Pain Management

Question 1

Pain

Answer 1

Common symptom that leads to healthcare
� Ethical duty to relieve pain to best of our ability
�Pain increases stress
� Untreated pain leads to chronic pain, hypersensitivity

Question 2

Barriers to Pain management

Answer 2

from healthcare professionals, families, system
types of pain meds that are given,
fear of addiction
if addict may need higher doses than usual

Question 3

Myths of pain and pain management

Answer 3

if given morphine - must be terminal

don’t want to be bad pt so they don’t complain about pain

Question 4

Physical Dependence:

Answer 4

a medication specific withdrawal. The withdrawal results from abrupt cessation, rapid dosage reduction, decreasing blood level of the drug, or administration of an antagonist.

Question 5

Tolerance:

Answer 5

exposure to a drug induces changes that result in the diminished effects of a drug over time. Dosages must increase to maintain effect.

Question 6

Addiction

Answer 6

they will do anything to get drug. steal, lie, etc

Will have 3 Cs - craving, compulsion, loss of control

Question 7

Pseudo-addiction

Answer 7

not addicted but want pain relief

will behave like addict

Question 8

Pain is …..

Answer 8

perceived in brain, transmitted via spinal cord

Question 9

Pain Assessment

Answer 9

location, description, type, intensity, pattern, when did it start, how long does it last, pain goal, what makes it better/worse, pain med hx

Question 10

Physiological and Psychological consequences to unmanaged pain

Answer 10

increases stress, change in ADLs, change in relationships

Question 11

Visceral Pain -

Answer 11

Visceral - localized to site, usually aching, may be referred

Question 12

Muscle Pain

Answer 12

• difficult to isolate, ex: charlie horse

Question 13

Bone Pain

Answer 13

• dull ache, well localized, when move, at night

Question 14

Neuropathic Pain

Answer 14

• superficial burning pain, constant, may be referred. Skin on fire, someone stabbed me, shooting pain

Question 15

Pleuritic Pain

Answer 15

• guarded, shallow breathing, hurts to breath in

Question 16

colic

Answer 16

• obstruction, cramping, comes and goes

Question 17

Acute Pain

Answer 17

after sx, protective mechanism, stop pt from doing something. vitals change

Question 18

Chronic Pain

Answer 18

chronic - lasts 3-6 months, no vital sign changes learn to adapt to pain

Question 19

Medication Administration

Answer 19

Routes - oral, iv IM, subQ, transdermal bucal, fecal etc
� Least invasive to most invasive
� Use multi-modal approach
� Individualize dose, route and schedule
� Pay attention to efficacy and side effects, titrate accordingly
� Maintain steady blood level with ATC dosing
� Medicate appropriately for breakthough pain

Question 20

Medication Administration DON’Ts

Answer 20

Don’t use meperidine (Demerol)
� Don’t use darvocet (propoxyphene)
� Don’t assume all opioids will have the same effect
� Don’t forget about the amount of acetaminophen in combined pain meds


Question 21

WHO - Step1 meds

Answer 21

Aspirin (ASA)
Acetaminophen (Acet)
Nonsteroidal anti- inflammatory drugs (NSAIDs), adjuvants

Question 22

WHO - Step 2 meds

Answer 22

Acet or ASA + Codeine Hydrocodone Oxycodone

+ Adjuvants

Question 23

WHO - Step 3 meds

Answer 23

Morphine Hydromorphone Methadone Fentanyl Oxycodone
+ Nonopioid analgesics
+ Adjuvants

Question 24

Adjuvant medications

Answer 24

Antidepressants
� Anticonvulsants
� Benzodiazepines
 �Anticholinergics 
�Sodium channel blockers 
�Calcium channel blockers �Antihypertensives
 �Muscle relaxants

Question 25

Interventional procedures:

Answer 25

Nerve block
�Intrathecal pump
�Radio frequency ablation
� Vertebroplasty/kyphoplasty �IDET
�Surgery
�Spinal cord stimulation - tens unit

Question 26

Alternative/complementary therapies

Answer 26

TENS unit
�Meditation
�Relaxation techniques
�Massage therapy 
�Physical therapy
�Heating pads/cold packs
�Compounded medications �Acupuncture/acupressure
�Pet therapy, 
music therapy
�Imagery
�Biofeedback
Hypnosis
�Counseling
�Laughter therapy
�Art therapy
�Prayer

Question 27

Opioid side effects

Answer 27

Constipation
�Sedation
�Nausea/Vomiting
�Delirium
�Respiratory Depression
�Urinary Retention
�Withdrawal/Physical Dependence 
�Tylenol Overdose

Question 28

Side effect management

Answer 28

Investigate for other possible causes of SEs
�Tolerance to lethargy, drowsiness, nausea usually develops w/in 3-5 days of regular dosing
�Reduce dose to maintain pain control while decreasing SEs
�Rotate opioids
�Medicate for SEs - stool softener, antiemitcs

Question 29

Issues with Opioids

Answer 29

Renal function
Hepatic function
Advanced age
History of substance abuse
Other medications
Route of administration

Question 30

PCA (Patient Controlled Analgesics)

Answer 30

very effective but pt must push button
will have iv fluid carrier
watch how breathing is doing
may be used with an epidural - should relieve pain but not make the patient numb, should have feeling in legs - epidural may have migrated if numb legs

Question 31

relister

Answer 31

new SubQ med that counteracts opioid constipation side effect

Question 32

PCA Meds

Answer 32

morphine, fentanyl, dilaudid

Question 33

PRN meds

Answer 33

Nausea - phergyn, Zofran
itching = benedryl
narcan - to reverse pain meds effect

Question 34

Side effects of Pain meds

Answer 34

Resp Depression, sedation increases, N/V, Itching, Constipation, LOC changes

Question 35

What comes first? Sedation or Resp Depression

Answer 35

Sedation

Question 36

APAP

Answer 36

stands for acetaminophen