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Clinical 2.0 winter > Intro to pain > Flashcards

Intro to pain Flashcards

1
Q

difference of chronic compared to acute pain

A

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

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2
Q

PQRST stands for

A 
provkes/precipitates
quality 
radiation, referal
severity 
timing
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3
Q

how can continuous opioids worsen the patients quality of life

A

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

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4
Q

what are wrong situations to throw opioids at

A

pain linked with emotional and psychosocial factors

helplessness and hoplessness root cause of suffering

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5
Q

more important questiona about function rather than pain severity

A 
mobility 
able to perform activities
irritability or depression 
how are they sleeping 
socializing
enjoying life
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6
Q

problems with the WHO ladder

A

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

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7
Q

pros of acetaminophen

A 
safe
well tolerated
high does for toxicity 
few DI 
cheap and accessible (bad?)
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8
Q

cons of acetaminophen

A

mild benefit
found in many products
interaction with warfarin increases INR

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9
Q

acetaminopehn effectiveness in headache

A

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

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10
Q

effectiveness of of acet in post dental surgery

A

NNT 3 for 50% reduction

ibuprofen is better

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11
Q

acet efficacy in osteo

A

min benefit in short term

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12
Q

acet efficacy in back pain

A

no effect vs placebo

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13
Q

risk factors for acet hepatotoxicity

A 
old age
poor nutritional status
fastin/anorexia 
glucuronidation inhibitors 
chronic alcohol use
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14
Q

NSAID pros

A

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

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15
Q

nsaid cons

A

no readily available injectable

safety….

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16
Q

baseline risk of upper GI event when using conventional dose

A

2.5%

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17
Q

risk factors for UGI event when using nsaids

A 
>65yoa
use of anticoagulant or steroids
histoyr of peptic ulcer disease
high dose of nsaid 
presence of hpylori
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18
Q

which treatments reduce UGI event risk in nsaid use

A

PPI cotherapy
coxib
hpylori treatment
misoprostol

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19
Q

risk of renal issues with nsaids use and risk factors

A 
increase 2x
volume depletion
CHF
acei, arb use
renal disease, cirrhosis
>70yoa
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20
Q

low dose ____ are CV neutral

A

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

21
Q

nsaids that increase cardiac risk 2-4x

A

diclofenac and high dose celecoxib

22
Q

nsaid effectiveness in OA

A

NNT4
similar to opioids
better than acet

23
Q

nsaid effectiveness in low back pain

A

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

24
Q

open label placebo treatment in chronic low back pain efficacy

A

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

25
Q

advantage of topical nsaids

A

less adverse effects bc very little systemically available

26
Q

disadvantage of topical nsaids

A

local skin reaction

stickiness

27
Q

what strength of topical nsaid

A

1-1.5% bid - tid

increasing dose not sure if it helps but prob still safe

28
Q

topical nsaid effectivness for osteo

A

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

29
Q

topical nsaid efficacy in acute pain - sprain, strain

A

very good NNT2

30
Q

topical nsaid for back pain, neuropathic, or widespread efficacy

A

no evidence to support use

31
Q

opioid advantages

A

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

32
Q

opioid disadvantages

A

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

33
Q

thoughts about tyelenol 1

A

useless

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

34
Q

opioid for mild-mod pain

A

codeiene
tramadol
buprenorphine patch

35
Q

opioid for mod-sev

A

morphine
hydromorph
oxycodone
later fentanyl patch or methadone

36
Q

difference between morphine and hydromorphone

A

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

37
Q

why wouldnt we use oxycodone

A

similar hepatic/renal considerations as mirphine

big street value

38
Q

safest way to switch opioids

A

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

39
Q

use of cyclobenzaprine

A

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

40
Q

non pharms

A 
heat/cold
physio
massage
chiropractor
acupuncture
exercise
music
yoga
CBT
41
Q

things you should consider before the who pain ladder

A

education and non pharms

42
Q

monitoring pain

A

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

43
Q

wehn is a pain diary useful

A

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

44
Q

monitoring function

A 
ability to perform activities and exercise
relief from irritability or depression 
sleep 
min med side effects
financial
45
Q

poor pain control in elderly can result in

A 
weight loss
decrease mobility 
falls 
depression 
alcohol consumption
malnutrition
46
Q

dosing in elderly

A

dose titration
start half of usual dose
go slow review often

47
Q

nsaids use in elderly

A

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

48
Q

opioid use in elderly

A

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

49
Q

skeletal muscle relaxant use in elderly

A

avoid

Clinical 2.0 winter (28 decks)

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