Pain II Flashcards
What is the triple whammy effect of ineffective pain management?
1) physicians under prescribe
2) nurses under administer
3) patients may under report
What are the 4 general methods of treatment for pain relief?
1) modifying the disease process
2) interrupting pain transmission (nerve blocks, rhizotomy)
3) pharmacological management
4) non-pharmacological management
What are the drugs listed under non-opioid analgesics?
Acetaminophen
NSAIDs
What are the adverse effects for acetaminophen?
Hepatic failure
What are the adverse effects for NSAIDs?
Ulcers/GI bleeds, inc bleeding, renal failure
How do non-opioid analgesics act (acetaminophen and NSAIDs)?
peripherally by blocking prostaglandins
What is one of the disadvantages of non-opioid analgesics?
they have a ceiling effect (that is, there is a point where increasing the dose no longer increases the relief)
What is often given alongside of NSAIDs to help reduce the adverse effects?
a PPI for ulcer reduction
List an advantage and disadvantage of using an opioid analgesic.
advantage: no ceiling effect
disadvantage: become tolerant and require higher doses
What are the AE that are associated with opioid analgesics?
Constipation Resp depression Pruritis Nausea Hallucinations HTN
How do opioid analgesics act?
on CNS receptor sites binding to opioid receptors
what is used to treat the nausea associated with opioids?
gravol
When someone takes too much opioids and goes into resp depression, what is the drug given to reduce this?
Narcan
What is the purpose of an adjuvant pain medication?
to manage specific types of pain and enhance the effectiveness of other analgesic meds and may decrease dose required of opioid
What are the 4 main classes of adjuvant pain medication?
1) Antidepressants
2) Anti-anxiety
3) Anti-convulsants
4) Corticosteroids
What type of pain are anticonvulsants used as an adjunctive for?
Neuropathic pain
What are the benefits of corticosteroids related to pain management?
suppresses inflammation and does also have a direct analgesic effect
used for Ca, bone pain
What type of pain are antidepressants often used as an adjunctive medication for?
chronic pain
What type of pain symptoms are anti-anxiety meds used as an adjunctive medication for?
Anxiety and muscle spasms
ex ativan
What types of analgesics are good for musculoskeletal pain?
Acetaminophen, NSAIDs, COX-2 inhibitor
What types of medication are used for bone pain?
Corticosteroids if Ca
Calcitonin, vit D and calcium for osteoporosis
What types of medications are used for neuropathic pain?
Anticonvulsants, antidepressants, capsaicin cr, combined with other classes
baclofen for muscle spasms
Describe the WHO three step pain ladder.
1) mild pain: non opioid + adjuvant
2) mild to mod pain: add opioid
3) mod to severe pain: inc dose of opioid and consider choice and route of opioid
What does ATC dosing mean? what does it help prevent?
it is around the clock dosing and helps prevent the recurrence of intolerable levels of pain
What are the 4 principles of pharmacological management?
1) 3 step pain ladder
2) combined analgesia (treat acute and chronic)
3) preemptive analgesia (treat perioperative pain or prior to mobilizing)
4) titrating dose upwards or downwards to individualize management
If you are using non-pharmacological approaches, are they a substitute for medications?
no they are not, they are to be used in addition.
What can be said about the outcomes of non pharmacological approaches?
they are highly unpredictable. Plans need to be individualized as different interventions will be effective for different individuals.
What are the guidelines for non-pharmacological treatment of pain?
1) clarify that it is not a replacement
2) assess attitude and experience
3) ask what helps besides medication for their pain
4) assess lvl of fatigue, cognitive status, and ability to concentrate and follow instructions
5) ask family and friends if they wish to be involved
6) provide adequate support
List some common non drug treatments.
Cutaneous stimulation: hot and cold, vibration, massage
Distraction
Relaxation
What must be done when assessing pain in the elderly.
1) ask about pain regularly
2) remember the misconceptions about pain in the elderly
3) expect pain whenever there is any possibility of it
4) use appropriate pain rating scales
5) believe the family and the pt
6) use the word pain medicine over drugs/narcotics
7) use the words discomfort or aching
What are some common misconceptions about pain in the elderly?
belief that pain is part of the aging process
belief that they have dec ability to detect pain
List some barriers to assessment of pain
Cognition
Hearing
Family members and individuals not wanting meds
What should you do when assessing elderly individuals with cognitive and communication impairment?
1) start with pt’s self report of pain
2) consider pathologic conditions and procedures that might cause pain
3) look for behaviours that indicate pain
4) use a proxy pain rating
5) know the pt and family
6) when in doubt, administer meds and evaluate response
What are the guidelines for pain management in the elderly?
1) use WHO ladder
2) combined analgesia
3) titrate slowly
4) preemptive analgesia
5) oral preferred
6) ATC dosing
7) use caution with certain drugs
What are some myths/misconceptions regarding pain in children?
Children do not feel pain
Children do not remember pain
Children may develop complications from opioid use
Fear of addiction
List some factors that influence pain in children.
Cognitive level
Temperament
Previous pain experience
Culture/family
What needs to be considered regarding pain in children?
conceptualization of pain r/t to age/stage
responses to pain r/t age/stage
cognitive knowledge
control issues
What is the acronym for child pain assessment and what does it mean?
QUEST
Question the child Use rating tools Evaluate behavior Sensitize parents and staff Take action
What age group is the faces assessment tool appropriate for?
3 and up
What age group is the poker chip assessment tool appropriate for?
4 and up
What age group is the visual analog scale good for?
age 7 and up
What are the two types of behavioural scales to assess pain?
Riley infant
FLACC
What is one thing you could do if you suspect a child is experiencing pain, but is not expressing it?
Use a teddy bear and ask if teddy is hurting today.
they often project
