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94 Cards in this Set
- Front
- Back
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Pain: Medical Definition
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unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
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Pain: Nursing definition
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pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does
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New definition of pain
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pain is the resulting product of an ensemble act with cellular, molecular, genetic, physiologic, psychologic, and social factors processing the signal to create the circumstances that a person designates as pain
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Gate Control Theory
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gating mechanism in the dorsal horn of the spinal cord processes pain impulses
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3 areas to target pain control
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cognitive, spinal cord, periphery
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How many people disabled by back pain
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over 5 million
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Number One reason for seeking medical care
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pain
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Metabolic effects of unrelieved pain
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hyperglycemia, glucose intolerance, insulin resistance
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CV effects of unrelieved pain
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increased heart rate, increased peripheral vascular resistance, increased systemic vascular resistance, HTN, increased myocardial oxygen consumption, DVT
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Respiratory effects of unrelieved pain
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decreased flow and volume, atelectasis, decreased cough, sputum retention, infection
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GU effects of unrelieved pain
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decreased urinary output, urinary retention
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GI effects of unrelieved pain
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decreased gastric and bowel motility, decreased gastric secretions
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MSK effects of unrelieved pain
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muscle spasm, fatigue, immobility
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Cognitive effects of unrelieved pain
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reduction in cognitive function, mental confusion
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immune effects of unrelieved pain
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depression of the immune response
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Developmental effects of unrelieved pain
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altered development of pain system, stress disorders, addictive behaviors, anxiety states
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effects of unrelieved pain on quality of life
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sleeplessness, fear, hopelessness, altered lifestyle, thoughts of suicide
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Transient pain
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for a moment
blood draw, IV stick |
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Acute pain
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relatively brief, subsides as healing occurs, mild to severe, can be recurrent
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Chronic, non-malignant pain
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duration of greater than 6 months (or longer than is reasonably expected)
mild to severe, cause often unknown, no predictable ending, psychological factors |
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Cancer pain
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disease process itself, damage to other organs, treatments
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Nociceptive pain
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stimuli from somatic and/or visceral structures (example: ankle, endometriosis, appendicitis)
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Neuropathic pain
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stimuli abnormally processed by nervous system (nerve pain; often described as burning)
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Assessment of pain
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SUBJECTIVE
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Assessment tools for pain
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visual analog scale, wong baker faces, FLACC, NIPS
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Pain is...
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whatever the experiencing person says it is, existing whenever he/she says it does
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Barriers to effective pain management
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MD under prescribe, nurses under administer, patients under report
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Barriers to pain management with healthcare providers
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fear, unfamiliarity, addiction issues, unbelief of pain, lack of education, unclear about goals, unavailable/unapprochable
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Barriers to pain management with patient
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age, sex, culture, language, fears, beliefs, fear of tolerance
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What is often the first sign that a disease is progressive?
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pain
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What is success for pain?
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50% decrease in patient's reported pain
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Some ways to treat chronic pain
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pharmacologic, nonpharmacologic, procedures, advanced therapies
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Pharmacologic pain relief step 1
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non opiod analgesic/ adjuvant
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Pharmacologic pain relief step 2
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opiod analgesic/adjuvant
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Pharmacologic pain relief step 3
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opiod analgesic/adjuvant
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Examples Step One Pharmacologic
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ASA, tylenol, NSAIDS, ultram/ultracet
muscle relaxer, sleepers, neuropathic aids, benzos lidoderm |
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What are benzodiazepines used for?
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withdrawal
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Examples Step Two pharmacologic
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vicodin, norco, lortab, vicoprofen, percocet, tylenol 3, davocet
oral preps and oral elixir |
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Examples Step 3 pharmacologic treatment
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morphine, hydromorphone, dilaudid, pallidone, oxycodone, oxycontin, demerol*
methadone, fentanyl, |
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Never use oral...
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demerol
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Oral demerol
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neurotoxic metabolite with very long half life that can cause tremors and seizures
make more prone to seizures if elderly have had seizures before or had liver or kidney trouble |
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Monitor with Methadone
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baseline EKG; start low and go slow
very long 1/2 half Cheap and great |
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Fentanyl patch
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once every 72 hours
good for elderly but need enough body fat |
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Step 4 pain pharmacologic treatment
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advance pain therapy
epidural, intrathecal, pump placed in abdomen less dosing=greater effect decrease side effects stimulator/surgery |
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Basic principles of pharmacology
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altered baseline for pain meds, treat flares and go back to baseline, narcotic agreement, narcotic holiday, Opiod induced hyperalgesia, ceiling effect, cumulative Tylenol amounts
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Never have over how much Tylenol?
