Pain II

Question 1

What is the triple whammy effect of ineffective pain management?

Answer 1

1) physicians under prescribe
2) nurses under administer
3) patients may under report

Question 2

What are the 4 general methods of treatment for pain relief?

Answer 2

1) modifying the disease process
2) interrupting pain transmission (nerve blocks, rhizotomy)
3) pharmacological management
4) non-pharmacological management

Question 3

What are the drugs listed under non-opioid analgesics?

Answer 3

Acetaminophen

NSAIDs

Question 4

What are the adverse effects for acetaminophen?

Answer 4

Hepatic failure

Question 5

What are the adverse effects for NSAIDs?

Answer 5

Ulcers/GI bleeds, inc bleeding, renal failure

Question 6

How do non-opioid analgesics act (acetaminophen and NSAIDs)?

Answer 6

peripherally by blocking prostaglandins

Question 7

What is one of the disadvantages of non-opioid analgesics?

Answer 7

they have a ceiling effect (that is, there is a point where increasing the dose no longer increases the relief)

Question 8

What is often given alongside of NSAIDs to help reduce the adverse effects?

Answer 8

a PPI for ulcer reduction

Question 9

List an advantage and disadvantage of using an opioid analgesic.

Answer 9

advantage: no ceiling effect
disadvantage: become tolerant and require higher doses

Question 10

What are the AE that are associated with opioid analgesics?

Answer 10

Constipation
Resp depression
Pruritis
Nausea
Hallucinations
HTN

Question 11

How do opioid analgesics act?

Answer 11

on CNS receptor sites binding to opioid receptors

Question 12

what is used to treat the nausea associated with opioids?

Answer 12

gravol

Question 13

When someone takes too much opioids and goes into resp depression, what is the drug given to reduce this?

Answer 13

Narcan

Question 14

What is the purpose of an adjuvant pain medication?

Answer 14

to manage specific types of pain and enhance the effectiveness of other analgesic meds and may decrease dose required of opioid

Question 15

What are the 4 main classes of adjuvant pain medication?

Answer 15

1) Antidepressants
2) Anti-anxiety
3) Anti-convulsants
4) Corticosteroids

Question 16

What type of pain are anticonvulsants used as an adjunctive for?

Answer 16

Neuropathic pain

Question 17

What are the benefits of corticosteroids related to pain management?

Answer 17

suppresses inflammation and does also have a direct analgesic effect

used for Ca, bone pain

Question 18

What type of pain are antidepressants often used as an adjunctive medication for?

Answer 18

chronic pain

Question 19

What type of pain symptoms are anti-anxiety meds used as an adjunctive medication for?

Answer 19

Anxiety and muscle spasms

ex ativan

Question 20

What types of analgesics are good for musculoskeletal pain?

Answer 20

Acetaminophen, NSAIDs, COX-2 inhibitor

Question 21

What types of medication are used for bone pain?

Answer 21

Corticosteroids if Ca

Calcitonin, vit D and calcium for osteoporosis

Question 22

What types of medications are used for neuropathic pain?

Answer 22

Anticonvulsants, antidepressants, capsaicin cr, combined with other classes

baclofen for muscle spasms

Question 23

Describe the WHO three step pain ladder.

Answer 23

1) mild pain: non opioid + adjuvant
2) mild to mod pain: add opioid
3) mod to severe pain: inc dose of opioid and consider choice and route of opioid

Question 24

What does ATC dosing mean? what does it help prevent?

Answer 24

it is around the clock dosing and helps prevent the recurrence of intolerable levels of pain

Question 25

What are the 4 principles of pharmacological management?

Answer 25

1) 3 step pain ladder 2) combined analgesia (treat acute and chronic) 3) preemptive analgesia (treat perioperative pain or prior to mobilizing) 4) titrating dose upwards or downwards to individualize management

Question 26

If you are using non-pharmacological approaches, are they a substitute for medications?

Answer 26

no they are not, they are to be used in addition.

Question 27

What can be said about the outcomes of non pharmacological approaches?

Answer 27

they are highly unpredictable. Plans need to be individualized as different interventions will be effective for different individuals.

Question 28

What are the guidelines for non-pharmacological treatment of pain?

Answer 28

1) clarify that it is not a replacement 2) assess attitude and experience 3) ask what helps besides medication for their pain 4) assess lvl of fatigue, cognitive status, and ability to concentrate and follow instructions 5) ask family and friends if they wish to be involved 6) provide adequate support

Question 29

List some common non drug treatments.

Answer 29

Cutaneous stimulation: hot and cold, vibration, massage Distraction Relaxation

Question 30

What must be done when assessing pain in the elderly.

Answer 30

1) ask about pain regularly 2) remember the misconceptions about pain in the elderly 3) expect pain whenever there is any possibility of it 4) use appropriate pain rating scales 5) believe the family and the pt 6) use the word pain medicine over drugs/narcotics 7) use the words discomfort or aching

Question 31

What are some common misconceptions about pain in the elderly?

Answer 31

belief that pain is part of the aging process belief that they have dec ability to detect pain

Question 32

List some barriers to assessment of pain

Answer 32

Cognition Hearing Family members and individuals not wanting meds

Question 33

What should you do when assessing elderly individuals with cognitive and communication impairment?

Answer 33

1) start with pt's self report of pain 2) consider pathologic conditions and procedures that might cause pain 3) look for behaviours that indicate pain 4) use a proxy pain rating 5) know the pt and family 6) when in doubt, administer meds and evaluate response

Question 34

What are the guidelines for pain management in the elderly?

Answer 34

1) use WHO ladder 2) combined analgesia 3) titrate slowly 4) preemptive analgesia 5) oral preferred 6) ATC dosing 7) use caution with certain drugs

Question 35

What are some myths/misconceptions regarding pain in children?

Answer 35

Children do not feel pain Children do not remember pain Children may develop complications from opioid use Fear of addiction

Question 36

List some factors that influence pain in children.

Answer 36

Cognitive level Temperament Previous pain experience Culture/family

Question 37

What needs to be considered regarding pain in children?

Answer 37

conceptualization of pain r/t to age/stage responses to pain r/t age/stage cognitive knowledge control issues

Question 38

What is the acronym for child pain assessment and what does it mean?

Answer 38

QUEST ``` Question the child Use rating tools Evaluate behavior Sensitize parents and staff Take action ```

Question 39

What age group is the faces assessment tool appropriate for?

Answer 39

3 and up

Question 40

What age group is the poker chip assessment tool appropriate for?

Answer 40

4 and up

Question 41

What age group is the visual analog scale good for?

Answer 41

age 7 and up

Question 42

What are the two types of behavioural scales to assess pain?

Answer 42

Riley infant FLACC

Question 43

What is one thing you could do if you suspect a child is experiencing pain, but is not expressing it?

Answer 43

Use a teddy bear and ask if teddy is hurting today. they often project