hyperalgesia/chemical coping/ the 5A's

Question 1

Hyperalgesia

Answer 1

• Hyperalgesia is a syndrome characterized by increasing pain pursued by escalating opioid doses, which results in a worsening of the clinical picture.
• When it occurs, increased opioid dosage results in paradoxical hyperalgesia.
• Manifests usually as increased pain sensitivity (e.g. light touch painful)
• Diagnosed retrospectively when there is improvement with dose reduction
• May be hard to distinguish from tolerance

Question 2

Chemical coping

Answer 2

• Attempting to treat both physical pain and emotional pain with opioids
• Use opioids in ways that it was not meant to be used
• Some patients may start to perceive emotional pain as physical pain and use opioids to cope.
• May report that opioids give them energy to work or help them to relax and go to sleep.
• Unpleasant emotions can intensify the perception of pain

Question 3

The 5 A’s

Answer 3

Gourlay & Heit 2005 recommend physicians monitor all patients on opioids by looking at the 5 A’s

1. Analgesia: Is the patient getting pain relief?
2. Affect: What is the patient’s mood?
3. Are the patient’s Activities of daily living better or worse?
4. What, if any, Adverse effects are occurring?
5. Is the patient displaying any Aberrant medication-taking behaviors?