pain mgmt Flashcards
Most reliable method for assessing pain
patients description of their experience
what is the pain a result from
2 opposing neuronal pathways:
first pathway: origin to brain
- generating pain sensation
secondary pathway: originates in brain
- supressess impulses along first pathway
- diminished pain sensation
what are pain receptors
mechanical
thermal
chemical
what enhances pain sensitivity
prostaglandins
substance P
Endogenous opioid compounds
released at synapse in brain and spinal cord to reduce pain
Nociceptive pain
injury to tissues
somatic : sharp/loclized
visceral: poorly localized pain/ diffuse aching
responds to opioid analegics
neuropathic pain
injury to peripheral nerves
sensations
- burning, jabbing tearing
responds poorly to opioid analgesics
responds positively to adjuvant analgesics (antidepressants, anticonvulsants)a
adjuvant drug
used to increase the efficacy or potency of certain drugs
what is pain in cancer patients caused by
caused by cancer itself
therapeutic interventions
metastases to bone= very common page
thearpeutic pain = 25%
What type of drugs relieve pain for 90% of patients
Analgesics
3 types of analgesics
Nonopiod (NSaids, acetaminophen
Opioid analgesics (oxycodone, fentanyl, morphine)
Adjuvant analgesics (amitriptyline, gabapentin, dextroamphetamine)
Drug Selection Ladder
1) mild to moderate
- nonopioid analgesics
2) more severe pain/ persisting, INCREASING
- Opioids of moderate strength
3) Severe pain
- powerful opioids
NCCN recomendations for pain mgmt
drug selection should be based upon patients pain intensity
-pain scale 4-10 directly with opioids
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Aspirin
Ibuprofen
NSAIDs mechanism
inhibits COX enzyme
result: pain relief, supression of inflammation and reduction of fever
NSAIDs Adverse Effects
gastric ulceration- bleeding
under chemo: increased bleeding
- effects is increased due to suppression of bone marrow platelet production
- avoid aspirin –> irreversible inhibition platelet aggregation
Acetaminophen
relieves mild to moderate
inhibits COX in CNS
- but not in PERIPHERY
- no antiflammatory
- no inhibition of plately aggregation
acetaminophen drug interactions
can increase warfarin concentrations to toxic levels
Opioid Analgesics
treatment for : moderate to severe cancer pain
- can relieve 90% all pain
what should the route of cancer pain treatment be?
PO- preferred
or transdermal, rectal
Patient controlled analgesia
- indwelling IV or subQ cath
- pt controls
- prevents giving 2nd dose before first one takes full effect
Adjuvant Analgesics
developed to treat depression, seizures, dysthmias
what are adjuvant analgesics used for
complement effects of opioids
NOT A SUBSTITUTE
what can adjuvant analgesics do
1) enhance opioid analgesia
2) manage concurrent symptoms that exacerbate pain
3) treat side effects
What are some adjuvant analgesics
Amitriptyline (antidepressant)
Gabapentin (anti seizure drug)
Dextroamphetamine (CNS stimulant)
