Pain Control

Question 1

Musculoskeletal Pain

Answer 1

NSAIDS

COX-2

Question 2

Example NSAID

Answer 2

Ibuprofen

naproxen

Question 3

Example of COX-2

Answer 3

diclofenac

celecoxib( celebrex)

Question 4

Neuropathic Pain

Answer 4

Anticonvulsants 1st line
and Analgesics
THEN
TCA
anticonvulsants 2nd line
SSRI
Anti-arrhythmic agent

Question 5

Example anti-convulsants 1st line- neuropathic

Answer 5

Gabapentin (neurontin)

Question 6

Example Analgesics anti-convulsants-neuropathic

Answer 6

PREGABLIN

Question 7

Example TCA-neuropathic

Answer 7

amitriptyline (Elavil)
nortirptyline (Pamelor)
imipramine (Tofranil)
desipramine (Norpramin)

Question 8

Example Anti-convulsants 2nd line - neuropathic

Answer 8

Phenytoin (Dilantin)
Carbamazepine (Tegretol)
Valporic Acid (depakote)

Question 9

Example SSRI- neuropathic

Answer 9

Fluoxetine (Prozac)
Sertaline (Zoloft)
Paroxetine (Paxil)
Duloxetine (CYmbalta)

Question 10

Example Anti-arrhythmic - neuropathic

Answer 10

Lidocaine

Question 11

Nociceptive Pain

Answer 11

Opioids

Pure Opioids

Question 12

Example Opioids - nociceptive

Answer 12

tramadol, percoet, codeine, tylenol 3, vicodin

Question 13

Example of Pure Opioids- nocicpetive

Answer 13

Morphine, oxycodone, hydromorphone, fentanyl, methadone

Question 14

Tolerance

Answer 14

medication is less effective over a prolonged period use of drug

Question 15

Dependence

Answer 15

medication has become physiologic requirement: abstinence syndrome develops if drug withdrawn

Question 16

Addiction

Answer 16

behavioral reaction from drug misuse; drug seeking; it is characterized by following behaviors: impaired control over drug use, compulsive use, continued use despite harm and craving

Question 17

Pseudoaddiction

Answer 17

behavioral reaction d/t inadq or under tx of pain

Question 18

Somatic

Answer 18

Well localized, aching, throbbing, gnawing, activation of nociceptors in cutaneous and deep tissue
bone mets, soft tissue injury - OA, post op

Question 19

Visceral Pain

Answer 19

poorly localized
deep aching, cramping, pressure, referred
activation of nocicpetors resulting from strech distention or inflammation
BO, billiary colic

Question 20

Neuropathic Pain

Answer 20

Spinal cord, brain, PNS

shooting, shock like, burning, n/t/itch

Question 21

Nociceptive 4 parts pathway of pain

Answer 21

Transduction- receptors trigger with injury
Transmisison- into spinal cord (a delta-c fibers)
Perception
Modulation- turn “down” signal natural endorphins, epi

Question 22

Indications for XRAY

Answer 22

trauma
neurologic deficit
systemic symptoms
temp >38
wt loss
hx CA, steriod use, ETOH use

Question 23

XRAY show

Answer 23

DDD, osteophytes (bridity of bone), instability, alignment, axial instability, basilar InVagination, compression fx

Question 24

“Dynamic “ xrays

Answer 24

-ordered to evaluate the overall structural integrity
- extreme ROM
-measurement of curvature
*no info about deformation of discs, facets, ligaments, or soft tissue
movement with neck hyperextension/flexion

Question 25

MRI show

Answer 25

``` confirm what you already know! soft tissue nerves discs osseus structures ligaments bone, disc, ligaments, neural elements, facet joints, paraspinal musculature ```

Question 26

high false + MRI

Answer 26

asymptomatic patients in lumbar spine and cervical

Question 27

CT show

Answer 27

- contraindication ot MRI- pacer, sharpnel in orbit, aneurysmal clips - bony detail- neuro compression - visualize neurological structure improve with myelogram

Question 28

CT for

Answer 28

bone sx, quick to sit through, fx, bld, osseus structure, osteophytes, foramenal stenosis, spinal stensosi, deg changes

Question 29

Bone Scan

Answer 29

screening tool, tumor, infection, occult fx | ID mets, infection, occult fx

Question 30

TENS

Answer 30

nerve stimulation w/ mild electrical current, interrupt pain transmission, variety of uses adn modes, electrodes placed on site of pain NOT for prego or implanted devices

Question 31

Heat

Answer 31

muscle tension, spasma, arthritis, NOT for lbd, topcial patches, irritated skin

Question 32

Cold

Answer 32

muscle spasm, HA, trauma, surgical, incisional pain, NOT for poor circulation or irritated skin

Question 33

Basic Comfort Measures

Answer 33

positioning, environ, pacing rest, support devices

Question 34

Physical Exercise

Answer 34

45 mins- ROM , passive exercises, best for general MS pain, OA, exercise tolerance if CV risk

Question 35

WHO 3 step analgesic for

Answer 35

non-opioid and adjuvant- Tyl, NSAID Opioid with adjuvant- codeine, hydrocodone, oxycodone, dihydrocodiene opioid + adjuvant- morphine, methadone, fentanyl, oxycodone, hydromorphone