Pain Meds Flashcards
What screening tool can you use to detect opioid abuse
Opioid risk tool
A score of 3 or lower indicates low risk for future abuse
A score 4-7 indicates moderate risk for opioid abuse
A score 8 or higher indicates a high risk for opioid abuse
Complementary therapies for pain
Acupuncture
Biofeedback
Energy therapies
Guided imagery and visualization
Heat or cold
Hypnosis
Massage
Meditation
Music therapy
Reiki
Tai chi
Tens
Yoga
What’s the withdrawal scale to use
COWs
First line for mild to moderate acute pain (NRS <7 )
Non opioid analgesics
(Tylenol or NSAIDS)
What if your pt with acute pain has severe pain. What medications do you recommend
Opioids
-codeine (Tylenol #3)
- morphine
-hydromorphone
-oxycodone
First line for chronic neuropathic pain
TCA, gabapentinoids or SNRI
Which two meds should you not combine
SNRI and TCA
What if a first line agent was not effective for neuropathic pain?
Try a different first line agent
Second line for neuropathic pain
Tramadol
Topical lidocaine
What are Nonpharm alternatives to neuropathic pain
Physio
Mindfulness
Yoga
Exercise
Psychotherapy
What do you keep your MED for non cancer pain
< 90 MED
Do you prescribe opioids to no cancer pain with a history of SUD? What about if they have active SUD
History- nonopioid meds should be optimized
Active SUD- never prescribe
Acute pain from herpes zoster virus what do you prescribe ?
Oral antivirals
Pain
#1 amitriptylline or gabapentin
If necessary could do opioids
First line for trigeminal neuralgia
Carbamazepine
First line for nerve root compression
Tylenol or NSAIDs
First line for CRPS or chronic neuropathic pain
Gabapentinoids
SNRI
TCA
How do you taper an opioid?
5-10% Q2-4 weeks
What are stages of change?
Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Can use motivational interviewing to switch pt to the next stage of change
Acute withdrawal treatment first line
Methadone
Or
Buprenorphine
+
Clonidine
Maintenance treatment for OUD
Buprenorphine/naloxone (suboxone) 8-24mg
-need to be >12-24 hours opioid free
Or
Methadone 60-120mg
-can start immediately
Or
Slow release morphine
-used as adjunct during methadone initiation or standalone if failed both
What’s the recommended length of time for OUD therapy
12 months but could be on long term
Optimal results = opioid maintenance combined with Nonpharm with as psychoed , group psychotherapy, relapse prevention, training and peer support
Read:
Concurrent psych problems should be treated in tandem with OUD
Low back pain treatment what is first line
Nonpharm
- physio
-massage therapy
-acupuncture
-spinal manipulation
-motor control exercises
Pharm approaches to low back pain. What is first line
1
NSAIDs > Tylenol
Can also use muscle relaxants if diagnosed with spastic component to their back pain
-baclofen, cyclobenzaprine
When do you use opioid therapy for low back pain?
When Nonpharm and pharm approaches have been optimized
It is last resort
D/c if no effect in 3-6 months
What are red flags for low back pain
Rapid wt loss
Fever
Neurological deficits (cause equina)
Inflammatory disorder
First line for muscle cramps
Nonpharm
-stretching
-hot pack or hot bath
-icing can be used
-reassure benign in nature
Pharm approaches for muscle cramps
No med found to be clearly beneficial
What labs should you check for muscle cramps
CBC
Iron
GFR
SCr
a1C
TSH
LFT
CK
First line for mild restless leg syndrome
Mental alertness activities
Abstain from alcohol, caffeine, nicotine
Take hot baths
Stretch and exercise moderately
Yoga might also help
Discontinue meds that might contribute to (mirtaZapine, metochlopramide, topiramate, Benadryl, seroquel, olanzapine and clozapine)
Minimize sleep deprivation
Intermittent restless leg syndrome <2x per week.
What are pharm approaches
- Levodopa
- Benzodiazepines
- Low potency opioids (codeine)
Chronic / persistent restless leg first line treatment
2 - GABA derivatives
Dopamine agonist
-pramipexole
-rotigotine
-ropinirole
SE= increased risk of developing high risk behaviors like pathological gambling and hyper sexuality
-needs to be tapered off
What must you rule out in blood work for RLS
Iron deficiency
