required readings

Question 1

1st line pharmacological treatments for neuropathic pain?

Answer 1

• Gabapentinoids
• Gabapentin NNT painful polyneuropathy - 6.4; PHN - 4.3
• pregabalin NNT painful polyneuropathy - 4.5; PHN - 4.2
• TCAs - NNT painful polyneuropathy - 2.1; PHN - 2.8
• SNRI Duloxetine- NNT painful diabetic neuropathy - 5.0

*carbamazepine for idiopathic TN

Question 2

2nd line pharmacological treatments for neuropathic pain?

Answer 2

• Tramadol NNT - 4.9
• opioids - NNT painful polyneuropathy and PHN - 2.6
• topical lidocaine (only for PHN)

Question 3

3rd line pharmacological treatments for neuropathic pain?

Answer 3

• cannabinoids NNT central neuropathic pain states - 3.4
• evidence in MS, HIV neuropathy, post-traumatic or post-surgical pain, combined central and peripheral neuropathic pain

Question 4

4th line pharmacological treatments for neuropathic pain?

Answer 4

• SSRIs; citalopram, paroxetine, escitalopram in painful polyneuropathy and PHN; NNT 6.8
• lamotrigine (positive trials in HIV neuropathy, TN, central post-stroke pain)
• lacosamide NNT 10-12
• methadone
• topical lidocaine
• topical capsacin
• tapentadol
• botulinum toxin
• topiramate

Question 5

Proposed clinical diagnostic criteria for CRPS (2007)?

Answer 5

1. Continuing pain which is disproportionate to the inciting event
2. Must report at least one symptom in 3 out of 4 categories of sensory, vasomotor, sudomotor/edema, motor/trophic
3. Must display at least one sign at the time of evaluation in two or more categories of sensory, vasomotor, sudomotor/edema, motor/trophic
4. No other diagnosis that better explains the signs and symptoms.

Question 6

What is the difference for the research criteria for CRPS?

Answer 6

• at least one symptom in ALL FOUR categories;
• sign category is the same - at least one sign at the time of evaluation in two or more categories

Question 7

What are the sign and symptom categories for CRPS and examples of each?

Answer 7

• sensory (hyperesthesia +/or allodynia)
• vasomotor (temperature changes +/- skin color changes +/- skin color asymmetry)
• sudomotor/edema (swelling or sweating changes)
• motor/trophic (decreased ROM +/- motor dysfunction +/- trophic changes)

Question 8

What is the sensitivity and specificity fo accurate diagnosis of CRPS with the Budapest clinical criteria?

Answer 8

• sensitivity 0.85
• specificity 0.69

Question 9

Complementary health approaches fall into what two main categories?

Answer 9

1. Natural products
2. Mind-body practices

Question 10

What is the difference between complimentary, alternative and integrative medicine?

Answer 10

Complimentary - involves from conventional (Western) and non-mainstream health practices while

Alternative uses only non-mainstream health practices and

Integrative medicine involve bringing conventional and complementary approaches together in a coordinated way.

Question 11

What are some examples of natural health products; the most commonly used natural product and was % of the population uses natural products?

Answer 11

1. herbs, vitamins, minerals, probiotics
2. fish oil
3. 17.7%

Question 12

What are the most popular mind-body practices used by adults?

Answer 12

• yoga
• mediation
• massage therapy
• osteopathic manipulation
• chirpractic manipulation

Question 13

Name mind-body practices used to treat pain?

Answer 13

• acupuncture
• relaxation techniques
  
  • deep breathing
  • guided imagery
  • porgressive muscle relaxation
• tai chi
• qi gong
• healing touch
• hypnotherapy

Question 14

What does NCCIH-funded research suggest regarding treatment with integrative approaches for symptomatic treatment in cancer patients?

Answer 14

• less pain and anxiety
• massage therapy may lead to short-term improvements in pain and mood
• yoga may relieve persistent fatigue

Question 15

Medical cannabis should not be used in what populations?

Answer 15

• under the age of 25
• allergy to cannabis
• serious hepatic, renal, cardiac or pulmonary disease
• personal or family history of serious mental illness
• pregnancy, breast feeding or planning for pregnancy
• man who wants to start a family…
• history of substance use disorder

Question 16

Cannabis drug interactions?

Answer 16

1. Any sedating medications including benzos, hypnotics, allergy or cold medications or AEDs
2. ARVs, PPIs, antibiotics and antifungals, St John’s Wort, etc…

Question 17

Cannabis dosing recommendations?

Answer 17

• most individuals use less than 3g per day
• if no previous exposure, start low and go slow
• smoking - more rapid onset, higher blood levels and shorter duration
• dose no more frequent than q30min (smoking); 2h (edibles)

Question 18

Symptoms of cannabis overdose?

Answer 18

• sedation
• confusion
• ataxia
• syncope
• CP
• palpitations
• panic attack
• dissociation
• seizures

Question 19

Short-term side effects of cannabis?

Answer 19

• sedation
• lightheaded
• headache
• cognitive impairment
• disorientation
• confusion
• paranoia
• elevated anxiety
• hallucinations
• impaired motor skills
• dry mouth
• tachycardia
• N/V

Question 20

Long-term side effects of cannabis?

Answer 20

• increased risk of precipitating/worsening psychiatric illness
• increased risk of resp disease
• decreased sperm count
• negative impact on behavioral and cognitive development of children born to mothers that used cannabis
• tolerance to cannabis
• withdrawal symptom emergence
• development of cannabis use disorder

Question 21

What are the restrictions for prescribing medical cannabis?

Answer 21

While there are no restrictions under the Access to Cannabis for Medical Purposes Regulations on the daily amount that you may authorize, there is a possession limit of the lesser of the equivalent of 150 grams or 30 times the daily amount of dried marijuana that is prescribed.