Pain Management

Question 1

Definition: tissue injury thar activates specific pain receptors

Answer 1

nociceptive pain

Question 2

What are the two types of nociceptice pain?

Answer 2

somatic & visceral

Question 3

List the characteristics of visceral pain. (2)

Answer 3

associated with internal organs; hard to pinpoint exact location

Question 4

What is the main characteristic of somatic pain?

Answer 4

easy to pinpoint the exact location of the pain

Question 5

How will patients usually describe nociceptive pain?

Answer 5

dull, throbbing, stabbing, aching

Question 6

Definition: pain due to damage of the nerves

Answer 6

neuropathic pain

Question 7

How will patients usually describe neuropathic pain?

Answer 7

burning, numbness, tingling

Question 8

List the questions involved in pain assessment.

Answer 8

Onset; provokes; quality; radiate; severe; time; understanding

Question 9

What question should you always ask patients before prescribing opioids?

Answer 9

Are you having regular bowel movements?

Question 10

What would you give a patient who rates their pain as a 7-10?

Answer 10

opioids

Question 11

What would you give a patient who rates their pain as a 4-6?

Answer 11

combination products/mild opioids

Question 12

What would you give a patient who rates their pain as a 1-3?

Answer 12

non-opioids (acetaminophen, NSAIDs)

Question 13

What is the max dose of morphine?

Answer 13

Trick question: there isn’t one

Question 14

How are morphine metabolites excreted?

Answer 14

renally (do not use in patients with renal insufficiency)

Question 15

Does oxycodone have an IV formulation?

Answer 15

no

Question 16

What metabolizes oxycodone?

Answer 16

CYP2D6

Question 17

What is the most potent opioid?

Answer 17

fentanyl

Question 18

Can patients with renal and/or hepatic dysfunction use fentanyl?

Answer 18

yes

Question 19

In what patient populations would you use methadone? (3)

Answer 19

pain refractory to opioids; neuropathic pain; low cost is important

Question 20

What is important to think about with methadone? (hint: half-life)

Answer 20

half-life is very unpredictable; risk of QT prolongation

Question 21

When switching between opioids, how much should you dose-reduce?

Answer 21

25%

Question 22

What should all opioid patients be on?

Answer 22

bowel regimen consisting of a stimulant laxative and stool softener

Question 23

Which opioid most commonly cause pruritus?

Answer 23

morphine

Question 24

Do patients develop tolerance to constipation due to opioid use?

Answer 24

No

Question 25

What is the dose-limiting toxicity of opioids?

Answer 25

respiratory depression

Question 26

What do you administer to treat respiratory depression?

Answer 26

naloxone given slowly through IV

Question 27

When are patients at the highest risk for respiratory depression and over-sedation?

Answer 27

in the first 24 hours after surgery

Question 28

In what patient population would you use a celiac plexus block?

Answer 28

patients with pancreatic cancer

Question 29

Definition: group of nerves that supply organs in the abdomen

Answer 29

celiac plexus

Question 30

When would you use an intrathecal pain pump?

Answer 30

in patients who are not obtaining relief with elevated doses of opioids

Question 31

Would you use a larger or smaller dose of opioids when using an intrathecal pain pump?

Answer 31

smaller (300:1)

Question 32

What does an On-Q pump do?

Answer 32

delivers local anesthetic on or near the surgical site

Question 33

List the types of bone-modifying agents. (2)

Answer 33

bisphosphonates (zolendronic acid, alendronate); RANK-L inhibitor (denosumab)

Question 34

When would you use radiation therapy for pain management? (3)

Answer 34

painful bony metastases; brain metastases; spinal cord compression