Substance Use Disorders Flashcards
Define pain
Unpleasant sensory, emotional experience with actual or potential tissue damage
Personal and subjective experience; patient is the most reliable indicator of pain.
What are the types of pain?
- Acute pain
- Chronic pain
- Breakthrough pain
Acute pain results from tissue damage, while chronic pain can be time-limited or last a lifetime.
Differentiate between acute pain and chronic pain.
Differs by duration; acute pain is result of tissue damage and chronic pain can last a lifetime
Chronic pain includes conditions like cancer and noncancer types such as peripheral neuropathy and osteoarthritis.
What is breakthrough pain?
chronic pain with acute exacerbations
What is nociceptive pain?
Physiologic pain resulting from tissue injury (somatic or visceral)
Includes somatic and visceral pain.
What is neuropathic pain?
Pathophysiologic pain resulting from damage to the peripheral or central nervous system
May occur in the absence of tissue damage and inflammation.
List the components of pain assessment.
- Self-report
- Location
- Intensity
- Quality
- Onset and duration
- Aggravating and relieving factors
- Effects on function and quality of life
Comfort-function goal is a key aspect of pain assessment.
What are the pain scales used for assessing intensity?
- Numeric Rating Scale (NRS)
- Visual Analog Scale (VAS)
- Wong-Baker FACES Pain Rating Scale
- FLACC
- Faces Pain Scale-Revised (FPS-R)
- Verbal Descriptor Scale (VDS)
- CPOT
Specific scales cater to different populations, including children and patients in critical care.
What is the hierarchy of pain measures for a patient with dementia (or nonverbal)?
- Obtain self report
- Search for potential causes
- Observe behavior
- Proxy reporting
- Attempt analgesic trial
What is the goal of pain management?
Effective and safe analgesia with optimal relief
Comfort function goal is the responsibility of all members of the health care team.
How do opioid analgesics work?
Act on the CNS to inhibit activity of ascending nociceptive pathways
This mechanism helps reduce the perception of pain.
How do NSAIDs work?
Decrease pain by inhibiting cyclooxygenase (COX), which is an enzyme involved in production of prostaglandins
How do local anesthetics work?
Block nerve conduction when applied to nerve fibers
What are the classifications of analgesic agents?
- Nonopioid (Acetaminophen, NSAIDs)
- Opioid (Mu agonist, agonist–antagonist)
Examples include morphine and buprenorphine.
Fill in the blank: _______ is a common nonopioid analgesic that inhibits COX to relieve pain.
Acetaminophen
What are adjunctive agents in pain management?
- Local anesthetics (lidocaine)
- Anticonvulsants (Gabapentin, pregabalin)
- Antidepressants (TCAs, SNRIs)
- Ketamine
These agents can enhance pain relief when used in conjunction with other analgesics.
What are nonpharmacologic methods in pain management?
- Natural products (herbs, botanicals, vitamins, probiotics)
- Mind and body practices (acupuncture, chiropractic manipulation, massage therapy, yoga, tai chi)
What is opioid tolerance?
Decrease in one or more of the effects; Increase usage needed to effect pain relief
What is opioid physical dependence?
Normal response with opioid use of 2 weeks or more; manifested by withdrawal symptoms
What is substance use disorder (SUD)?
Impaired use of a substance despite major problems, characterized by impaired control, continued use despite harm, and craving
Influenced by genetic, psychosocial, and environmental factors.
List some commonly misused drugs.
- MDMA (Ecstasy)
- Spice (synthetic cannabinoid)
- Bath salts
- Inhalants
- Cannabis
- Cocaine
- Opioids
- Barbiturates
- Amphetamines
- Hallucinogens
Each of these substances has unique effects and potential for abuse.
What are some signs of substance use disorder?
- Mood changes
- Poor hygiene
- Odd sleep patterns
- Frequent injuries
- Relationship difficulties
- Poor job performance
- Social Isolation
- Anorexia
These indicators can help in assessing SUD.
What are the gerontologic considerations with opiates?
- Sensitive to sedation
- Initiate with low dose
- Increased risk for NSAID-induced GI toxicity
- Opioid dose reduction by 25-50%
- Risk for undertreated pain
Risk for undertreated pain exists in older adults.
Opiate risk assessment
- Personal or family history of substance abuse
- Psychological disease
- Sexual abuse history
