Pain Meds

Question 1

What screening tool can you use to detect opioid abuse

Answer 1

Opioid risk tool

A score of 3 or lower indicates low risk for future abuse

A score 4-7 indicates moderate risk for opioid abuse

A score 8 or higher indicates a high risk for opioid abuse

Question 2

Complementary therapies for pain

Answer 2

Acupuncture
Biofeedback
Energy therapies
Guided imagery and visualization
Heat or cold
Hypnosis
Massage
Meditation
Music therapy
Reiki
Tai chi
Tens
Yoga

Question 3

What’s the withdrawal scale to use

Answer 3

COWs

Question 4

First line for mild to moderate acute pain (NRS <7 )

Answer 4

Non opioid analgesics
(Tylenol or NSAIDS)

Question 5

What if your pt with acute pain has severe pain. What medications do you recommend

Answer 5

Opioids

-codeine (Tylenol #3)
- morphine
-hydromorphone
-oxycodone

Question 6

First line for chronic neuropathic pain

Answer 6

TCA, gabapentinoids or SNRI

Question 7

Which two meds should you not combine

Answer 7

SNRI and TCA

Question 8

What if a first line agent was not effective for neuropathic pain?

Answer 8

Try a different first line agent

Question 9

Second line for neuropathic pain

Answer 9

Tramadol
Topical lidocaine

Question 10

What are Nonpharm alternatives to neuropathic pain

Answer 10

Physio
Mindfulness
Yoga
Exercise
Psychotherapy

Question 11

What do you keep your MED for non cancer pain

Answer 11

< 90 MED

Question 12

Do you prescribe opioids to no cancer pain with a history of SUD? What about if they have active SUD

Answer 12

History- nonopioid meds should be optimized

Active SUD- never prescribe

Question 13

Acute pain from herpes zoster virus what do you prescribe ?

Answer 13

Oral antivirals

Pain
#1 amitriptylline or gabapentin

If necessary could do opioids

Question 14

First line for trigeminal neuralgia

Answer 14

Carbamazepine

Question 15

First line for nerve root compression

Answer 15

Tylenol or NSAIDs

Question 16

First line for CRPS or chronic neuropathic pain

Answer 16

Gabapentinoids
SNRI
TCA

Question 17

How do you taper an opioid?

Answer 17

5-10% Q2-4 weeks

Question 18

What are stages of change?

Answer 18

Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse

Question 19

Can use motivational interviewing to switch pt to the next stage of change

Question 20

Acute withdrawal treatment first line

Answer 20

Methadone
Or
Buprenorphine
+
Clonidine

Question 21

Maintenance treatment for OUD

Answer 21

Buprenorphine/naloxone (suboxone) 8-24mg

-need to be >12-24 hours opioid free

Or

Methadone 60-120mg
-can start immediately

Or

Slow release morphine
-used as adjunct during methadone initiation or standalone if failed both

Question 22

What’s the recommended length of time for OUD therapy

Answer 22

12 months but could be on long term

Optimal results = opioid maintenance combined with Nonpharm with as psychoed , group psychotherapy, relapse prevention, training and peer support

Question 23

Read:
Concurrent psych problems should be treated in tandem with OUD

Question 24

Low back pain treatment what is first line

Answer 24

Nonpharm
- physio
-massage therapy
-acupuncture
-spinal manipulation
-motor control exercises

Question 25

Pharm approaches to low back pain. What is first line

Answer 25

#1 NSAIDs > Tylenol Can also use muscle relaxants if diagnosed with spastic component to their back pain -baclofen, cyclobenzaprine

Question 26

When do you use opioid therapy for low back pain?

Answer 26

When Nonpharm and pharm approaches have been optimized It is last resort D/c if no effect in 3-6 months

Question 27

What are red flags for low back pain

Answer 27

Rapid wt loss Fever Neurological deficits (cause equina) Inflammatory disorder

Question 28

First line for muscle cramps

Answer 28

Nonpharm -stretching -hot pack or hot bath -icing can be used -reassure benign in nature

Question 29

Pharm approaches for muscle cramps

Answer 29

No med found to be clearly beneficial

Question 30

What labs should you check for muscle cramps

Answer 30

CBC Iron GFR SCr a1C TSH LFT CK

Question 31

First line for mild restless leg syndrome

Answer 31

Mental alertness activities Abstain from alcohol, caffeine, nicotine Take hot baths Stretch and exercise moderately Yoga might also help Discontinue meds that might contribute to (mirtaZapine, metochlopramide, topiramate, Benadryl, seroquel, olanzapine and clozapine) Minimize sleep deprivation

Question 32

Intermittent restless leg syndrome <2x per week. What are pharm approaches

Answer 32

1. Levodopa 2. Benzodiazepines 3. Low potency opioids (codeine)

Question 33

Chronic / persistent restless leg first line treatment

Answer 33

Dopamine agonist -pramipexole -rotigotine -ropinirole SE= increased risk of developing high risk behaviors like pathological gambling and hyper sexuality -needs to be tapered off #2 - GABA derivatives

Question 34

What must you rule out in blood work for RLS

Answer 34

Iron deficiency