Substance Abuse and Pain Flashcards
What is pain defined as?
Unpleasant sensory, emotional experience with actual or potential tissue damage
Who is the most reliable indicator of pain?
Pain is a personal and subjective experience, making the patient the most reliable indicator of pain.
What is the difference between acute and chronic pain?
Acute pain
* results from tissue damage
* less than 3-6 months
Chronic pain
* can be time limited or last a lifetime
* Cancer
* Noncancer: peripheral neuropathy, back pain, osteoarthritis
What are the classifications of pain?
- Nociceptive (physiologic) pain
- Neuropathic (pathophysiologic) pain (develops over time, harder to treat)
- Mixed pain: combination of nociceptive and neuropathic (poorly defined)
What causes neuropathic pain?
Damage or dysfunction of the peripheral or central nervous system
Ex: Autoimmune disorders, lupus, fibromyalgia
It may occur in the absence of tissue damage and inflammation.
What are the components of pain assessment?
- Self-report
- Location
- Intensity
- Quality
- Onset and duration
- Aggravating and relieving factors
- Effects on function and quality of life
- Comfort-function goal - where do they WANT to be?
What are some pain scales used for assessing intensity?
- Numeric Rating Scale (NRS)
- Visual Analog Scale (VAS)
- Wong-Baker FACES Pain Rating Scale
- FLACC
- Faces Pain Scale-Revised (FPS-R)
- PAINAD
- Verbal Descriptor Scale (VDS)
- CPOT
Different scales are used for various populations, including children and patients with advanced dementia.
What is the role of pharmacologic interventions in pain management?
Effective and safe analgesia aimed at optimal relief
This responsibility involves all members of the health care team and includes multimodal approaches.
What does the Opiate Risk Assessment look at?
- Family history of substance abuse
- Personal history of substance abuse
- Psychological disease
- Sexual abuse history
How do opioids work?
Act on the CNS to inhibit activity of ascending nociceptive pathways
What are some examples of NSAIDs?
- Ibuprofen
- Naproxen
- Ketorolac (Toradol)
- Celecoxib (Celebrex)
How does Acetaminophen work as an analgesic?
Inhibits synthesis of prostaglandins in the central nervous system
How do NSAIDs work?
Decrease pain by inhibiting Cyclooxygenase (COX) which is an enzyme involved in production of prostaglandins
What are some examples of Mu Agonist Opioid agents?
- Morphine
- Hydromorphone
- Fentanyl
- Oxycodone
What are some examples of Agonist-Antagonist Opioid agents?
- Buprenorphine
- Nalbuphine
- Butorphanol
What are some adjunctive agents used in pain management?
- Local anesthetics (e.g., Lidocaine patch)
- Anticonvulsants (e.g., Gabapentin, Pregabalin): inhibit nociceptor pain signals
- Antidepressants (e.g., TCAs, SNRIs): often for neuropathic/chronic pain
- Ketamine: street names: Special K, K, Kit Kat, Cat Valium, Super Acid, Special La Coke, Purple, Jet, Vitamin K
These agents help enhance pain relief and may target different pain mechanisms.
What constitutes substance use disorder (SUD)?
- Impaired use of a substance despite major problems
- Impaired control over use
- Continued use despite harm
- Craving for the substance
SUD can be influenced by genetic, psychosocial, and environmental factors.
What are some commonly misused drugs?
- MDMA (Ecstasy)
- Spice (synthetic cannabinoid)
- Bath salts
- Inhalants
- Cannabis
- Cocaine
- Opioids
- Barbiturates
- Amphetamines
- Hallucinogens
These substances have various methods of use and effects, highlighting the complexity of substance misuse.
What are some assessment signs of substance use disorder?
- Mood changes
- Poor hygiene
- Odd sleep patterns
- Frequent injuries
- Relationship difficulties
- Poor job performance
- Anorexia or weight loss
- Social isolation
- Financial problems
These indicators help identify individuals who may be struggling with substance misuse.
Which populations have the highest prevalence of alcohol abuse?
young adults
and
adults > 60 years
What are short-term and long-term effects of alcohol use in older adults?
- Short-term: Motor vehicle accidents, falls, drowning
- Long-term: Hypertension, heart disease, stroke, liver disease, digestive issues
Older adults are particularly vulnerable to the effects of alcohol due to physiological changes.
What are some Physical Non-Pharmacologic methods to relieve pain?
- Proper body alignment
- Application of heat/cold packs
- Massage
- Transcutaneous electrical nerve stimulation (TENS)
- Acupuncture
- Physical Therapy
- Aqua Therapy
Be aware that some of these methods require a prescription and some can cause harm (burns or frostbite)
What are some Cognitive and Behavioral Non-Pharmacologic methods to relieve pain?
- Relaxation breathing
- Distraction
- Listening
- Singing
- Rhythmic tapping to music
- Imagery
- Humor
- Pet therapy
- Prayer
- Meditation
- Hypnosis
Prior to use, evaluate patient’s cognitive ability to learn and perform necessary activities
What are some Movement Non-Pharmacologic methods to relieve pain?
- Yoga
- T’ai Chi
Prior to use, evaluate the patient’s physical ability to perform necessary activities
