Pain Management Flashcards
defin pain
unpleasant sensory and/or emotional experience typically associated with physical damage to the body
define chronic pain
lasts longer than three months
can occur w/out known cause, after injry has healed, or a condition has been treated
chronic primary pain
pain persists after body has healed or no identifiable causes
fibromyalgia, pelvic pain, musculoskeletal pain, lower back pain
chronic secondary pain
occurs together with underlying diseases or issues
cancer pain, post-surgical pain, and rheumatoid arthritis
__ in __ Canadians live with chronic pain
1 n 5
__% of Canadians living with chronic pain have lived with it for over 10 years
50%
how many Canadians over age 65 live with chronic pain?
1 in 3
__ to __% of people with substance abuse disorder report chronic pain
31-55%
highest prevalence of chronic pain in Canada
Indigenous people
chronic pain conditions in Indigenous peoples
diabetes 16%
arthritis 18%
chronic back pain 12%
direct healthcare cost for Canada regarding chronic pain
$7.2 billion/yr
combined direct and indirect cost of chronic pain in Canada =
$ 56-60 billion/ yr
the most common and most expensive cause of work-related disability in the population younger than 45 y/o
chronic back pain
the leading cause of long-term disability in adults, esp. in the 45-65 age range
arthritis
60% of ppl with chronic pain will…
- loss their jobs
- will have reduction in responsibilities
- suffer income loss
people with chronic pain who are employed will lose ____ days of work per year
28.5
how many ppl in Alberta are estimated to have chronic pain
940 000
total health expenditure spent on chronic pain in Alberta
6-8%
how many people in AB take opioids for pain relief?
596 000
how many ppl who use opioids in AB ar considered problematic users?
58 000
how many deaths in 2023 (Jan-April) are from opioids?
613
define non-specific low back pain
pain, muscle tension, or stiffness that occurs between the rib cage and inferior gluteal folds, with or without leg pain and has no identifiable cause
specific low back pain
associated with an identified cause =
infection, fracture, arthritis, tumor
what is the percentage of non-specific back pain in the total cases of back pain?
90%
in the majority of pople with chronic back pain, the pain will resolve in __ weeks
2
- 20% to 40% will xperience another episode within the year
- 2 to 7% = chronic lower back
- 10% of cases cause more than 80% of the cos for low back pain
what percentage of people return to work from sick leave from lower back pain within 1 week?
66%
- 90% within 2 months
- less than 50% = after 6 months
- virtually no one will return to work after 2 years
patients with disabling pain or functional limitation should be referred to a specialist within…
2-6 weeks
approach to pain treatment
- indivs with chronic pain benefit from a multidisciplinary treatment approach
- combined exercise and patient education significantly reduce pain
- efficacy for chronic opioid therapy for chronic noncancer pain is limited
- nonetheless, COT for chronic noncancer pain increased between 1980 and 2000
T or F. Chronic pain and SUDs overlap
T
- 3-48% of chronic pain patients have SUDs
- 24-67% of patients with SUDs have chronic pain
- substance use may be a maladaptive coping response to pain
broad spectrum analgesics used for treatment of
nociceptive and neuropathic pain
published rates of abuse and/or addiction in chronic pain populations are __ to __%
3 to 19%
known risk factors for addition to any substances are good predictors for ..
problematic prescription opioid use
- past cocaine use, h/o alcohol or cannabis use
- lifetime history of substance use disorder
- family history of substance abuse, a history of legal problems and drug and alcohol abuse
- tobacco dependence
- history of severe depression or anxiety
risk of not Rx
continue addiction
unsuccessful detoxification
increase distress and anxiety may trigger relapse
risk of Rx
may trigger relapse
pressured to supply opioids to addicted friends
maybe tempted to sell opioids to supplement income
COT guidelines for high risk patients monitoring tools:
- opioid treatment agreements
- urine drug testing
- opioid risk assessments helpful for long term use
- pill counts
also:
- consultation with mental health/addiction spcialist
- constant need for re-eval
- discontinuation of COT for diverting opioids or serious aberrant behaviours
______ drug testing is another tool in the tool box for appropriate care of patients with SUD and/or chronic pain
urine
predictors of UDS ordering
younger age
positive cage questionnaire results
early stage of cancer or no disease status
high pain intensity
lower fatigue scores
a primary care, managed approach to opioid therapy in chronic pain patients at risk for substance use
opioid renewal clinic
45% of pts with previously demonstrated aberrant drug related behaviours were able to adhere to their medication regimes after:
- management with urine drug monitoring
- signed agreements
- multispecialty care
R03 recommendation statement
when using UDS t establish a baseline measure of risk or to measure compliance, be aware of benefits and limitations, appropriate test ordering and interpretation and have a plan to use results
