Pain Management Flashcards
Pain
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
Barriers to Pain management
from healthcare professionals, families, system
types of pain meds that are given,
fear of addiction
if addict may need higher doses than usual
Myths of pain and pain management
if given morphine - must be terminal
don’t want to be bad pt so they don’t complain about pain
Physical Dependence:
a medication specific withdrawal. The withdrawal results from abrupt cessation, rapid dosage reduction, decreasing blood level of the drug, or administration of an antagonist.
Tolerance:
exposure to a drug induces changes that result in the diminished effects of a drug over time. Dosages must increase to maintain effect.
Addiction
they will do anything to get drug. steal, lie, etc
Will have 3 Cs - craving, compulsion, loss of control
Pseudo-addiction
not addicted but want pain relief
will behave like addict
Pain is …..
perceived in brain, transmitted via spinal cord
Pain Assessment
location, description, type, intensity, pattern, when did it start, how long does it last, pain goal, what makes it better/worse, pain med hx
Physiological and Psychological consequences to unmanaged pain
increases stress, change in ADLs, change in relationships
Visceral Pain -
Visceral - localized to site, usually aching, may be referred
Muscle Pain
- difficult to isolate, ex: charlie horse
Bone Pain
- dull ache, well localized, when move, at night
Neuropathic Pain
- superficial burning pain, constant, may be referred. Skin on fire, someone stabbed me, shooting pain
Pleuritic Pain
- guarded, shallow breathing, hurts to breath in
colic
- obstruction, cramping, comes and goes
Acute Pain
after sx, protective mechanism, stop pt from doing something. vitals change
Chronic Pain
chronic - lasts 3-6 months, no vital sign changes learn to adapt to pain
Medication Administration
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
Medication Administration DON’Ts
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

WHO - Step1 meds
Aspirin (ASA)
Acetaminophen (Acet)
Nonsteroidal anti- inflammatory drugs (NSAIDs), adjuvants
WHO - Step 2 meds
Acet or ASA + Codeine Hydrocodone Oxycodone
+ Adjuvants
WHO - Step 3 meds
Morphine Hydromorphone Methadone Fentanyl Oxycodone
+ Nonopioid analgesics
+ Adjuvants
Adjuvant medications
Antidepressants � Anticonvulsants � Benzodiazepines �Anticholinergics �Sodium channel blockers �Calcium channel blockers �Antihypertensives �Muscle relaxants
Interventional procedures:
Nerve block �Intrathecal pump �Radio frequency ablation � Vertebroplasty/kyphoplasty �IDET �Surgery �Spinal cord stimulation - tens unit
Alternative/complementary therapies
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
Opioid side effects
Constipation �Sedation �Nausea/Vomiting �Delirium �Respiratory Depression �Urinary Retention �Withdrawal/Physical Dependence �Tylenol Overdose
Side effect management
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
Issues with Opioids
Renal function Hepatic function Advanced age History of substance abuse Other medications Route of administration
PCA (Patient Controlled Analgesics)
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
relister
new SubQ med that counteracts opioid constipation side effect
PCA Meds
morphine, fentanyl, dilaudid
PRN meds
Nausea - phergyn, Zofran
itching = benedryl
narcan - to reverse pain meds effect
Side effects of Pain meds
Resp Depression, sedation increases, N/V, Itching, Constipation, LOC changes
What comes first? Sedation or Resp Depression
Sedation
APAP
stands for acetaminophen
