Pain lecture part 2 Flashcards
The primary action of oxymorphone is
Mu (respiratory depression)
some delta activity (psychomimetic)
Hydrocodone has activity on
Mu, some Kappa (dysphoria)
combined with acetaminophen
Hydromorphone as activity on
Mu & Kappa (dysphoria)
-may be used intrathecally
Methadone is a
NMDA antagonist
Mu agonist
cardiotoxic
Tramadol is a
weak opioid analogue of codeine
considered to be non-addictive but can be
not safer than opioids
Opioid therapy for chronic pain is
NOT a good long term solution
Tolerance to opioids over time includes
opioid induced hyperalgesia
rotation of opioids improve analgesia and reduce side effects
Corticoid steroids commonly used in pain management include
methylprednisolone
triamcinolone
betamethasone
All steroids have some
mineralcorticoid effects such as sodium retention & insulin resistance
Long acting particulate steroids can cause ______ if vascular injection
spinal infarct
-short acting dexamethasone is okay
Frequent side effects of steroids include
fluid retention
hyperglycemia with increased insulin requirements
Infrequent side effects of steroids include
hypertension amenorrhea hypokalemia exacerbation of CHF anaphylactoid/hypersensitivity reactions adrenal suppression
Long term use of steroids causes
hyperpigmentation
osteoporosis
myopathy
Topical steroids can be used for
multiple chronic pain syndromes because they have continued peripheral nerve stimulation,
high benefit/low risk
Sleep aids can
decrease pain because lack of sleep contributes to pain and vice versa
-sleep aids combined with pain medications pose a significant risk
Treatment for sleep should begin with
non-pharmaceuticals & include
mechanical aids (pillows, positioning)
natural aids, exercise (stretching), biofeedback
Antidepressant considerations
complimentary to pain medications
not appropriate for acute pain (take days to weeks to be effective)
increased compliance and mood reported
Pain due to changes in sensory process may be effectively treated with
anticonvulsants
Anticonvulsants may treat
fibromyalgia (functional pain)
trigeminal neuralgia- most effective
little evidence exists for support of other treatments
NMDA receptors may play a role in
Alzheimers disease and schizophrenia
NMDA receptors are critical in
synaptic plasticity, a cellular mechanism for learning and memory
NMDA antagonists include
Ketamine
PCP
robitussin
methadone
Low dose ketamine has been studied for the treatment of
complex regional pain syndrome
Preemptive treatment with NMDA antagonist may be effective to prevent
post-operative pain hypersensitivity (0.25 mg/kg)
Muscle relaxants should not be used
as a first line agent & should be limited for use for a short amount of time
used for myofascial pain
Pain has ______ consequences
psychological
______ & _____ often develop simultaneously
chronic pain & depression
The two dimensions of perceptive pain include
sensory discriminators in dorsal sensory cortex (causes perception of pain)
The most common cause of pain and disability is
lumbar radicular syndrome
Causes of lumbar radicular syndrome include
various
discogeic, osteogenic, neurogenic
associated nerve root inflammation
The purpose of treatment for lumbar radicular syndrome is to
reduce nerve root pressure caused by inflammation
Symptoms of lumbar radicular syndrome include
pain, parestehsia, and/or numbness following a particular dermatomal distribution, diminished reflexes, increased pain with straight-leg raises
Treatment options for lumbar radicular syndrome include
interlaminar ESI
transforaminal ESI
caudal ESI
Interlaminar ESI includes
catheter or without
lowest risk
lowest results
Transforaminal ESI includes
highest risk
best results
Caudal ESI includes
most versatile
good results
catheter recommended for lumbar
Red flags for lumbar radicular syndrome (i.e. explore other possibilities)
<20 years old, congenital issue >50 years, rule out malignancy, AAA short term <3 m. more serious etiology recent trauma ay signs of infection unrelated pain incontinence, bilateral neurological symptoms (excluding pain)
Describe the symptoms of facet arthropathy.
focal pain over joint, no significant radiculopathy, no neurological deficit, pain exaggerated on twisting movement
Qualifications for insurance pre-authorization includes:
must have radicular symptoms following a specific dermatome
must have failed conservative treatment for three weeks (NSAIDs, PT, etc.)
must have an average pain score greater than 6 out of 10
must cause reduction in ability to work and perform ADL
must not be at more than two levels
Qualifications for repeat injection include
must have had greater than 50% improvement from first injection
must have shown improved mobility
must not have more than 3 injections in a six month period of time
The purpose of the SI joint is
shock absorption for the spine, along with the job of torque conversion
Symptoms of sacroiliac joint syndrome include
pain in the superior medial buttock, lateral buttock, radiation to the hip and groin
Symptoms of occipital neuritis include
headaches that originate in the neck and radiate along the occipital skull to the top of the head and later to ear
Patient barriers to treat pain include
lack of access to care ignorance and fear of treatment misinformation cultural issues provider barriers inadquate continuing education lack of pain treatment as a prioirty absence of adequate pain monitoring regulatory hostility toward aggressive pain treatment lack of empathy
Consequences of failure to treat pain include
debilitation lower quality of life depression divorce suicide
