Pharmaceutical Care of Pain Flashcards
Describe fibromyalgia
Widespread pain across whole body
Severe fatigue
Poor sleep
Aching + stiffness
Flare-ups
What non-drug therapies recommended?
Acupuncture/dry needling
Acceptance + commitment therapy (ACT)
Cognitive behavioural therapy (CBT)
What do you consider for pharmacological management of chronic pain?
Antidepressant (18years +)
eg. amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine + sertraline
What wouldn’t you recommend for management of chronic pain?
Anti-epileptics
Anti-psychotics
Benzodiazepines
Ket
NSAIDs
Opioids
Paracetamol
What are pregabalin + gabapentin?
Sch 3 CD = risk of misuse
When are pregabalin + gabapentin NOT recommended?
When already taking medications
What is the evidence against opioids?
No evidence on efficacy with use over 6 months
Increased risk of dependence
What is the evidence against benzodiazepines?
Psychological + physical function worsen
Risk of addiction
What is the evidence against NSAIDs?
No difference on QoL or pain
Worsened physical function
Risk of harm - eg. GI bleeds
What is the evidence against gabapentin?
Risk of misuse
Lack of evidence in primary chronic pain
Some role in neuropathic pain
Risk of pregnancy
What needs to happen if a female is put on gabapentin/pregabalin?
Need to be enrolled into a pregnancy programme
What are the prescribing points for gabapentin/pregabalin?
Risk of malformations to unborn baby
Recommend adequate contraception
Avoid using during pregnancy
If unavoidable = lowest effective dose
What is the advice on valproate in pregnancy?
Do NOT use
Ensure pregnancy prevention plan is in place
Risk of malformations
What are examples of neuropathic pain?
Diabetic neuropathy
Post-herpetic neuralgia
Trigeminal neuralgia
Post-surgical
Neuropathic cancer pain
What are the drugs used in neuropathic pain?
TCAs
SSRIs
SNRIs
Anti-epileptics
Topical
Opioids
