Flashcards in Pharmacology of Pain Deck (22):
What is total pain?
Suffering in the context of serious illness, where suffering is a state of severe distress associated with events that threaten the intactness of the person
How should you assess pain level if a patient is non-verbal and cannot use a visual analog scale or numerical rating scale?
Look for non-verbal cues like labored breathing, negative vocalization, bad body language / facial expressions, and inconsolability
Useful in children and adults with dementia
What is the source of the majority of behavioral problems in nursing homes?
What is acute pain?
Pain following an identified event, resolves in days to week, usually nociceptive
What is chronic malignant pain and what causes it?
Pain due to malignancy like tumor pressure on internal organs or release of cytokines in the surrounding area
What is chronic pain not due to malignancy? Timescale and cause?
Pain lasting longer than 3 months
Cause: **poorly treated acute pain**, phantom limb pain, can be nociceptive and neuropathic, or due to a central pain syndrome
What is a central pain syndrome and what is the best treatment? Who is it most common in?
Pain originating in the brain
Most common in women who had previous psychological / sexual trauma
Best treatment: Behavioral treatment to unlearn your pain, although anti-epileptics and SNRIs may have a role
What are the two types of nociceptive pain? Their quality?
Somatic - often a sharp or dull pain which is easy to describe and localize, i.e. fracture, muscle strain
Visceral - dull and colicky pain which is difficult to localize and radiates, i.e. kidney stone, pancreatitis, gastritis
What is neuropathic pain? How is described?
Disordered peripheral or central nerve pain due to compression, transection, infiltration, ischemia, or metabolic injury of nerve, as in diabetic nephropathy. Pain will often exceed observable injury.
Burning or electrical shock feeling
How is neuropathic pain vs nociceptive pain treated?
Both are treated with opioids, non-opioids, and non-pharmacologic interventions.
For neuropathic pain, antiepileptics and SNRIs are of good value
What are some nonpharmacologic treatments of pain?
Acupuncture, physical therapy, massage, transcutaneous electrical nerve stimulation
Why should aspirin not be used in kids?
1. Overdose is common
2. Linked to Reye's syndrome in kids
What should be the order of employment of pain treatments?
1. Identify cause of pain and always consider psychological / emotional / spiritual aspects first
2. Use non-pharmacologic treatments first
3. Use non-opioid drugs second-line (NSAIDs, Tramodol, capsaicin)
3. Use opioid drugs as a last resort
What is the maximum daily dose of acetaminophen, and why has the maximum dosing schedule been dropped by some companies?
4 grams / day
Dropped because acetaminophen is put in basically everything -> don't want to overdose because you're coadministering another drug
What opioid regimen should be prescribed for chronic pain?
A long-acting / delayed release formulation with short-acting adjuncts for "breakthrough pain"
What should absolutely not be used for acute pain?
Long-acting / sustained release opioids -> can lead to overdose
How many more times potent is hydromorphone than morphine?
Should you ever prescribe methadone for pain?
No - leave that to experienced physicians that use it all the time
What opioids are safer in renal failure?
Oxycodone, fentanyl, and methadone
What should be done when switching from one opioid to another?
Use a conversion chart, and drop the dose by 25-50% on top of that (possible incomplete cross-tolerance)
What are the other forms how fentanyl can be given?
Lollipops, transdermal patches, oral dissolving tabs