Therapeutic Pain Management Flashcards
Exam 2
How much neuronal loss occurs in people with chronic pain?
5-11% neuronal loss, this is equivalent to 10-20 years of aging
What is pain?
The sensation of harmful stimulation
What is suffering?
The emotional component of subjective distress
Who has a lower pain threshold?
Younger/Older?
Men/Women?
Energized/Tired?
Older
Men
Fatigued
Which neurotransmitter is associated with pain and depression?
Seratonin
Explain acute pain.
Acute pain lasts from seconds - 3 months and is easily localized. Acute pain is the result of a specific injury, and subsides when the condition resolves. Acute pain can be recurrent with episodes being separated by periods of time that are pain-free.
Examples include recurrent corneal erosions, corneal uclers, corneal abrasions, etc
Explain chronic pain.
Chronic pain lasts more than 3-6 months and is not easily localized or defined. Chronic pain can be the result of a known medical condition and traditional analgesics are less effective and require higher doses. Chronic pain can be treated but is unlikely to be cured.
What is neurotrophic pain?
Chronic pain associated with nerve damage
What is dysesthesia?
Abnormal sensations such as burning, tingling, and/or pins/needles
What is allodynia?
Pain associated with non-painful stimuli
What is the first thing you should ask about a patient’s pain?
Subjective rating 1-10
What is FOLDAR?
Pain management acronym F: Frequency O: Onset L: Location D: Duration A: Association R: Relief
What are the three types of topical ophthalmic medications used to treat pain? Give a couple of examples of each.
Cycloplegics:
Homatropine (Gold Standard for synechia)
Cyclopentolate
NSAIDS:
Voltaren
Corticosteroids: (Only for pain from inflammation) Prednisolone Acetate (Pred Forte)
How do cycloplegics manage pain?
Relax ciliary body
Block AcH receptors
What are the three types of oral medications used to treat pain? Give an example of each.
OTC non-narcotic analgesics:
Aspirin
Acetaminophen
Ibuprofen
Prescription Non-Narcotic analgesics:
Indomethacin
Prescription Narcotic Analgesics (Controlled substances) :
Codeine
Hydrocodone
Tramadol
What are the three mechanisms for non-narcotic analgesics?
- Central Acting: Interrupt pain signal in the CNS
- Peripheral Acting: Prevent the discharge of pain the pain receptor.
- Anesthetic agent: Interrupt pain signal from reaching the CNS.
What are the benefits of non-narcotic analgesics?
- Ceiling effect, so no increase in effect with an increase in dosage
- No tolerance of dependence develop
- Not addictive
What are the different OTC non-narcotic analgesics?
Aspirin
Acetaminophen (APAP)
Ibuprofen
Naproxen
What is the MOA of aspirin?
Irreversible inactivation of COX-1 and COX-2, inhibiting prostaglandin synthesis
What are the clinical indications of aspirin?
Analgesic (mild to moderate)
Anti-pyretic (fever)
Antiinflammatory (with high dosage)
Anticoagulant/cardio-protective effects**
What are the adverse effects of aspirin?
GI upset/irritation
Prolonged bleeding time
**When taken daily for 12+ months, 59% increase in the incidence of wet AMD
What are the contraindications of aspirin use for pain?
Stomach ulcers/GI bleeding
Asthma
Excessive alcohol use
Pregnancy (Avoid in 3rd trimester)
What pregnancy category is aspirin?
Category D, fetal harm can occur, so don’t use in the third trimester of pregnancy
What is the MOA of acetaminophen?
Unknown, but may inhibit central prostaglandin synthesis (COX-2) Acetaminophen has NO anti-inflammatory properties
