Tx in Pain Management Flashcards
NSAIDs examples ?
Acetylsalicylic Acid (Aspirin) Acetaminophen (Tylenol) Ibuprofen (Advil, Motrin, Nuprin) Meloxicam (Mobic) Naproxen Sodium (Aleve, Anaprox) Diclofenac/misoprostol (Arthrotec, Cytotec)
Cyclooxygenase-2 (Cox-2) Inhibitors
examples ?
Celecoxib (Celebrex)
Antispasmodic’s
examples ?
Metaxalone (Skelaxin)
Cyclobenzaprine (Flexeril)
Disease-Modifying Antirheumatic Drugs ?
Methotrexate (Rheumatrex)
Leflunomide (Arava)
Hydroxychloroquine (Plaquenil)
Tumor Necrosis Factor (Tnf) Inhibitors ?
infliximab (Remicade)
etanercept (Embrel)
Adalimumab (Humira)
Steroids ?
Hydrocortisone (Solu-Cortef)
Prednisone (Deltasone)
Methylprednisolone (Solu-Medrol)
Drugs Used to Treat Gout ?
Indomethacin (Indocin)
Allopurinol (Zyloprim)
Colchicine (Generic)
Probenecid (Probalan)
Sulfinpyrazone (Anturane)
Acute Pain facts ?
The most common reason for a patient to consult a physician’s assistance
More than 17 million people took six days in 1995 due to pain conditions
One of adults 65 years and older experience low back pain
3/5 of adults 65 and older say their pain lasted one year more
Arthritis, back pain, cancer and headaches are the major contributors of pain
68% of American adults experience some sort of back
pain in their lifetime
70% of cancer patients suffer from significant pain
Definition of pain ?
Bodily, mental or emotional suffering due to injury or illness
Pain or unpleasant sensory and emotional experience arising from actual or perceived tissue damage
Chronic pain lasts for more than three months while the key thing has an identifiable cause or cure end point
Both adults and children experience pain however children are less able to describe their pain
Acute pain ?
Generally considered nociceptive pain
Pain that follows the usual pain sensory pathways
Responses with elevation in blood pressure, increased pulse and diaphoresis
__________ pain is caused by stimulation of peripheral nerve fibers that respond only to stimuli
Nociceptive
How is pain classified ?
Classified according to the mode of noxious stimulation
Most common pain ?
Thermal (e.g. heat or cold)
Mechanical (e.g. crushing, tearing, shearing, etc.)
Chemical (e.g. iodine in a cut or chemicals)
Nociceptive pain may also be divided into ?
Visceral
“deep somatic” pain
“superficial somatic” pain
_______ structures are highly sensitive to stretch, ischemia and inflammation
Visceral
Visceral pain is ?
diffuse
difficult to locate
Visceral pain may be accompanied by ?
N / V
Visceral pain description ?
May be described as sickening, deep, squeezing, and dull
Deep somatic pain ?
stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles
Deep somatic pain description ?
dull, aching, poorly-localized pain
Deep somatic pain examples ?
Ankle sprain
Fractures
___________ pain is initiated by activation of nociceptors
Superficial
Superficial pain where is it and description ?
In the superficial tissue of skin
sharp, well-defined and clearly located
Superficial pain examples ?
Injuries that produce superficial somatic pain
minor wounds and minor (first degree) burns
Neuropathic pain causes ?
Caused by damage or disease affecting any parts of the nervous system
involved in bodily feelings somatosensory system
Peripheral neuropathic
description ?
burning, tingling, electrical, stabbing, or pins and needles
Peripheral neuropathic examples ?
Bumping the “funny bone” elicits acute peripheral neuropathic pain.
Phantom pain ?
Pain felt in a part of the body that has been lost
From which the brain no longer receives signals.
It is a type of neuropathic pain.
Phantom limb pain is a common experience of amputees
Psychogenic pain AKA ?
psychalgia
somatoform pain
Psychogenic pain is ?
pain caused, increased, or prolonged by mental, emotional, or behavioral factors
Psychogenic pain examples ?
Headache, back pain, and stomach pain are sometimes diagnosed as psychogenic
Psychogenic Pain considerations ?
often stigmatized by both medical professionals and the general public
Tend to think that pain from a psychological source is not “real”
Specialists consider that it is no less actual or hurtful than pain from any other source
Chronic Pain facts ?
35% of American population has some degree of chronic pain
50 million Americans partially or totally disabled due to chronic pain
Chronic Pain considered to be a symptom rather than diagnosis for several years
“Chronic Pain Syndrome” ICD-10 code G89.4
Seven Tenants for Conscientious Prescribing of Drugs for Pain ?
- Remove barriers that render pain management ineffective
- Never forget the consequences resulting from pain being poorly managed
- Properly assess pain before prescribing any drug
- Remember the goal of using medications for acute pain
- Remember to use different prescribing algorithms for mild, moderate and severe pain
- Use different algorithms when prescribing for chronic pain
- There is a role for adjuvant medications
Tenant #1 ?
Remove barriers that render pain management ineffective
There are barriers to effective treatment of pain on the part of both the patient and clinician
The stigma of the pain medicines being too strong or harmful
Share concerns about drugs being addictive
Concerns about regulatory agencies like DEA
Tenant #2 ?
Impaired function and poor quality life
Depression
Polypharmacy through treatment of other manifestations of pain:
Agitation, confusion, sleep disturbance, false, cognitive dysfunction, decreased socialization, anorexia
Never forget the consequences resulting from pain being poorly managed
Tenant #3 ?
A detailed history and physical is imperative
“Controlled Substance Act”
-federal law and are scheduled depending upon its medical use and potential for abuse and safety
Pain needs to be identified by its source and type
A complete diagnostic evaluation
Use a standardized pain scale
Discuss with the patient realistic goals of pain control
Properly assess pain before prescribing any drug
Tenant #4 ?
A primary goal of acute pain management is to restore function as soon as possible and prevent the redevelopment of a chronic pain syndrome
Use different combinations of medicines with decreasing potential for addiction and harm
This applies to acute pain and chronic pain
Remember the goal of using medications for acute pain
Tenant #5 ?
Use a variety of medications that starts with mild pain and progress using different endpoints and assessments
Start with NSAID’s or creams Ben-Gay
For moderate pain use medications like tramadol or Tylenol with codeine or hydrocodone
For severe pain use higher dose opioids like morphine and Dilauded
Remember to use different prescribing algorithms for mild to moderate and severe pain
Tenant #6 ?
Pain described as lasting longer than three months
Often includes a significant neuropathic component and usually requires the use of medications to manage chronic pain
Hyperstimulation of NMDA receptors and ultimately decrease the effectiveness of opioids upon the mu receptors
Down regulation of the mu receptors or excessive pre-and post synaptic substance P.
Use different algorithms when prescribing for chronic pain - these are tough patients to manage
