Pain lecture part 2 Flashcards by Hannah Garrison

The primary action of oxymorphone is

Mu (respiratory depression)

some delta activity (psychomimetic)

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Hydrocodone has activity on

Mu, some Kappa (dysphoria)

combined with acetaminophen

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Hydromorphone as activity on

Mu & Kappa (dysphoria)

-may be used intrathecally

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Methadone is a

NMDA antagonist
Mu agonist
cardiotoxic

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Tramadol is a

weak opioid analogue of codeine
considered to be non-addictive but can be
not safer than opioids

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Opioid therapy for chronic pain is

NOT a good long term solution

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Tolerance to opioids over time includes

opioid induced hyperalgesia

rotation of opioids improve analgesia and reduce side effects

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Corticoid steroids commonly used in pain management include

methylprednisolone
triamcinolone
betamethasone

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All steroids have some

mineralcorticoid effects such as sodium retention & insulin resistance

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Long acting particulate steroids can cause ______ if vascular injection

spinal infarct

-short acting dexamethasone is okay

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Frequent side effects of steroids include

fluid retention

hyperglycemia with increased insulin requirements

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Infrequent side effects of steroids include

hypertension
amenorrhea
hypokalemia 
exacerbation of CHF
anaphylactoid/hypersensitivity reactions
adrenal suppression

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Long term use of steroids causes

hyperpigmentation
osteoporosis
myopathy

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Topical steroids can be used for

multiple chronic pain syndromes because they have continued peripheral nerve stimulation,
high benefit/low risk

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Sleep aids can

decrease pain because lack of sleep contributes to pain and vice versa
-sleep aids combined with pain medications pose a significant risk

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Treatment for sleep should begin with

non-pharmaceuticals & include
mechanical aids (pillows, positioning)
natural aids, exercise (stretching), biofeedback

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Antidepressant considerations

complimentary to pain medications
not appropriate for acute pain (take days to weeks to be effective)
increased compliance and mood reported

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Pain due to changes in sensory process may be effectively treated with

anticonvulsants

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Anticonvulsants may treat

fibromyalgia (functional pain)
trigeminal neuralgia- most effective
little evidence exists for support of other treatments

NMDA receptors may play a role in

Alzheimers disease and schizophrenia

NMDA receptors are critical in

synaptic plasticity, a cellular mechanism for learning and memory

NMDA antagonists include

Ketamine
PCP
robitussin
methadone

Low dose ketamine has been studied for the treatment of

complex regional pain syndrome

Preemptive treatment with NMDA antagonist may be effective to prevent

post-operative pain hypersensitivity (0.25 mg/kg)

Muscle relaxants should not be used

as a first line agent & should be limited for use for a short amount of time used for myofascial pain

Pain has ______ consequences

psychological

______ & _____ often develop simultaneously

chronic pain & depression

The two dimensions of perceptive pain include

``` sensory discriminators in dorsal sensory cortex (causes perception of pain) ```

The most common cause of pain and disability is

lumbar radicular syndrome

Causes of lumbar radicular syndrome include

various discogeic, osteogenic, neurogenic associated nerve root inflammation

The purpose of treatment for lumbar radicular syndrome is to

reduce nerve root pressure caused by inflammation

Symptoms of lumbar radicular syndrome include

pain, parestehsia, and/or numbness following a particular dermatomal distribution, diminished reflexes, increased pain with straight-leg raises

Treatment options for lumbar radicular syndrome include

interlaminar ESI transforaminal ESI caudal ESI

Interlaminar ESI includes

catheter or without lowest risk lowest results

Transforaminal ESI includes

highest risk | best results

Caudal ESI includes

most versatile good results catheter recommended for lumbar

Red flags for lumbar radicular syndrome (i.e. explore other possibilities)

``` <20 years old, congenital issue >50 years, rule out malignancy, AAA short term <3 m. more serious etiology recent trauma ay signs of infection unrelated pain incontinence, bilateral neurological symptoms (excluding pain) ```

Describe the symptoms of facet arthropathy.

focal pain over joint, no significant radiculopathy, no neurological deficit, pain exaggerated on twisting movement

Qualifications for insurance pre-authorization includes:

must have radicular symptoms following a specific dermatome must have failed conservative treatment for three weeks (NSAIDs, PT, etc.) must have an average pain score greater than 6 out of 10 must cause reduction in ability to work and perform ADL must not be at more than two levels

Qualifications for repeat injection include

must have had greater than 50% improvement from first injection must have shown improved mobility must not have more than 3 injections in a six month period of time

The purpose of the SI joint is

shock absorption for the spine, along with the job of torque conversion

Symptoms of sacroiliac joint syndrome include

pain in the superior medial buttock, lateral buttock, radiation to the hip and groin

Symptoms of occipital neuritis include

headaches that originate in the neck and radiate along the occipital skull to the top of the head and later to ear

Patient barriers to treat pain include

``` lack of access to care ignorance and fear of treatment misinformation cultural issues provider barriers inadquate continuing education lack of pain treatment as a prioirty absence of adequate pain monitoring regulatory hostility toward aggressive pain treatment lack of empathy ```

Consequences of failure to treat pain include

``` debilitation lower quality of life depression divorce suicide ```