Pain & Pain Management Flashcards
(26 cards)
The loss of painful impression without the loss of tactile sense. For the alleviation of pain.
Analgesia
A behavioral pattern of dug use characterized by compulsive use, accompanied by psychological need.
Addiction
State of physiologic adaption to chronic use of a drug that abrupt dosage reduction results in abstinence syndrome.
Physical Dependence
State of physiologic adaptation to a drug such that higher than usual dosages are required to achieve the same effect.
Tolerance
Characteristic physical and emotional signs and symptoms precipitated by abrupt reduction or discontinuation of a drug on which an individual is physically dependent.
Withdrawal or abstinence syndrome
The dosage of analgesic beyond which no addition analgesia occurs.
Ceiling effect
Narcotics vs. Opioids
- Narcotics are natural or synthetic with a morphine-like action
- Opioids are derived from opium or synthetic drugs which have similar actions
- Narcotics HAVE a ceiling effect
3 variables for the assessment of pain
- Behavioral: body movement/position, crying, facial expression
- Stress hormones: EPI, NE, insulin, glucagon, cortisol, aldosterone
- Physiological: heart rate, respiratory rate, oxygenation
-When pain is not effectively treated, stress and reflex reactions can caus hypoxia, hypercapnia, hypertension, cardiac activity, emotional difficulties
4 considerations in the management of pain
- Location, duration, intensity, characteristics of pain
- Coping strategies used by the patient
- Pain producing pathology of the underlying condition
- Previous pain relief interventions, including analgesics, and their success or failure
Chronic pain
4 things
- Persists for more than 3 months
- Usually resistant to standard pain therapy
- 4 most common areas: lower back, headache, neck, facial
- Consequences of pain included diminished physical function, psychological changes, social consequences, societal consequences
2 types of chronic pain
- Identifiable/Malignant: ongoing, cause is known.
2. Nonidentifiable/Neuropathic: no known (or inadequate) cause of pain, has a neuropathic component
Neuropathic Chronic Pain
5 things
- Symptoms wax and wane over time
- Causes include diabetic peripheral neuropathy, alcohol, and more
- Originates from an injury to PNS or CNS
- Often mediated through NMDA receptor sensitization, substance P
- Approaches to management include: antidepressants (TCAs, SNRIs), anticonvulsants, local anesthetic antiarrhythmics, sympatholytics, topicals and opioids
Antidepressants (for neuropathic pain)
6 things
- First line treatment
- TCAs are superior
- Pain alleviation seems separate from antidepressant function
- Used for: diabetic peripheral neuralgia, chronic back pain, fibromyalgia, post-herpetic nerve pain
- TCAs: Amitriptyline, Imipramine, Clomipramine, Nortriptyline
- SNRIs: Milnacipran HCL, Duloxetine
SNRIs (for neuropathic pain)
3 things
- Milnacipran HCL
- For fibromyalgia
- ADRs: Headache, insomnia, dizziness, hot flashes, nausea, constipation
Anticonvulsants (for neuropathic pain)
3 things
- Pregabalin, Gabapentin (post herpetic neuralgia), Carbamazepine (most frequent)
- Used for: headaches, neuralgias, TMJ pain
- May be combined with antidepressants
Pregabalin (for neuropathic pain)
4 things
- Structurally similar to GABA
- Used for: diabetic peripheral neuropathy, post herpetic neuralgia
- ADRs: headache, dizziness, fatigue, weight gain, GI distress, peripheral edema
- Do NOT stop abruptly, withdrawal may occur
Local Anesthetic Antiarrhythmics (for neuropathic pain)
4 things
- Lidocaine/Mexilitine
- Decreases abnormal spontaneous and evoked discharge in damaged nerves
- Does not affect other responses
- Lidocaine response is predictive of mexilitine response
Sympatholytics (for neuropathic pain)
4 things
- Phentolamine/Clonidine
- Turns off NE release
- Phentolamine infusion predicts response to clonidine
- Clonidine interacts with opioid receptors to suppress withdrawal symptoms, can also be used for spinal cord injuries and neuropathic pain
Topical Agents (for neuropathic pain) 5 things
- Capsaicin (from chili peppers)
- Counter irritant, may affect substance P
- Used for allodynia (light mechanical stimulation of skin caused pains)
- Adlea: TRPV1 agonist (C-neuron anesthetic)
- Other topicals can include a clonidine patch
Chronic Malignant Pain
- Treat pain assoicated with terminal illness aggressively
- Regular, scheduled doses of pain relievers are better than as needed
- 70-90% receive complete relief
- Approaches to management include: Non-opioids (NSAIDs, Acetaminophen, Duloxetine) and opioids
NSAIDs (for chronic malignant pain)
4 things
- Block COX mediated transformation of arachidonic acid to prostaglandins
- Ibuprofen: bone pain
- Ketrolac: short term (under 5 days), ACUTE pain that requires analgesia at opioid level
- Caution in elderly and decreased renal function
Opioids (for chronic malignant pain)
5 things
- Oral is best if possible
- Always dose around the clock
- Alter schedules for renal and hepatic dysfunction
- DOC for elderly and very young
- ADRs: constipation, nausea, vomiting, sedation, respiratory depression, miosis
Bone pain
- NSAIDs (ibuprofen)
- Steroids
- Bisphosphonates
Management of pain in old people
5 things
- Treat aggressively
- Use a pain scale to measure
- NSAIDs should be used with caution (renal probs)
- Acetaminophen is DOC for mild/moderate musculoskeletal pain
- Opioids are good for moderate to severe pain
