Pain MGMT

Question 1

What are the 7 steps to better chronic pain management?

Answer 1

1 - Empathize & Partner
2 - Assess biopsychosocial aspects of dz
3 - Reset expectations / set functional goals
4 - Use shared decision making
5 - Employ a multi-modal tx plan
6 - Employ targeted rational polypharmacy
7 - Reassess

Question 2

What are categories of anti-nociceptive agents?

Answer 2

NSAIDs, acetaminophen, opioids

Question 3

What are categories of anti-neuropathic agents?

Answer 3

Anti-convulsants, tricyclics, SNRIs

Question 4

7 steps to safe(r) opioid mgmt?

Answer 4

1- select appropriate pts
2 - discuss benefit & harm
3 - Tx agreement / exit strategy
4 - understand opioid pharmacology
5 - assess and re-assess 5 As
6 - Frame and respond to problems in terms of harm/benefti
7 - Document

Question 5

What are the 5 As of opioid mgmt?

Answer 5

Analgesia: 11 pt numeric rating scale
ADLs/function: “your goal was to get walking again, how’s it going?”
AEs: detailed Qs
Addiction/overuse: observe, urine test, …
Adherence: to Tx agreement

Question 6

What are the lab testing procedures for a UDT?

Answer 6

First: screen w/EIA then if unexpected finding, confirm w/gas chromatography/mass spectrometry

Question 7

First line analgesia in elderly

Answer 7

acetaminophen: low cost & overall safety profile

Question 8

What are important considerations w/long term use of opioids / sequelae?

Answer 8

Tolerance, withdrawal, opioid induced hyperalgesia

Question 9

SEs of opioids

Answer 9

constipation, itching, N/V, hypogonadism, sedation, impaired cognition, falls/MVAs, blunted respiratory drive, Addiction/opioid use d/o, nonfatal and fatal OD