Pain Flashcards
(31 cards)
chronic non-cancer pain (CNCP) definition
musculoskeletal pain
caused by lesion or disease of the ms system (muscles, ligaments, tendons, joints)
consequences to failure to use multimodal approach
miss the benefits of physical, behavioral, and psychological approaches to train the nervous system and maximize recovery
consequences to failure to target the mechanism of pain
suboptimal pain control and increased costs when pain control is not effective
consequences to failure to treat neuropathic pain with adjuvant medications
worsening hypersensitivity of nervous system and suboptimal pain control
consequences to heavy use of short acting opioids instead of long acting opioids
increased breakthrough pain, disturbed sleep, development of opioid tolerance, APAP toxicity with combo products
pain assessment
PQRST, pain scales, FLACC scale
P: palliative/provocative
Q: quality
R: radiation
S: severity
T: temporal
barriers to recognition of pain
no objective markers of pain, blunted response, cognitive & communication, co-morbidities, staff training
common misconceptions about chronic pain
sign of personal weakness, part of aging, punishment, death is near, indicates serious illness
nonspecific s/s of pain
frowning, grimacing, clenched teeth, bracing, guarding, restlessness, agitation, eating/sleeping poorly, sighing, groaning, loss of function, change in gait/behavior, decreased activity levels
factors associated with the development of chronic pain in elderly
degenerative joint disease, RA, osteoporosis, neuropathic pain, HA, oral/dental pathology, PVD, amputations
non-pharm pain management
physical activity, patient education, cognitive-behavioral therapies, adjuncts (heat/cold, massages, spirituality)
steps in treating pain
- nonopioid +/- adjuvant
- opioid for mild-to-mod pain +/- adjuvant, +/- nonopioid
- opioid for mod-to-severe pain +/- nonopioid, +/- adjuvant
general principles for prescribing pain control in long-term care settings
● admin meds routinely, not prn
● use least invasive route of admin first
● begin with low dose, titrate carefully
● reassess and adjust dose frequently
non-opioid analgesic- acetaminophen pro
useful for mild-to-mod pain, elder safe, adjunctive, starting point
non-opioid analgesic- acetaminophen con
very few: caution in hepatic failure, watch total use (<4gm/day)
non-opioid analgesic- NSAID pro
useful for mild-to-mod pain, musculoskeletal (inflammation, cancer), topical diclofenac
may be selected carefully in safer therapies have failed
non-opioid analgesic- NSAID con
“ceiling effect”, toxicity, absolute CIs (PUD, CKD, HF)
bottom line with NSAIDs in elders
evaluate for risk vs. benefit, use lowest possible effective dose, analgesic vs. anti-inflammatory, COX-2 may be safer, GI prophylaxis for patients at risk
Journavx (suzetrigine) 50 mg tabs
approved for short term (14 day) use for acute moderate and severe pain (non-opioid)
adjunctive agents
duloxetine (chronic musculoskeletal pain), lidocaine
avoid TCAs
neuropathic pain treatment
first line: a-2 ligands (pregabalin, gabapentin), SNRIs, TCAs (CAUTION)
second line: topical agents (lidocaine, capsaicin)
opioid analgesic pro
mod-to-severe pain, ceiling dose, routes of admin, long acting agents available
all patients with mod-to-severe pain should be CONSIDERED for opioid treatment
opioid analgesic in elders side effects vs toxicity- pulmonary
respiratory depression vs. severe resp. depression and apnea
opioid analgesic in elders side effects vs toxicity- CNS
lethargy vs. ↓ LOC, unarousable
