Witches and Wizards: Chronic Pain Flashcards
neuropathic pain
pain iniiated or caused by a primary lesion or dysfuncton in the nervous system
nociceptive pain
pain causde by inury to body tissues
musculoskeletal pain
pain caused y a lesion or disease of the musckuloskeletal system including muscles, ligaments, tedons, cartilaginous structures or oints
T/F: physicians have an excellent udnerstanding of chronic pain
lol no
PQRSTU of pain
- palliative/provocative: what causes and relieves it
- quality
- radiation
- severity
- temporal
- u: how are u affected
why codeine not effectve in geriatrics
has to be converte to morphine in liver. old people have reduced hepatic conversion
how should chroic pain meds be given
around the clock, routinely, NOT PRN
adjuvant pain meds
- APAP
- NSAIDs
- duloxetine
- lidocaine
gabapentin and capsaicin too?
treatement of neuropathic pain
- first line:
- pregabalin, gabapentin
- SNRI (duloxetine)
- TCAs (caution in odler adults)
- second line: topical agents (lidocaine, capsaicin) - can consider these first line in geriatrics dt less CNS ADR
APAP pros
- good for mild-moderate
- safe in geriatrics
- adjuctive
- starting point
APAP cons
- hepatic failure
- can’t use with EtOH
- DDI with warfarin
- TDD is 4gm
- pt perception (APAP got a bad rep)
- failure to complete adequate trial (give it a week)
NSAID pros
- good for mild-moderate
- musculoskeletal (inflammation, cancer)
- topical agent
NSAID cons
- limit use to select pt when other therapeis have failed
- ceiling effect
- absolute CI: PUD, CKD, HF
- realative CI: HTN, H pylori, hx PUD
- GI risk
- CV risk (CHF, MI)
- renal risk
- coagualtioin
- DDI: asa
steroid use in pain anagament
only for pts with inflammatory disorders or metastati bone pain
opioids pro
- moderate-severe
- no ceiling dose
- multiple routes of admin
- long acting agens
opioids con
ADR
- resp depresssion (toxicity: severe resp depression, apnea)
- lethargy/sedatoin (todxiity: decreased level of consciousness, unaraousbale)
- delirium, hallucinations
- ocular miosis (toxiity: pinpoint pupils)
- constipation
- n/v
- orthostasis
- urinary incontinence
if using an opioid in geriatirc pt, whcih are preferred
- morphine
- hydrocodone
- oxy
- hydromorphone
- fentayl
treatment of opiodi inducedd n/v
- haloperidol
- chlropromazine, prochlroperazine
- antihistamies (diphenydramine, hydroxyzine, meclizine)
- antichoinergics (scopolomine)
- ondansetron
- metaclopramide
- lorazepam
most have DA or ACh effect
treatment of opioid inducedd constipation
- stool softner: docusate (not useful on own because the constipatio is dt gut being paralyed and something is needed to help push)
- stimulant: bisacodyl, senna
- osmotics: glycern suppository, lactulose, peg, sorbitol
- saline: mag citrate
- opioid antag: methylnaltrexone, naloxone
- lubricant: mineral oil
opioid guidelines (approach to treatment)
- non-pharm and non-opioid first
- establish treatment goals
- risk v benefit consideration and talk about this with pt
- IR preferred for starting
- start low, go slow
- for acute, ds should be 3 (very rarely >7)
- evaluate pts within 1-4 weeks of start (risk v benefit analysis again)
- screen pt for risk fctors for opioid related harm
- review pmp
- annual drug screens in chronic users
- big risk with conmittnat benzos use
- if use dsiroder devleoped, get help @ 1-877-8-HOPE-NY
