Pain
Opioids
Pure Opioids
Example Opioids - nociceptive
tramadol, percoet, codeine, tylenol 3, vicodin
Example of Pure Opioids- nocicpetive
Morphine, oxycodone, hydromorphone, fentanyl, methadone
Tolerance
medication is less effective over a prolonged period use of drug
Dependence
medication has become physiologic requirement: abstinence syndrome develops if drug withdrawn
Addiction
behavioral reaction from drug misuse; drug seeking; it is characterized by following behaviors: impaired control over drug use, compulsive use, continued use despite harm and craving
Pseudoaddiction
behavioral reaction d/t inadq or under tx of pain
Somatic
Well localized, aching, throbbing, gnawing, activation of nociceptors in cutaneous and deep tissue
bone mets, soft tissue injury - OA, post op
Visceral Pain
poorly localized
deep aching, cramping, pressure, referred
activation of nocicpetors resulting from strech distention or inflammation
BO, billiary colic
Neuropathic Pain
Spinal cord, brain, PNS
shooting, shock like, burning, n/t/itch
Nociceptive 4 parts pathway of pain
Transduction- receptors trigger with injury
Transmisison- into spinal cord (a delta-c fibers)
Perception
Modulation- turn “down” signal natural endorphins, epi
Indications for XRAY
trauma neurologic deficit systemic symptoms temp >38 wt loss hx CA, steriod use, ETOH use
XRAY show
DDD, osteophytes (bridity of bone), instability, alignment, axial instability, basilar InVagination, compression fx
“Dynamic “ xrays
-ordered to evaluate the overall structural integrity
- extreme ROM
-measurement of curvature
*no info about deformation of discs, facets, ligaments, or soft tissue
movement with neck hyperextension/flexion
MRI show
confirm what you already know! soft tissue nerves discs osseus structures ligaments bone, disc, ligaments, neural elements, facet joints, paraspinal musculature
high false + MRI
asymptomatic patients in lumbar spine and cervical
CT show
- contraindication ot MRI- pacer, sharpnel in orbit, aneurysmal clips
- bony detail- neuro compression
- visualize neurological structure improve with myelogram
CT for
bone sx, quick to sit through, fx, bld, osseus structure, osteophytes, foramenal stenosis, spinal stensosi, deg changes
Bone Scan
screening tool, tumor, infection, occult fx
ID mets, infection, occult fx
TENS
nerve stimulation w/ mild electrical current, interrupt pain transmission, variety of uses adn modes, electrodes placed on site of pain NOT for prego or implanted devices
Heat
muscle tension, spasma, arthritis, NOT for lbd, topcial patches, irritated skin
Cold
muscle spasm, HA, trauma, surgical, incisional pain, NOT for poor circulation or irritated skin
Basic Comfort Measures
positioning, environ, pacing rest, support devices
Physical Exercise
45 mins- ROM , passive exercises, best for general MS pain, OA, exercise tolerance if CV risk
WHO 3 step analgesic for
non-opioid and adjuvant- Tyl, NSAID
Opioid with adjuvant- codeine, hydrocodone, oxycodone, dihydrocodiene
opioid + adjuvant- morphine, methadone, fentanyl, oxycodone, hydromorphone
