Pain Palliation Flashcards
1
Q
Somatic Nociceptive Pain
A
- Dull
- Aching
- Well-localized
- Skin, bone, joint, soft tissues
EX:
-Mets to bone or fractures
2
Q
Visceral Nociceptive Pain
A
- Diffuse
- Deep
- Aching
- Gnawing
- Poorly localized
EX:
- Bladder distension/cramping
- Intestinal distention
- Constipation
- Angina
3
Q
Neuropathic Pain
A
- Burning
- Shooting
- Pricking
- Parasthesias
EX:
- Phantom limb pain
- SCI Pain
- Stroke
- Diabetic Neuropathy
- Post-herpetic neuralgia
4
Q
Pain + Cancer
A
- One of the most common and feared symptoms
- Negative impact on several life factors and overall QoL
5
Q
Acute Pain + Cancer
A
- Diagnose via biopsy or lumbar puncture
- Intervene with stent placement paracentesis, or chest tube insertion
6
Q
Chronic Pain + Cancer
A
- Tumor-related
- Somatic, visceral, or neuropathic
7
Q
Durations of Pains
A
- Acute: seconds to less than 3 months
- Peripheral nociceptors activated and COX enzymes/prostaglandins are released
- Chronic: >= 3 mo
- Sensitization at the level of spinal neurons via multiple mechanisms
- Breakthrough: Seconds to hours
- Due to movement, spontaneous, or from weaning off drugs or effect of drug in a well-treated patient
8
Q
Chemo-Related Pains
A
- Oral mucositis**
- Neuropathy**
- Arthralgia/myalgia
- Hand-foot syndrome
- Chemo-induced headaches
9
Q
Opioid Indications
A
- Treating moderate to severe pain that doesn’t respond to non-opioids alone
- Used for acute and breakthrough pain, cancer pain, visceral/somatic pain, opioid sparing regimens, and treating addiction
- Possible AE: Cough, diarrhea, dyspnea, opioid dependence
10
Q
Opioid MoA
A
- Bind to receptors in CNS
- Inhibits transmission of nociceptive input from periphery to spinal cord
- Alters limbic system activity
- Modifies sensory and affective aspects of pain
11
Q
Opioids + Renal Failures
A
Caution with:
- Meperidine
- Morphine
- Codeine
- Tramadol
12
Q
Opioids + Liver Failure
A
- Codeine
- Meperidine
- Methadone
13
Q
Opioid Escalation Strategies
A
- For moderate to severe pain increase opioid TDD by 50-100% regardless of starting dose
- For mild to moderate pain, increase by 25-50% of TDD regardless of starting dose
- Increase short-acting opioids safely every 2 hours
- Long acting opioids can be safely increased every 24 hours (excluding methadone and patches)
14
Q
Fentanyl Patches
A
- Good for chronic, stable pain
- DON’T give to opioid naive patients
- NOT good for rapid escalations
- > 12 hour onset of action and 3 days to steady state
- Unusual conversion to MME
15
Q
Transmucosal Fentanyl
A
- Required REMS training for providers
- Buccal tabs, film, oral lozenge, nasal or SL spray, SL tablet
- Starting dose: 100 mcg with duration of axn 1-2 hours (opioid TOLERANT)
- Only use in failed standard IR therapies
