Pain Flashcards
Types of Pain
Acute- Duration is usually short (<6 months), and caused by tissue damage. Something that is repairable that needs a little time.
Chronic- Continual or episodic pain of longer duration (>6 months). Combination therapy is usually needed to effecitvely treat.
Locations of pain
Cutaneous- Localized on the skin or surface of the body such as sunburns or blisters.
Visceral- Poorly localized such as with internal organs such as gallbladder pain or peptic ulcer disease.
Somatic- Non localized, originates in muscle, bone, nerves, blood vessels, and supporting tissue such as a soft tissue injury.
Neuropathic- Frequently caused by a tumor, involves nerve pathway injury or compression such as sciatica.
World Health Organizations Ladder of Pain Management.
A three step progressive ladder starting with aspirin, acetaminophen or a NSAID and continues to build through the three steps with heavier narcotics added, while maintining the initial choice of aspirin, acetaminophen or NSAIDS.
Step 1 pain management
- Non opioids +/- adjuvant
-Aspirin
-Acetaminophen
-NSAIDs - +/- adjuvant
Step 2 pain management
Aspirin or acetaminophen PLUS:
-Codeine
-Hydrocodone
-Oxycodone
-Dihydrocodeine
- +/- adjuvant
Step 3 pain management
Nonopioid analgesic plus stronger pain medication:
-Morphine
-Hydromorphone
- Methadone
- Levorphanol
- Fentanyl
- Oxycodone
- +/- adjuvant
Break through cancer pain
Use of fentanyl patches for sustained release are recommended.
Transdermal or transmucosal is usually recommended after recieving a rescue dose of immediate relief (morphine) due to safety risks.
Metastatic bone pain management
Consider bisphosphonates. They inhibit bone resorption, acting by inducing osteoclast apoptosis and therby preventing the development of cancer induced bone lesions.
-Alendronate (Fosamax)
-Risedronate (Actonel)
-Ibandronate (Boniva)
Headache
Three most common type:
1.) Tension headache
2.) Migraine headaches
3.) Cluster headaches
Components of Headache evaluation:
-Chronology is the most important history item, how did it start?
-Location, duration, quality should be evaluated
-Associated acivity? Exertion, sleep, tension, relaxation?
-Timing of menstrual cycle (migraine classic)
-Presence of associated symptoms
-Presence of triggers (migraines have most triggers)
Tension headache
The single most common type of headache
S/S:
-Viselike or tight quality
-Usually generalized
-May be more intense about the neck or back of head
-No associated focal neurological symptoms
-Usually last for several hours
Lab/diagnostics: None
Management:
OTC analgesics and relaxation
Migraine headaches
- Related to dilation and excessive pulsation of branches of the external carotid artery.
- Typically lasts 2-72 hours and follows the trigeminal nerve pathway
- Females are more affected than males
- Usually family history
- Onset usually adolescence or early adult years
- Triggers are associated with migraines such as emotional or physical stress, lack or excess sleep, missed meals, specific foods, beverages, menstruations, oral contraceptives, nitrate containing foods, changes in weather.
Two different types:
Classic migraines (has aura)
Common migraines (has no aura)
S/S of migrain headaches
Unilateral, lateralized throbbing headache that occurs episodically.
May be dull or throbbing
Build gradually and lasts for several hours or longer.
POSITIVE NEURO FINDINGS
-Focal neurologic disturbances may precede or accompany migraines
-Visual disturbances such as focal defects, luminous isual hallucinations (stars)
-Aphasia, numbness, tingling, clumliness, or weakness
-N/V
-Photophobia and phonophobia
Physical exam findings of migraine headaches
Many times are normal, although may see neuro deficits.
Appears ill
Careful neuro exam for focal deficits or findings supportive of tumor.
-In pts with new migraine headaches, a variety of baseline studies must be done to rule out organic causes o symptoms such as:
–BMP, CBC, VDRL (r/o syphilis), ESR, CT of head.
Management of migraines
Avoid of triggers
Relaxation/stress management
Rest in dark, quiet room
Simple analgesic taken right away may provide some relief
Sumatriptan subq or PO
Prophylactic daily therapy if attacks occur more than 2-3 times a month:
-Anticonvulsants, beta blockers, Calcium channel blockers, botox, tricyclic antidepressants, Nsaids and other triptans.
Cluster headaches
Very painful syndromes, mostly affecting middle-aged men.
-Often no family history
-May be precipitated by alcohol
S/S:
-Characterized by severe, unilateral, periorbital pain occuring daily for several weeks.
-Usually occurs at night, awakening pt from sleep
-Usually lasts less than 2 hours, pain free months or weeks between attacks
-Ipsilateral nasal congestion, rhinorrhea and eye redness may occur.
**Physical exam: **Usually normal, may see eye redness and rhinorrhea
Management:
Oral drugs usually unsatisfactory
100% O2 may help
Sumatriptan
