Pain management

Question 1

management of acute pain

Answer 1

follow WHO pain ladder

Question 2

use of non-opioid analagesics for acute pain

Answer 2

use adjuncts for breakthrough pain

Question 3

gabapentin and pregabalin efficacy

Answer 3

comparable (but emerging drugs of abuse)

Question 4

TCAs for pain?

Answer 4

modest benefit, low-quality evidence

Question 5

low potency opioids

Answer 5

tramadol
codeine (metabolized to morphine)

Question 6

high potency opioids

Answer 6

fentanyl
hydrocodone
hydromorphone
morphine
oxycodone

Question 7

drug to be careful with when combining with opioids

Answer 7

acetaminophen (double edged sword…)

Question 8

onset of opiiods

Answer 8

30 minutes with orals, 10 minutes

Question 9

other impt point about pain management

Answer 9

teach patients to anticipate pain and take dose before onset of severe pain (so that they’re not behind, and it takes much more drug to chase pain, so you can decrease total dose)

Question 10

opioid type for acute pain

Answer 10

don’t use long-acting, short course (3-7 days) with close follow up.

Question 11

pseudoaddiction

Answer 11

• same behaviors as addicts (doctor shopping, etc.) but pain is poorly managed, actually in severe pain

Question 12

management of neuropathic pain

Answer 12

• use adjuncts

- no good evidence that opioids work

Question 13

max dose of opioids per CDC

Answer 13

over 90 mg of MME

Question 14

cautionary dose of opioids per CDC

Answer 14

50 MME (shouldn’t prescribe more than 50)

Question 15

management of non-opioid responsive pain

Answer 15

• maximize adjuncts and minimize opioids, if opioids aren’t working, more won’t help and they may be worsening pain
• most common if actually neuropathic or psychiatric.

Question 16

who to consult for acute pain management

Answer 16

palliative care providers