Pain Management

Question 1

Delivery

Answer 1

Intrathecal

Question 2

d

Answer 2

d

Question 3

Zinconotide (Prialt)

Answer 3

d

Question 4

Intrathecal Baclofen

Answer 4

d

Question 5

Topicals

Answer 5

Analgesics
Anesthetics
Counterirritants
Antipruritic

Question 6

Topical Analgesics

Answer 6

Methyl salicylate (wintergreen oil)
Trolamine salicylate

Caution: Watch salicylates with anticoagulants; Watch for aspirin allergy; Short term use (Generally no more than one week)

Question 7

Counterirritants Names

Answer 7

Menthol
Camphor
Capsaicin

Question 8

Counterirritants

Answer 8

MOA: creates ittitation/inflammation locally to relieve inflammation in underlying of adjacent tissues; local anesthetic actions; antinociceptive effects due to activation of endogenous opioids
Use: minor myalgia/arthralgia

Question 9

Topicals

Answer 9

chart?

Question 10

Counterirritants:

Menthol

Answer 10

Use: orally for GI complaints; antispacmodic for IBS; lower GI motility; relaxes LES
topically for pain, inflammation, pruritus (directly inhibit pain receptors and alter pain perception

ADRs: Oral: heartburn, N/V
Topical: skin irritation, contact dermatitis

Question 11

Menthol Rub Abuse

Answer 11

• Used at raves to enhance high from XTC or MDMA
• Some smear on a fan to blow around the room
• Some heat on washcloth in microwave and inhale liberally or blow into someone else’s face
• Huffing Vick’s inhalers
• Some apply to eye

Question 12

Counterirritants:

Camphor

Answer 12

Topical antitussive/analgesic
FDA approved in concentrations up to 11%
Use: Possibly effective for OA
ADRs: Very toxic orally; N/V, burning of mouth and throat initially; Breath will have characteristic camphor odor; Can lead to seizure, respiratory failure

Question 13

Counterirritants:

Capsaicin (Zostrix, Qutenza)

Answer 13

MOA:
[TRPV 1 channel agonist
Transient receptor potential vanilloid 1
Ion channel-receptor complex attached to skin nociceptors; activated by heat and low pH ]

Initially enhances TRPV1 stimulation
Pain relief follows when TRPV1 nociceptors are reduced (desensitized)
Depletes substance P due to downregulation

Ind: post-herpetic neuralgia
Uses: tons

ADRs: PO-Gi discomfort, sweating, flushing, anticoag
Topical: burning, stinging, erythema, worse ACEI cough (improve with time)

Question 14

Counterirritants:
Capsaicin (Zostrix, Qutenza)

Indications and Uses

Answer 14

Indication:
Post-herpetic neuralgia

Uses:
Oral: dyspepsia, flatulence, colic, diarrhea, cramps, toothache, poor circulation, excessive blood clotting, seasickness, swallowing dysfunction, alcoholism, malaria, fever, hyperlipidemia, and preventing heart disease
Topical: pain of shingles, OA, RA, post-herpetic neuralgia, trigeminal neuralgia, diabetic neuropathy, back pain, and post-surgical neuralgias, HIV-associated neuropathy, and fibromyalgia
relieve muscle spasms, as a gargle for laryngitis, and as a deterrent to thumb-sucking or nail biting
Intranasal: allergic rhinitis, perennial rhinitis, migraine headache, cluster headache, sinonasal polyposis, and sinusitis

Question 15

Iontophoresis

Answer 15

• Transdermal drug delivery
• Uses ion current to deliver charged drugs through the skin
• Often dexamethasone phosphate to reduce inflammation: NSAIDs, local anesthetics, salicylates
• Can be used in PT
  6. 2.16: FDA warning: burns with Zecuity (migraine drug)