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palli119 > (W1/2) Pain Management > Flashcards

(W1/2) Pain Management Flashcards

1
Q

What are the dimensions of Total Pain?

A

1) Physical
2) Psychological
3) Social
4) Spiritual

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2
Q

How to assess Physical pain?

A

OLDCART/ SOCRATES SMM

Site
Onset
Characteristics
Radiation (where pain moves to)
Associated factors
Time
Exacerbating and reliving factors
Severity

Sleep/Function
Mood
Meaning

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3
Q

What are the causes of physical pain?

A

1) Nociceptive (from tissue injury)
- Somatic (bones, joints, muscle, connective tissue)
- Visceral (organs)

2) Neuropathic (from nerve injury)
- Peripheral
- Central

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4
Q

When do you assess for physical pain?

A
  • New onset
  • Changing characteristics of pain
  • Post-analgesia
    ~ Evaluation of effectiveness
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5
Q

How can you describe nociceptive pain?

A
  • Stinging
  • Heavy
  • Stinging
  • Suffocating
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6
Q

How can you describe neuropathic pain?

A
  • Numbness, pins and needles
  • Burning
  • Aching
  • Throbbing
  • Pulling
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7
Q

What is Psychological pain?

A
  • Anxiety of worsening pain
  • Fear of dying
  • Reminder of ill health
  • Anger, despair, hopelessness
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8
Q

What is Social pain?

A
  • Loss of role
  • Restricted social activities and contacts
  • Affects interpersonal relationships and their environment
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9
Q

What is Spiritual pain?

A
  • Loss of sense of purpose, role and identity
  • Feeling of being punished
  • Altered relationship with god
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10
Q

What are the 3 basic principles of pharmacotherapeutic intervention?

A

1) By the mouth
- Oral is the least invasive and safest
- Only use injections if px cannot take orally or drug is not able to be absorbed via GIT

2) By the clock
- Most oral analgesics only last <4 hours
~ Tf must be prescribed every 4 hrs to achieve effects

3) By the ladder
- Following WHO’s pain ladder
- Dose titrated until:
~ Max recommended dose is reached
~ Pain is relieved or
~ Px has serious side effects

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11
Q

What is WHO’s pain ladder?

A

Step 1: Non-opioids
- NSAIDs, Paracetamol
- +- adjuvant analgesics

Step 2: Weak opioids
- TRAMADOL
- CODEINE

Step 3: Strong opioids
- Immediate releade
~ MORPHINE solution
~ Oxycodone
~ Methadone
- Controlled release
~ MORPHINE SULPHATE tab
~ Transdermal FENTANYL
~ Oxycontine

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12
Q

What are adjuvant analgesics?

A
  • Treats neuropathic pain
  • Can be added to any of the steps in the WHO Pain Ladder
  • Tricyclic antidepressants
  • Anticonvulsants
    ~ Gabapentin
    ~ Pregabalin
  • Topical
    ~ Lignocaine
  • Steroids
    ~ Dexamethasone
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13
Q

Why is it important to have opioid rotation?

A
  • Resistance
  • Side effects
  • Morphine is available orally (tf least invasive)
  • Fentanyl is not effective for acute pain
  • Fentanyl takes longer to work (8-12 hours)
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14
Q

Is there a maximum dose for morphine and fentanyl in a palliative situation?

A
  • No max dose
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15
Q

When is morphine used?

A
  • Moderate to severe pain
  • Dyspnea
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16
Q

What are the different forms of morphine?

A

1) Liquid
- Mist morphine (1mg/ml)

2) Tablet
- Morphine sulphate/MST (sustained-release)
~ Cannot be cut or crushed
~ Available in 10 or 30mg tabs

3) Injectable
- 10mg/ml ampoules

17
Q

Comparison of morphine types

A

Onset of duration
- IV (5 min) -> SC (15 min) -> Mist (30 min) -> MST (1-2 hrs)

Maximal effect
- IV / SC (10-20 mins) -> Mist (60 mins)

Duration of action
- IV / SC / Mist (4-6 hrs) -> MST (8-12 hrs)

18
Q

What are the side effects of morphine?

A
  • Constipation
    ~ Tf laxatives are always given to px on morphine
  • N/V
  • Sedation
  • Confusion
  • Morphine toxicity
19
Q

What are signs of morphine toxicity?

A
  • Myoclonic jerks
  • Pinpoint pupils
  • Respiratory depression
20
Q

When is fentanyl used?

A
  • When oral intake is not possible (Due to N/V)
  • Difficult compliance to oral morphine
  • Px has side effects/morphine toxicity
  • Severe constipation with morphine
    ~ Fentanyl causes less const.
  • When px has renal or liver impairment
    ~ Safe to use fentanyl, unlike morphine
21
Q

What doses are available for the fentanyl patches + injectable fentanyl?

A
  • 12mcg/hr
  • 25 mcg/hr
  • 50 mcg/hr
  • 100mcg/2ml
  • 500 mcg/10 ml

Note: doses are the same for subcu, transdermal and IV routes

22
Q

What are the usual start doses of transdermal and infusion fentanyl?

A

Transdermal: 6mcg/hr every 72 hours
~ Same patch will be used for the 3 days before being changed

Infusion: 10mcg/hr (0.2ml/hr)

23
Q

Duration of fentanyl patches?

A

Maximal effects: 8-12hrs
Residual effect: 8-12 hrs after removal

Last for about 72 hours

24
Q

Conversion of morphine to fentanyl patch?

A

eg Morphine syrup 5mg q4H

1) Total mist morphine/day: 5x6=30 mg/day

2) Morphine mg to mcg: 30x1000=30 000mcg
- As morphine is more potent

3) Morphine/hr: 30 000 / 24 = 1250 mcg / hr

4) Morphine to fentanyl ratio (1:100): 1250 /100 = 12.5 mcg

Tf: Px uses 12mcg/hr transdermal patch q72 hours

_______________OR________________
1) Total morphine: 5x6=30mg
2) Fentanyl needed: 30/2.4 = 12.5mcg/hr

(conversion factor 2.4 method)

25
Q

How to convert fentanyl patch dose to morphine?

A

Eg Fentanyl 25mcg/hr patch

1) Total morphine daily dose: 25x2.4 = 60 mg
2) Morphine / 4 hrs = [(60/24) x 4] = 10 mg/4 hrs

26
Q

Can opioids be used in renal and liver failure?

A
  • Fentanyl recommended in mod to severe impairment
    ~ Caution req when estimated creatinine clearance <30ml/min
27
Q

What non-pharmacotherapeutic interventions are there for pain?

A
  • Radiotherapy
  • Surgery
  • PT/OT
  • Transcutaneous Electrical Nerve Simulators (TENS)
    ~ Small electric pulses that reduces pain signals to spinal cord and brain
  • Massage therapy
  • Acupuncture
  • Art therapy

palli119 (5 decks)

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