Pain Management - Chronic Flashcards
1
Q
Signs and Sxs of Persistent Pain
A
- depression, anxiety, sleep disturbances
- frustration, anger
- decreased self esteem, social involvement, libido
- financial stresses, work issues, altered family dynamics, legal issues
2
Q
Treatment Goals for Chronic Pain
A
- increase tolerance for physical activity
- decrease suffering and pain
- decrease reliance on healthcare system
- decrease reliance on medications
- return to work or other functional role in society
- develop appropriate strategies for self-management
3
Q
General Strategies for Chronic Pain
A
- taper use of inappropriate meds
- provide education about chronic pain
- focus on increase in function and physical activity
- establish a time frame for achieving goals
4
Q
Nonpharm Options for Persistent Pain
A
- TENS
- biofeedback
- PT if appropriate
5
Q
List 3 pharm options for persistent pain.
A
- non-opioids: NSAIDs and APAP
- tramadol
- opioids
6
Q
How Are Opioids Used in Treating Chronic Pain
A
- scheduled regular release product
- PRN regular release product for breakthrough pain
- consider changing to sustained release product when adequate scheduled dose is established
- start a bowel program
7
Q
List Adjuvant Analgesics for Chronic Pain
A
- TCAs
- AEDs
- SNRIs
- local anesthetics, eg lidocaine
8
Q
TCAs MOA
A
-inhibit NE and 5-HT reuptake
9
Q
TCAs Generic Names
A
- amitriptyline
- nortriptyline
- desipramine
10
Q
TCAs Onset
A
weeks
11
Q
AEDs MOA
A
- decrease synaptic transmission (carbamazepine)
- inhibit neuronal activity and increase GABA (gabapentin)
- decrease release of glutamate, NE and substance P (pregabalin)
12
Q
AEs of Carbamazepine
A
- CNS
- CYP450 induced
13
Q
AEs of Gabapentin
A
- CNS
- GI
14
Q
Valproic Acid AEs
A
- GI
- CNS
- increased LFTs
- decreased platelets
15
Q
Pregabalin AEs
A
- dizziness
- sedation
- dry mouth
- peripheral edema
- weight gain
- blurred vision
