drug in rehab setting

Question 1

what is pain

Answer 1

Physical/electrical input comes from the body and is combined with historical and contextual factors in the brain. If the threat seems real enough, there will be pain

Question 2

what is central sensitivation

Answer 2

Body has pathophysiological changes in the nervous system that makes it more responsive to input that typically would be nonpainful

pain threshold is lower than usual
overactive system alarm

pain lasting for longer than 3 month

Question 3

how does nerve adapt in central sensitization

Answer 3

increase their resting levels of excitement -> continue inflamation response, continuing stress response

Question 4

what repeated pain experience cause to system

Answer 4

sensitized
nervous system become more sensitized -> original pain threshold decrease = experience pain at decrease levels of activity

Question 5

how does NSAID work

Answer 5

Suppress inflammation by inhibiting the enzyme cyclooxygenases (COXs)
Cyclooxygenase (COX-1protects stomach lining from harsh chemicals and COX-2 is produced when joints are injured/inflamed)
Good at treating pain caused by slow tissue damage, such as arthritis

Question 6

T/F NSAID is typically not used more than 10 days for pain unless doctors say it ok

Answer 6

T

Question 7

how does acetaminophen work

Answer 7

Blocks pain by inhibiting the synthesis of prostaglandin (a natural substance in the body that initiates inflammation) in the CNS (brain) but not in the peripheral system
Reduces pain signals

Acts as an analgesic and reduces fever but has NO anti-inflammatory or antiplatelet properties

Does not cause GI irritation so often is used as a replacement for aspirin

Question 8

can you use ibuprofen and acetaminophen together

Answer 8

yes
best to take them 2-4h apart

Question 9

when will it be a better option to use topical NSAID

Answer 9

Direct application to painful site to produce local pain-relieving effect which avoids whole body distribution of the drug at physiological levels
Penetrates the skin, can be absorbed by the blood and transported to site to inhibit COX enzymes

More superficial painful conditioning such as sprains, strains, muscle and tendon soreness and not deep visceral pain or headaches

Question 10

benefit of corticosteroid injection

Answer 10

Widely used to help decrease inflammation and pain by delivery of potent anti-inflammatories

Concerns include length of benefits and safety concerns that limit the frequency of use

Question 11

T/F Studies have shown that prolonged use of CS have a detrimental effect on articular cartilage and accelerate the progression of OA

Answer 11

T

Question 12

Higher doses of corticosteroid for longer treatment durations were associated with

Answer 12

chondrotoxicity

Physicians typically limit 3-4 injections/year to a joint

Question 13

T/F Recommendation for use recognizes that CS are indicated for short term use

Answer 13

T

Question 14

what is the goal of muscle relaxant

Answer 14

Goal is to normalize muscle excitability without a profound decrease in muscle function
Can be used in conjunction with therapeutic techniques (can be synergetic relationship)

Question 15

Type of medication to help reduce increased muscle tone and spasticity

Answer 15

Neuromuscular blocker (often used in surgery, ICU, emergency)
Spasmolytics used more in physical therapy community
Over the counter Robaxin (methocarbamol)
Flexeril cyclobenzaprine **most studied muscle relaxer with strong evidence for effectiveness

Question 16

indication for muscle relaxant

Answer 16

Indicated for SHORT TERM use…therefore should be used in conjunction with multiple modalities (example: physical therapy) to have lasting effects

Question 17

benefit of cannabidiol

Answer 17

rest better (improve sleep latency, sleep continuity, subjective sleep quality and reduce nightmares and insomnia)
reduce their stress and feel better in the face of challenges (anxiolytic and antidepressant)
can deflate their muscles after damage caused by physical exertion (anti-inflammatory)
reduce pain caused by high physical demands

Question 18

what are opioid

Answer 18

Broad group of pain relieving drugs that work by interacting with opioid receptors in your cells

Made from poppy plant or Synthesized in a lab

Question 19

Topical NSAID is absorbed where

Answer 19

blood

Question 20

where is acetamoniphen processed

Answer 20

liver

Question 21

where is ibuprofen processed

Answer 21

through kidney

Question 22

what is often use in remplacement of aspirin since it doesn’t cause GI irritation

Answer 22

acetaminophen

Question 23

what will you want to use if you want to reduce clotting action

Answer 23

NSAID -> aspirin

Question 24

is Tylenol a NSAID

Answer 24

no -> pain reliever

Question 25

is CBD accept among professional athlete

Answer 25

yes

Question 26

risk factor of opioid use

Answer 26

Caucasian race, contact sports, postretirement unemployment, and undiagnosed concussion

Question 27

how to complete a pain management plan

Answer 27

Individualized education- talk to your patient!
- High Risk Factors
- Diversion programs
- Overdose management (co-prescribing Naloxone to at risk patients)
- Proper disposal**
Realistic expectations and goals
3-7 day supply limit
Lowest effect dose
Non-Opioid alternatives
Physician re-evaluation
Refill policies