Pain Management Flashcards
acute pain:
recent onset of pain that abates as healing occurs; serves as a warning signal that something is wrong or needs attention
addiction
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
adjuvant analgesic agent:
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
agonist–antagonist:
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)
allodynia
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
antagonist
drug that competes with agonists for opioid receptor binding sites; can displace agonists, thereby inhibiting their action
breakthrough pain
a transitory increase in pain that occurs on a background of otherwise controlled persistent pain
ceiling effect
an analgesic dose above which further dose increments produce no change in effect
central sensitization
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
chronic or persistent pain
pain that may or may not be time limited but that persists beyond the usual course/time of tissue healing
comfort–function goal
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)
efficacy
the extent to which a drug or another treatment “works” and can produce the effect in question—analgesia in this context
half-life
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)
hydrophilic
readily absorbed in aqueous solution
intraspinal
“within the spine”; refers to the spaces or potential spaces surrounding the spinal cord into which medications can be given; synonymous with neuraxial
lipophilic
readily absorbed in fatty tissues
metabolite
the product of biochemical reactions during drug metabolism
mu agonist
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
neuraxial
of the central nervous system; synonymous with intraspinal
neuropathic (pathophysiologic) pain
pain sustained by injury or dysfunction of the peripheral or central nervous systems and distinctly different from nociceptive (physiologic) pain
neuroplasticity
the ability of the peripheral and central nervous systems to change both structure and function as a result of noxious stimuli
nociceptive (physiologic) pain
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
nociceptor
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
nonopioid
refers to analgesic agents that include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs); term is used instead of “nonnarcotic”
NSAID
nonsteroidal anti-inflammatory drug (pronounced “en said”); also referred to as aspirinlike drugs. 3,000mg PO, 4,000mg IV max dose (2018)
opioid
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”
opioid dose-sparing effect
occurs when a nonopioid or adjuvant is added to an opioid, allowing the opioid dose to be lowered without diminishing analgesic effects
opioid-induced hyperalgesia
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
opioid naïve
denotes a person who has not recently taken enough opioid on a regular enough basis to become tolerant to the opioid’s effects
opioid tolerant
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
peripheral sensitization
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
physical dependence
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
placebo
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
preemptive analgesic agents
preinjury pain treatments (e.g., preoperative epidural analgesia and preincision local anesthetic infiltration) to prevent the establishment of peripheral and central sensitization of pain
refractory
nonresponsive or resistant to therapeutic interventions such as analgesic agents
self-report
the ability of an individual to give a report—in this case, of pain, especially intensity; the most essential component of pain assessment
titration
upward or downward adjustment of the amount (dose) of an analgesic agent
tolerance
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
withdrawal
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
example of local anesthetics
Lidocaine patch 5%
examples of anticonvulsants
gabepentin (mood stabilizer), pregabalin (nonopioid analgesic)
examples of antidepressants
TCAs: desipramine or nortriptyline (increase poswer of serotonin and dopamine)
SNRIs: duloxetine & venlafaxine (inhibits serotonin and norepinephrine)
Narcan/noloxone
opioid analgesic