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4 g in a day
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Side effects of pain medication
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allergy vs. side effects
Most side effects are class related Some side effects, such as sleepiness, decrease over time Constipation is a very common side effect that will not diminish and must be treated |
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Common side effects of pain medication
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nausea (usually within 24-48 hours), itchine, urinary retention (more common in males), seizures (most common with Demerol), mental status changes, sedation, respiratory depression
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What is always appropriate for anyone in pain
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psychological referral
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Non pharmacologic nursing treatments for pain
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alone, none are proven effective
excellent adjunct with many medications many do not need order |
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Physical comfort
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positioning, temperature, nutrition, hydration
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Cutaneous stimulation
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heat, cold, vibration (TENS unit), massage
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How does massage help pain
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overrides pain sensation to brain
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Distraction
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music, TV, social interactions, visual focus, conversation, hobbies
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Relaxation techniques
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music, breathing, meditation, prayer, imagery, humor
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Lifestyle changes for pain
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diet, exercise, correct posture, body mechanics, smoking cessation, stress management, anger management, financial changes, sleep, adaptation of lifestyle
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What has a huge effect in lower back pain
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smoking cessation
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Disc procedures for pain
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cervical, thoracic, lumbar, caudal epidural, steroid injections
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Vertebrae treatments for pain
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vertebroplasty/kyphoplasty
facets |
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What is kyphoplasty
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fixing fractures in the back
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Blocks for pain
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diagnostic (if not sure what spinal nerve is causing it)
Permanent Chemical (alcohol) Thermal ablation (heat or cold) |
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What is epidural
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depositing steroids into the epidural space to bathe the nerve and decrease swelling
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Intrathecal drug pump
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narcotics, adjuvant, local anesthetics, muscle relaxant
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Spinal Stenosis
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any condition that causes a narrowing of the space around the spinal nerves
occurs at any level of the spine that is often the result of a degenerative process Sometimes neuropathic pain, surgery, injections, medications, arthritis, DDD, bulging disk rarely in thoracic spine |
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Degenerative Disk Disease
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disc space narrows, probably most common cause of back/leg pain for older adults
Low back pain that radiates to buttocks, legs, groin and treated with epidural steroid injections, PT, medications |
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Acute disc herniation
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usually associated with incident
significant radicular pain Treated with time, rest medications, physical therapy, aquative therapy, injections, surgery Gets better with time: disc moist and filled with fluid Can do steroid injections later if others not working |
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Post laminectomy syndrome, or failed back
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back pain with radiation to hops, buttocks, groin, legs
neuropathic pain treated with epidural steroid injections, medications, PT, advanced pain therapies |
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Facet syndrome
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arthritis of the joints of the spine
Meds: NSAIDS, lidoderm, narcotics, facet joint injection, medial branch nerve blocks, RFNA ablation, facet fusion |
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RFNA ablation
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can burn nerves and give pain relief for 6 months to 1 year
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Relieve pressure off joint with facet syndrome
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lean forward
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Vertebral compression fractures
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trauma, osteoporosis, cancer
Treatment: time, rest, meds, brace, kyphoplasty vs vertebroplastly |
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Best treatment for Vertebral compression fracture
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prevention!
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Peripheral neuropathy
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diabetic or PVD
neuropathic pain treat cause! narcotic meds little value Meds: neurontin, cymbalta, lyrica Can use spinal cord stimulator |
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Phantom limb pain
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100% phantom sensation
85% phantom pain: burning, cramping, shooting difficult to treat |
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Post Herpetic Neuralgia (Herpes Zoster)
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pain remainds after lesions have healed
Pain can be exquisite, Neuropathic Injections sometimes effective Adjuvant meds: neurontin, elavil, lidoderm |
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Fibromyalgia
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generalized pain and MSK tenderness, fatigue, non-restorative sleep
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Diagnosis of fibromyalgia
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exclusion
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Fibromyalgia tender points
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18 of them
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meds for fibromyalgia
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Antidepressants, muscle relaxants, PT, trigger point injections, NSAIDS, Lyrica
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Central Pain Syndrome
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centrally mediated pain, unilateral (most common) or all over
Post CVA, cancer, post-neurosurgery Difficult to treat; treat with meds and psychotherapy |
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Complex Regional Pain Syndrome
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Multisystem syndrome affecting nerves, skin, muscles, blood vessels, and bones
Occurs in all age groups, including children and often goes undiagnosed potentially disabling that usually involves a distal portion of an exteremity |
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Complex Regional Pain Syndrome type one
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injury to affected limb
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Complex Regional Pain Syndrome type 2
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injury to a nerve
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Complex Regional Pain Syndrome type 3
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no apparent cause
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Complex Regional Pain Syndrome signs
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pain, allodynia, edema, change in color, change in temperature, decrease in hair growth, atrophy of skin and nails, atrophy of tissue and muscle, bone demineralization
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allodynia
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anything hurts
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Complex Regional Pain Syndrome treatment
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early treatment is ESSENTIAL to good outcome
nerve blocks with physical therapy, meds, psych support |
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Ultimate goal of cancer pain in terminal cases
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pain control
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Cancer terminal illness pain relief
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no limit to the amount of narcotics
can use blocks and ablations |
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common misconceptions pain relief
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dependence, tolerance, addiction, pseudo addiction
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dependence
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physiological response to medication. If abruptly withdrawn, they'll have side effects: must have tapering off of med
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Tolerance
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completely normal: need amount adjusted or increased
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Addiction
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inappropriate measures to get medication for something other than pain control: psychological problem
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Pseudo addiction
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inappropriate behavior but still used to kill pain: when they receive pain control, the behaviors will stop
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