Pain Management

Question 1

acute pain:

Answer 1

recent onset of pain that abates as healing occurs; serves as a warning signal that something is wrong or needs attention

Question 2

addiction

Answer 2

a chronic neurologic and biologic disease characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving to use the opioid for effects other than pain relief

Question 3

adjuvant analgesic agent:

Answer 3

a drug that has a primary indication other than pain (e.g., anticonvulsant, antidepressant, sodium channel blocker, or muscle relaxant) but is an analgesic agent for some painful conditions; sometimes referred to as coanalgesic

Question 4

agonist–antagonist:

Answer 4

a type of opioid (e.g., nalbuphine [Nubain] and butorphanol [Stadol]) that binds to the kappa opioid receptor site acting as an agonist (capable of producing analgesia) and simultaneously to the mu opioid receptor site acting as an antagonist (reversing mu agonist effects)

Question 5

allodynia

Answer 5

pain due to a stimulus that does not normally provoke pain, such as touch; typically experienced in the skin around areas affected by nerve injury and commonly seen with many neuropathic pain syndromes

Question 6

antagonist

Answer 6

drug that competes with agonists for opioid receptor binding sites; can displace agonists, thereby inhibiting their action

Question 7

breakthrough pain

Answer 7

a transitory increase in pain that occurs on a background of otherwise controlled persistent pain

Question 8

ceiling effect

Answer 8

an analgesic dose above which further dose increments produce no change in effect

Question 9

central sensitization

Answer 9

a key central mechanism of neuropathic pain; the abnormal hyperexcitability of central neurons in the spinal cord, which results from complex changes induced by the incoming afferent barrages of nociceptors

Question 10

chronic or persistent pain

Answer 10

pain that may or may not be time limited but that persists beyond the usual course/time of tissue healing

Question 11

comfort–function goal

Answer 11

the pain rating identified by the individual patient above which the patient experiences interference with function and quality of life (e.g., activities the patient needs or wishes to perform)

Question 12

efficacy

Answer 12

the extent to which a drug or another treatment “works” and can produce the effect in question—analgesia in this context

Question 13

half-life

Answer 13

the time it takes for the plasma concentration (amount of drug in the body) to be reduced by 50% (after starting a drug, or increasing its dose, four to five half-lives are required to approach a steady-state level in the blood, irrespective of the dose, dosing interval, or route of administration; after four to five half-lives, a drug that has been discontinued generally is considered to be mostly eliminated from the body)

Question 14

hydrophilic

Answer 14

readily absorbed in aqueous solution

Question 15

intraspinal

Answer 15

“within the spine”; refers to the spaces or potential spaces surrounding the spinal cord into which medications can be given; synonymous with neuraxial

Question 16

lipophilic

Answer 16

readily absorbed in fatty tissues

Question 17

metabolite

Answer 17

the product of biochemical reactions during drug metabolism

Question 18

mu agonist

Answer 18

any opioid that binds to the mu opioid receptor subtype and produces analgesic effects (e.g., morphine); used interchangeably with the terms full agonist, pure agonist, and morphinelike drug

Question 19

neuraxial

Answer 19

of the central nervous system; synonymous with intraspinal

Question 20

neuropathic (pathophysiologic) pain

Answer 20

pain sustained by injury or dysfunction of the peripheral or central nervous systems and distinctly different from nociceptive (physiologic) pain

Question 21

neuroplasticity

Answer 21

the ability of the peripheral and central nervous systems to change both structure and function as a result of noxious stimuli

Question 22

nociceptive (physiologic) pain

Answer 22

pain that is sustained by ongoing activation of the sensory system that conducts the perception of noxious stimuli; implies the existence of damage to somatic or visceral tissues sufficient to activate the nociceptive system

Question 23

nociceptor

Answer 23

a type of primary afferent neuron that has the ability to respond to a noxious stimulus or to a stimulus that would be noxious if prolonged

Question 24

nonopioid

Answer 24

refers to analgesic agents that include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs); term is used instead of “nonnarcotic”

Question 25

NSAID

Answer 25

nonsteroidal anti-inflammatory drug (pronounced “en said”); also referred to as aspirinlike drugs. 3,000mg PO, 4,000mg IV max dose (2018)

Question 26

opioid

Answer 26

refers to codeine, morphine, and other natural, semisynthetic, and synthetic drugs that relieve pain by binding to multiple types of opioid receptors; term is preferred to “narcotic”

Question 27

opioid dose-sparing effect

Answer 27

occurs when a nonopioid or adjuvant is added to an opioid, allowing the opioid dose to be lowered without diminishing analgesic effects

Question 28

opioid-induced hyperalgesia

Answer 28

a phenomenon in which exposure to an opioid induces increased sensitivity, or a lowered threshold, to the neural activity conducting pain perception; it is the “flip side” of tolerance

Question 29

opioid naïve

Answer 29

denotes a person who has not recently taken enough opioid on a regular enough basis to become tolerant to the opioid’s effects

Question 30

opioid tolerant

Answer 30

denotes a person who has taken opioids long enough at doses high enough to develop tolerance to many of the opioid’s effects, including analgesia and sedation

Question 31

peripheral sensitization

Answer 31

a key peripheral mechanism of neuropathic pain that occurs when there are changes in the number and location of ion channels; in particular, sodium channels abnormally accumulate in injured nociceptors, producing a lower nerve depolarization threshold, ectopic discharges, and an increase in the response to stimuli

Question 32

physical dependence

Answer 32

the body’s normal response to administration of an opioid for 2 or more weeks; withdrawal symptoms may occur if an opioid is abruptly stopped or an antagonist is given

Question 33

placebo

Answer 33

any medication or procedure, including surgery, that produces an effect in a patient because of its implicit or explicit intent and not because of its specific physical or chemical properties

Question 34

preemptive analgesic agents

Answer 34

preinjury pain treatments (e.g., preoperative epidural analgesia and preincision local anesthetic infiltration) to prevent the establishment of peripheral and central sensitization of pain

Question 35

refractory

Answer 35

nonresponsive or resistant to therapeutic interventions such as analgesic agents

Question 36

self-report

Answer 36

the ability of an individual to give a report—in this case, of pain, especially intensity; the most essential component of pain assessment

Question 37

titration

Answer 37

upward or downward adjustment of the amount (dose) of an analgesic agent

Question 38

tolerance

Answer 38

a process characterized by decreasing effects of a drug at its previous dose, or the need for a higher dose of drug to maintain an effect

Question 39

withdrawal

Answer 39

result of abrupt cessation or rapid decrease in dose of a substance upon which one is physically dependent. It is not necessarily indicative of addiction

Question 40

example of local anesthetics

Answer 40

Lidocaine patch 5%

Question 41

examples of anticonvulsants

Answer 41

gabepentin (mood stabilizer), pregabalin (nonopioid analgesic)

Question 42

examples of antidepressants

Answer 42

TCAs: desipramine or nortriptyline (increase poswer of serotonin and dopamine)
SNRIs: duloxetine & venlafaxine (inhibits serotonin and norepinephrine)

Question 43

Narcan/noloxone

Answer 43

opioid analgesic