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pain management Flashcards

1
Q

pain def 1

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

pain def 2

A

A revised definition identifies pain as “a somatic perception containing: (1) a bodily sensation with qualities like those reported during tissue-damaging stimulation, (2) an experienced threat associated with this sensation, and (3) a feeling of unpleasantness or other negative emotion based on this experienced threat”

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3
Q

hyperalgesia

A

Increased response to a stimulus that normally is painful

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4
Q

hypoalgesia

A

Diminished response to a normally painful stimulus

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5
Q

hyperesthesia

A

Increased sensitivity to stimulation, excluding the special senses

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6
Q

hypesthesia

A

Diminished sensitivity to stimulation, excluding the special senses

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7
Q

dysesthesia

A

An unpleasant abnormal sensation, whether spontaneous or evoked

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8
Q

paresthesia

A

An abnormal sensation, whether spontaneous or evoked

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9
Q

allodynia

A

Pain resulting from a stimulus (such as light touch) that does not normally elicit pain

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10
Q

addiction

A

misuse of a substance for purposes other than one for which it was prescribed and despite negative consequences in health, employment, or legal/social spheres, demand for specific medications and doses, anger and irritability, poor cooperation, disturbed interpersonal reactions

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11
Q

pseudo-addiction

A 
exhibiting behaviors associated with addiction but only because their pain is inadequately treated
*undercontrolled*
figuring out difference is tough!*
-assess validity of pain
-multidisc. approach
-get a good hx
-tx pain
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12
Q

avoid profiling in drug addiction

A

“white women” are the face of modern pill addiction

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13
Q

Neuropathic pain

A

abnormal neural activity secondary to disease, injury, or dysfunction of the nervous system

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14
Q

Sympathetically mediated pain (SMP) arises from ???
assoc. w/ ???
known as…
most common cause ??

A

a peripheral nerve lesion
associated with autonomic changes (complex regional pain syndrome I and II, formerly known as reflex sympathetic dystrophy and causalgia)
Diabetic neuropathy most common!

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15
Q

Peripheral neuropathic pain

A

damage to a peripheral nerve without autonomic change (postherpetic neuralgia, neuroma formation)

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16
Q

Central pain arises from ???

examples:

A

abnormal central nervous system (CNS) activity

phantom limb pain, pain from spinal cord injuries, and post-stroke pain
-hard to tx, tx CNS issue

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17
Q

pain toxonomy axes (IASP)

A

Axis I: Anatomic regions
Axis II: Organ systems
Axis III: Temporal characteristics, pattern of occurrence
Axis IV: Intensity, time since onset of pain
Axis V: Etiology

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18
Q

chronic pain dx

A 
Chronic complaints of pain
Symptoms frequently exceed signs
Minimal relief with standard treatment
History of having seen many clinicians
Frequent use of several nonspecific medications
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19
Q

visceral pain is very hard to ?

A

localize

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20
Q

fibromyalgia dx

A

Usually women aged 20-50

  • Chronic widespread musculoskeletal pain syndrome with multiple tender points
  • Fatigue, headaches, numbness
  • Inflammation absent*, lab studies normal
  • easily written off!
  • look like have MDD
21
Q

afferent pain tract

A

STT: spinothalamic tract

22
Q

benzos for chronic pain

A

diazepam (valium)
lorazepam (ativan)
midazolam (versed)
clonazepam (klonopin)

23
Q

opioid withdrawal stage I

A
24
Q

opioid withdrawal stage II

A

8-24 hrs

insomnia, restlessness, anxiety, yawning, stomach cramps, lacrimation, rhinorrhea, diaphoresis, mydriasis

25
Q

opioid withdrawal stage III

A

up to 3 days

vomiting, diarrhea, fever, chills, musc. spasms, tremor, tachycardia, piloerection, HTN, seizures (neonates)

26
Q

muscle relaxants for chronic pain

A 
cyclobenzaprine
carisoprodol (soma)
baclofen (lioresal)
methocarbamol (robaxin)
*loopiness-take before bed, used with ice packs
27
Q

barriers

A

Physicians have poor training
Fears of legality:
FDA, DEA, controlled substance
document!
Fears of abuse:
-Tolerance vs Dependence vs Addiction vs Pseudo-addiction
-IPMP website, can see pts prescribed opioids to

28
Q

pain1 slide 17: KNOW!!***

A

WHO analgesic ladder

29
Q

mild pain

A

non-opioid: acetaminophen (paracetomol)(liv. tox, not v. strong), ASA, NSAID (GI, CV, renal SE)
+/-adjuvant

30
Q

mild-mod pain

A

opioid (codeine-not so much, tramadol*partial agonist)
+/- non-opioid
+/- adjuvant

31
Q

mod-sev pain

A

opioid (morphine, fentanyl, dilaudid etc)
+/-non-opioid
+/-adjuvant

32
Q

nociceptive pain: joints

A

patches, topical lidocaine

33
Q

non-imflamm pain

A

tylenol

34
Q

for chronic pain

A

adjuvants

35
Q

neuropathic pain tx: 1st line agents

A

gabapentin
SNRIS
TCAs

36
Q

neuropathic pain tx: 2nd line

A

opioids (tramadol)

antiepileptics

37
Q

neuropathic pain tx: 3rd line

A

NMDA antagonists
combo
tizanidine
baclofen

38
Q

neuropathic pain tx: 4th line

A

consider botulinum toxin injection or

intrathecal ziconotide

39
Q

spinal stimulator

A

for chronic lower lumbar pain, block pain

not first line tx, meds first

40
Q

opioid manangement

A

document everything

  • avoid refills
  • printed out, NOT electronic prescription
41
Q

benzos good for..

but…

A

central, spasm, neuropathic pain, also tx anxiety rel. to pain
tough to manage, can make pt “high”
-Brown does not give often

42
Q

tapering protocal

A

DEA have sp. protocol for opioids, give less and less with added behavioral therapy

43
Q

palliative care focus

A

Focus on symptoms, quality of life, and goals of care

44
Q

palliative care management

A

Pain
Dyspnea
Nausea,vomiting
Constipation
Agitation
Emotional distress (depression, anxiety, relationships)
Existential distress (spiritual distress)

45
Q

opioid SEs

A

constipation- may need meds (docusate, colace, etc)

methalnaltrexone reverses constipation

46
Q

OMM

A

medium effect on chronic low back pain

47
Q

case 1: motorbike accident, 100 mph, road rash, stabilized

A

Need pain scale
Probably in v. severe pain, potentially in shock (mental)
Opioids are a good choice: don’t want to give so much stop breathing, or affect neural reflexes and cannot monitor
-give morphine, “start low and go slow”(better for when you want to give a lot and worried about neuro) could use dilaudid, longer dosage schedule, not ideal
-do everything when get to ER: head CT, CXR (ptx, broken clavicle etc.)
-paramedics may call ahead to drs and give meds/prep for others/procedures
-needle thoracotomy (fastest- relieves pressure, chest tube)

48
Q

case 2: sharp stomach pain around lunch time, right of bb-radiates to right side
no rebound tenderness
no pmhx

A
  • abdominal CT: appendicitis (take out), diverticulitis
  • visceral pain, not well localized
  • morphine, potentially stronger- dilaudid, fentanyl patch
  • control pain, prep for surgery
49
Q

case 3: unresponsive old man, low RR, HTN, dying, end-stage lung ca

A
  • family wanted comfort measures only (not IV)
  • palliative care, end of life care (not just, however-diff than hospice)
  • fentanyl patch: long-acting

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