Pain Management Flashcards
Classification of pain
- Duration: acute vs chronic
- Origin: Nociceptive (somatic, throbbing, well localized) vs. Neuropathic (result of nerve damage, burning, tingling, shock like, or shooting)
- Intensity: e.g. on a scale 1-10
General characteristics of nociceptive pain
- Acute
- Short duration and resolves
- Directly related to tissue healing
- Somatic
- Associated with cancer
General characteristics of neuropathic pain
- Chronic
- Persists longer than would be expected
- Related to a chronic disease
- Without identifyable cause
- Associated with cancer
Approach to management of acute pain
- Early intervention and treatment
- Prompt adjustments in therapy if inadequately controlled,
- Reduction of pain to acceptible levels with minimization of side effects,
- Facilitation of recovery from underlying injury/surgery/disease
Treatment goals of chronic pain
- control pain and decrease suffering
- functional restoration
- decreased utilization of the health care system
Approach to chronic pain management
- Enhancement of descending inhibitory pathways
- Opiods
- Antidepressants; block serotonin uptake
- Decrease in central sensitization
- Decrease in peripheral sensitization
Opioid analgesics: role in acute pain + efficacy
- Role:
- Moderate/severe pain
- Decrease perception/rxn
- Modulation
- Transmission
- Efficacy
- Very - cornerstone of moderate to severe pain treatment
Local anesthetics: role in acute pain + efficacy
- Role:
- Transmission
- Transduction
- Intense, prolonged anesthesia
- Opioid sparing
- Efficacy
- Very good
NSAIDs: role in acute pain + efficacy
- Role:
- mild pain tx
- reduce perception/rxn
- transduction
alpha-2 agonists: role in acute pain + efficacy
- Role:
- modulation of pain
- reduce perception/rxn
NMDA-receptor antagonist: role in acute pain + efficacy
- Role:
- Modulation
- Perception/rxn
- Block ascending pathway
Opioid analgesics: Pharmacokinetics & SE
- Pharmacok
- Liver metabolized
- SE
- Respiratory depression, euphoria, constipation, nausea, vomiting, miosis, sedation, pruritis
Local anesthetics: Pharmacokinetics & SE
- PharmacoK
- Routes: neuraxial infusion or peripheral nerve block amongst others
- SE
- Neurotoxicity, hypotension, dizziness, drowsiness
NSAIDs: Pharmacokinetics & SE
- PharmacoK
- COX2 centrally
- SE
- hepatotoxicity
NMDA-receptor antagonist: Pharmacokinetics & SE
- PharmacoK
- IV
- intranasal spray
- SE
- Anterograde amnesia
- HTN
Standard tx for mild acute pain
non-opoid +/- adjuvant analgesics
Standard tx for moderate acute pain
opioid for mild/moderate pain +/- non opioid +/- adjuvant analgesics
Standard tx for severe acute pain
opioid for moderate/severe pain +/- non opioid +/- adjuvant analgesics
Tricyclic antidepressants: role in chronic pain management, efficacy, pharmacoK, SE
- role: descending pain inhibition
- efficacy: good
- pharmacoK:
- SE: several toxic side effects
Serotonin Norepinenphrine Reuptake Inhibitors (SNRIs): role in chronic pain management, efficacy, pharmacoK, SE
- role: descending inhibition
- efficacy:
- pharmacoK:
- SE:
SSRIs: role in chronic pain management, efficacy, pharmacoK, SE
- role: descending inhibition
- efficacy:
- pharmacoK:
- side effects:
Anticonvulsants: role in chronic pain management, efficacy, pharmacoK, SE
x
Local anesthetics: role in chronic pain management, efficacy, pharmacoK, SE
- role: peripheral sensitization
- efficacy:
- pharmacoK: local/targeted delivery possible
- SE:
Non-opioid analgesics: role in chronic pain management, efficacy, pharmacoK, SE
- role:
- efficacy:
- pharmacoK:
- SE:
Opioid analgesics: role in chronic pain management, efficacy, pharmacoK, SE
- role: descending inhibition
- efficacy:
- pharmacoK:
- SE:
