Intro to pain

Question 1

difference of chronic compared to acute pain

Answer 1

chronic more dependence to meds, psychological component, no organic cause, family issues, insomnia common, depression
treatment goal is just to improve functionality and pain reduction

Question 2

PQRST stands for

Answer 2

provkes/precipitates
quality 
radiation, referal
severity 
timing

Question 3

how can continuous opioids worsen the patients quality of life

Answer 3

using exogenous opioids chronically sacrifice normal healthy motivational behaviors, socialization, coping becuase the bodies ability to produce endogenous endorphins is decreased

Question 4

what are wrong situations to throw opioids at

Answer 4

pain linked with emotional and psychosocial factors

helplessness and hoplessness root cause of suffering

Question 5

more important questiona about function rather than pain severity

Answer 5

mobility 
able to perform activities
irritability or depression 
how are they sleeping 
socializing
enjoying life

Question 6

problems with the WHO ladder

Answer 6

created for cancer patient which is different
assumes that if were in pain we take something
when do we come back down
does a step up = better analgesic

Question 7

pros of acetaminophen

Answer 7

safe
well tolerated
high does for toxicity 
few DI 
cheap and accessible (bad?)

Question 8

cons of acetaminophen

Answer 8

mild benefit
found in many products
interaction with warfarin increases INR

Question 9

acetaminopehn effectiveness in headache

Answer 9

NNT = 8 but prob high bc placebos good at reducing pain and most people feel better in 2hr anyway
prob works much better

Question 10

effectiveness of of acet in post dental surgery

Answer 10

NNT 3 for 50% reduction

ibuprofen is better

Question 11

acet efficacy in osteo

Answer 11

min benefit in short term

Question 12

acet efficacy in back pain

Answer 12

no effect vs placebo

Question 13

risk factors for acet hepatotoxicity

Answer 13

old age
poor nutritional status
fastin/anorexia 
glucuronidation inhibitors 
chronic alcohol use

Question 14

NSAID pros

Answer 14

can be given topically
many to choose from
OTC
better than acet sometimes

Question 15

nsaid cons

Answer 15

no readily available injectable

safety….

Question 16

baseline risk of upper GI event when using conventional dose

Answer 16

2.5%

Question 17

risk factors for UGI event when using nsaids

Answer 17

>65yoa
use of anticoagulant or steroids
histoyr of peptic ulcer disease
high dose of nsaid 
presence of hpylori

Question 18

which treatments reduce UGI event risk in nsaid use

Answer 18

PPI cotherapy
coxib
hpylori treatment
misoprostol

Question 19

risk of renal issues with nsaids use and risk factors

Answer 19

increase 2x
volume depletion
CHF
acei, arb use
renal disease, cirrhosis
>70yoa

Question 20

low dose ____ are CV neutral

Answer 20

naproxen (750-850/d)
ibuprofen (1200-2000/d)
celecoxib (<200/d)

Question 21

nsaids that increase cardiac risk 2-4x

Answer 21

diclofenac and high dose celecoxib

Question 22

nsaid effectiveness in OA

Answer 22

NNT4
similar to opioids
better than acet

Question 23

nsaid effectiveness in low back pain

Answer 23

similar to opioids but based on few trials
reduce 3.3 points of 100pain scale
reduce ,9 points of 24 diability scale
dont know numbers just know not that great

Question 24

open label placebo treatment in chronic low back pain efficacy

Answer 24

compared to treatment as usual elicited better pain reduction with moderate to large effect sizes

Question 25

advantage of topical nsaids

Answer 25

less adverse effects bc very little systemically available

Question 26

disadvantage of topical nsaids

Answer 26

local skin reaction | stickiness

Question 27

what strength of topical nsaid

Answer 27

1-1.5% bid - tid | increasing dose not sure if it helps but prob still safe

Question 28

topical nsaid effectivness for osteo

Answer 28

as good as oral for hands and knees initially as time goes on effect decreases

Question 29

topical nsaid efficacy in acute pain - sprain, strain

Answer 29

very good NNT2

Question 30

topical nsaid for back pain, neuropathic, or widespread efficacy

Answer 30

no evidence to support use

Question 31

opioid advantages

Answer 31

highly effective for some types high dose ceiling for effect - cancer IV/SC improved access and quick onset

Question 32

opioid disadvantages

Answer 32

dose related SE threshold for serious toxicity can be long in some tolerance, dependence abuse long term SE - dry mouth, androgen deficiency

Question 33

thoughts about tyelenol 1

Answer 33

useless | 8mg no pain relief so increase to try get relief and end up taking way too much acet and caffiene

Question 34

opioid for mild-mod pain

Answer 34

codeiene tramadol buprenorphine patch

Question 35

opioid for mod-sev

Answer 35

morphine hydromorph oxycodone later fentanyl patch or methadone

Question 36

difference between morphine and hydromorphone

Answer 36

active metabolites of morphine renally eliminated caution with accumulation in renal dysfunction, less caution in hydro morphine histamine release causes itchiness

Question 37

why wouldnt we use oxycodone

Answer 37

similar hepatic/renal considerations as mirphine | big street value

Question 38

safest way to switch opioids

Answer 38

convert based on the table then decrease the dose by 25%

Question 39

use of cyclobenzaprine

Answer 39

only is muscle spasm present most benefit in 4-7 days cane use up to 2 weeks drowsiness major SE

Question 40

non pharms

Answer 40

``` heat/cold physio massage chiropractor acupuncture exercise music yoga CBT ```

Question 41

things you should consider before the who pain ladder

Answer 41

education and non pharms

Question 42

monitoring pain

Answer 42

PQRST analgesic use dose and frequency non drug being used pain diary

Question 43

wehn is a pain diary useful

Answer 43

when looking how to dose long acting meds determining what causes pain help patient understand their pain document what theyre able to do

Question 44

monitoring function

Answer 44

``` ability to perform activities and exercise relief from irritability or depression sleep min med side effects financial ```

Question 45

poor pain control in elderly can result in

Answer 45

``` weight loss decrease mobility falls depression alcohol consumption malnutrition ```

Question 46

dosing in elderly

Answer 46

dose titration start half of usual dose go slow review often

Question 47

nsaids use in elderly

Answer 47

increased risk of GI bleed, CV, and renal events add a PPI monitor renal function use topical instead

Question 48

opioid use in elderly

Answer 48

uncommon do 3 day tolerance check - sedation, imbalance, confusion, constipation** sedation occurs before resp depression

Question 49

skeletal muscle relaxant use in elderly

Answer 49

avoid