Chronic pain

Question 1

Meds for neuropathic pain

Answer 1

Pregabalin
Gabapentin
SNRI
Capsaicin

Question 2

How to mitigate diversion/ abuse when prescribing meds w/ potential for this

Answer 2

limit doses
document reasons
check for double doctoring
Use written treatment contract with realistic consequences
limiting prescribed quantities or carries
when pt breaches contract, manage your own emotions, address impact on staff, apply or judiciously amend contract

Question 3

Indication for cannabis

Answer 3

Refractory severe neuropathic pain or palliative pain, has tried >3 neuropathic pain meds

Question 4

CI to cannabis

Answer 4

<25y/o
Fam hx psychosis
Cannabis or SUD
CV/ resp dz
Pregnant

Question 5

Safety education for cannabis

Answer 5

No driving 6 hrs after smoking, 8hrs after ingestion
Vaporizer preferred
SE: drowsy, memory impairment
Sign drug agreement

Question 6

Dosing for cannabis

Answer 6

100-400mg of 9% THC daily

Question 7

What to consider when providing analgesia for acute pain

Answer 7

Dose appropriately based on narcotic naivete and renal function
consider addiction risk
consider metabolic responses (codeine in pregnant/ breastfeeding pts)
Inform pt not to use OTC drugs from same class
Use non-pharmacological treatments to control pain and manage function
Recognise transition to chronic pain

Question 8

Management of trigeminal neuralgia

Answer 8

Carbamazepine
Gabapentin
Pregabalin
Phenytoin
Lamotrigine
Valproic Acid
Tricyclic Antidepressants
Baclofen

Question 9

Difference between Trigeminal Neuralgia and Herpes Zoster

Answer 9

Trigeminal Neuralgia and Herpes Zoster are both unilateral presentations; however Trigeminal Neuralgia will usually have a normal physical and sensory examination while Herpes Zoster is usually accompanied by either allodynia, numbness and has an associated rash and/or occular involvement if involving the face.

Question 10

Indications for marijuana

Answer 10

palliative pain, neuropathic pain, N/V post chemo, spasticity w/ MS

Question 11

Opioid guidelines for chronic non cancer pain

Answer 11

max new start 50mg MED, taper to 90mg MED if currently higher

Question 12

When to use opioids?

Answer 12

When TCAs, nabilone, NSAIDs, CBT, exercise, PT, self management

Question 13

Guidelines for opioids + elderly

Answer 13

Rx should only be for 3d, max 1w. Slow taper

Question 14

Managing sx of withdrawal: pain

Answer 14

rx w/ neuropathic or NSAIDs

Question 15

Managing sx of withdrawal syndrome

Answer 15

clonidine if BP >90/50 + pulse >50

Question 16

Managing sx of withdrawal: diarrhea

Answer 16

loperamide

Question 17

Managing sx of withdrawal: cramping (muscle + abdo)

Answer 17

muscle = quinine, abdo = hyoscine

Question 18

Managing sx of withdrawal: sweating

Answer 18

oxybutinin

Question 19

Guidelines for cannabis in elderly

Answer 19

avoid if hx of MH/ SU, brain or balance impairment, CVD. Assess falls + driving risk, use CUDIT