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Flashcards in Chronic Pain Deck (42):
1

is pain a normal part of growing old?

No

2

is pain more common as you get older

yes

3

if it is chronic pain how should it be dosed?

by the clock so pain is more steady

4

are most patients under or over treated for pain?

under

5

what are manifestations of pain

clenched teeth
grimacing
splinting
posturing

6

what drug shouldn't be used due to ataxia, dizziness, increased risk for falls

propoxyphene

7

what drug shouldn't be used due to tremor, myoclonus, seizures

meperidine

8

if you are using COX 2 + aspirin or NSAID what else should they recieve

PPI

9

Should you begin treating pain with the lowest level on the analgesic ladder then slowly work your way up to opioids?

No, The initial choice of agents is based on the characteristics of the pain, the pain intensity, and the individual patient

10

0-3 on pain scale is ____ pain

mild

11

7-10 on pain scale is ____ pain

severe

12

4-6 on pain scale is ____ pain

moderate

13

What pain drug should be prescribed with opioid analgesia to ensure a combination with maximum efficacy?

Acetaminophen and NSAID

14

Non pharm treatment of pain

Physical activity and exercise
Distracting measures
Heat, ice, stretching, massage, US, acupuncture

15

When do you choose acetaminophen for pain?

mild to moderate pain
MSS (OA, LBP)

16

What should you use if you are taking NSAIDs for GI protection?

PPI or misoprostol

17

Side Effects of Opiod

respiratory depression
sedation
falls
constipation
N/V
delirium

18

What 2 opiods should you not use for pain?

propoxyphene (increases risk of falls, dizziness, sedation, drowsiness, confusion, constipation)
meperidine (tremors, myoclonus, delirium, seizures)

19

Stage of OA? Fibrillation and erosion of the cartilage surface develop, with subsequent release of proteoglycan and collagen fragments into the synovial fluid

stage 2

20

Stage of OA? Proteolytic breakdown of the cartilage matrix occurs

Stage 1

21

Stage of OA? Breakdown products of cartilage induce a chronic inflammatory response in the synovium, which in turn contributes to further cartilage breakdown

Stage 3

22

For OA: Stiffness during _____ (gelling) may develop, with morning joint stiffness usually lasting for less than _____

rest; 30 minutes

23

Does OA have erythema or warmth over affected joints?

Not usually

24

What joints does OA affect?

DIP, but also PIP and joints at base of thumb

25

Pain >3 months
Trouble concentrating
Low energy level
Trouble sleeping

chronic pain

26

2 types of nociceptive pain

somatic
visceral

27

arising from skin, bone, joint, muscle, CT. It is described as well localize, constant, throbbing, aching, stabbing. Nociceptors are the pain receptors. (ex: arthritis, bone mets, fracture, acute post-op).

Somatic pain

28

arises from viscera of internal organs (large intestines and the pancreas, renal colic, bowel obs) abnormal processing of sensory input by the peripheral or central nervous system. Poorly localized, diffuse, referred pain, dull, colicky, deep. Associated with N/V, diaphoresis.

Visceral pain

29

PNS or CNS cause. Burning, tingling, shock-like, shooting, prickling, squeezing, abnormal DTRs, impaired motor function, paresthesias. (cervical or lumbar radiculopathy, postherpetic neuralgia, trigeminal neuralgia, diabetic neuropathy, post-stroke syndrome, herniated intervertebral disc)

Neuropathic Pain

30

Source of pain is not understood, widespread MSS pain, stiffness, weakness. Myofascial pain syndrome, somatoform pain disorders.

Undetermined Pain

31

Somatization and hysterical reactions

Psychological

32

What is the PAINAD?

Pain Assessment In Advanced Dementia

33

What is the procedure of PAINAD?

Observe 3-5 min with movement (bathing, turning, transferring).
-For each item select the score (0, 1, 2) that reflects the current state of the behavior.
-Add the scores. Total scores range from 0 to 10 (0= “no pain” to 10= “severe pain”).

Always compare the score to a previous score. An increased score suggests pain is increased, while a lower score suggests pain is decreased.

34

What are the 5 types of scoring for PAINAD?

Breathing
Negative vocalization
Facial expression
Body language
Consolability

35

What are treatments for neuropathic pain?

antidepressants, anticonvulsants, opioids, topical anesthetics

36

What are treatments for undetermined pain?

antidepressants, anti-anxiety, psychological therapy.

37

Risk Factors of OA

Age- strongest risk factor
F>M
Obesity
Lack of osteoporosis
Occupation
Previous injury
Muscle weakness
Genetic elements (COL2A1 mutation)

38

What is hallmark of OA?

cartilage degeneration

39

OA stiffness in affected joints for ___ minutes

<30; gelling phenomenon (resolves with motion, recurs with rest)

40

What are the 2 types of nodes of OA?

Bouchard's nodes (PIP)
Heberden nodes (DIP)

41

What is the clinical choice to diagnose OA?

Xray

42

1st drug to try for OA

Acetaminophen