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60 Cards in this Set
- Front
- Back
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why do we need to be aggressive in the management of pain - relates to cost, QOL, caregivers
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reduce healthcare costs - decrease amount of time spent with the patient and ER, unscheduled visits
impact of QOL - perform ADLs decrease burden on caregiver - esp with cancer patients avoid lidigation - legislation starting to pass laws on right to treat pain |
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under the multiple dementions of pain:
organic orgin of pain type of pain/duration |
physiologic
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under the multiple dementions of pain:
location, sensory, quality |
sensory
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under the multiple dementions of pain:
emotional responce, suffering, psychiatric disorders |
affective
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under the multiple dementions of pain:
view of self, meaning of pain, coping strategies, attitude influencing factors |
cognition
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under the multiple dementions of pain:
indicators of pain, pain control behaviors, communication of pain, associated symptoms: fatigue, sleep deprivation |
behavioral
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under the multiple dementions of pain:
cultural background, personal family and work roles, caregiver perspective |
socio-cultural
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this is a dual - sensation and emotional experience
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pain
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is pain a vital sign or an important clinical indicator
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indicator
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on scale of 0-10, what level of pain impacts enjoyment of life, which affects life and work
and which affects sleep, mood or other activities |
3
4 5-6 |
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what are some reasons pain is undertreated? by the caregiver or patient
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lack of knowledge
desire to please and conceal fear of increased pain with progression of disease fear of addiction caregivers avoid giving cancer pateints meds because of addiction fear |
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why is pain undertreated by the practitioner
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knowledge deficit
insignificant symptom failure to use optimal medication to relieve pain late referral to pain management stigma of specific populations: HIV, Minorities, substance abusers, migraine patients, and chronic pain patients |
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how long is acute pain
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few days or weeks
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how long is chronic pain
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six months
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what is nociceptive pain
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somatic - MS, skin, connective tissue or bone
Describe as aching, throbbing, well localized, respond to both opiods and non opiods Visceral - organ- GI tract, pancreas describe achying, localized obstruction - poor localization, cramping |
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what is neuropathic pain
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centrally generated- injury to PNS, a burn or phantom pain
peripheral - poly neuropathies in ETOH, DM, guillian barre, mono - known nerve injury, pain along damaged nerve |
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does complimentary therapy work for acute pain
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no - only chronic pain does accupuncture, reiki, distraction work
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how is the nerve conduction in acute verses chronic pain
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acute rapid, chronic slow
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does acute pain affect social life
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minimal, variable in chronic pain
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what medication is best for neuropathic pain
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neurotin or lyrica
opiods and tylenol do not help |
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this occurs with movements or known painful sensation, not always
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incidental pain
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this pain will come at anytime because the person is not receiving enough medication
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breakthrough
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pain that startes right before the next dose, seems like they are drug seeking
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end of dose failure
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when someone has continuous or background pain, what type of regimen is best
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longer acting continuous pain medication
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when someone has incident pain, what type of regiment should be added
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PRN medications before the initiation of pain
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breakthrough pain needs what type of regimen
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increase in continuous medication
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end of dose failure pain needs what type of regimen
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longer acting medication
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what is the primary goal for management of pain
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to change abnormal hyperactive system towards normalcy
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which is the route of choice for pain medications
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oral then transucosal
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if the medication is hydophillic how well does the medication absorb sublingually
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poor
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can you use IM for pain management
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unpredictable
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is nebulized pain medication a treatment of choice
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never use
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why should you not use transdermal patch for someone with end stage cancer
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poor fat, unable to absorb
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what type of pain does methadone cover best
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nociceptive pain, head and neck cancer, neuropathic pain, because its long acting
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what are side effects of opiods
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constipation
itching n/v |
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how should you give oxycodone and tylenol
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give seperate, when one pill they are a fixed ratio,
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TENS unit treats what type of pain
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neurpathic
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accupuncture treats what type of pain
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bone/muscle
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tramadol treats what type of pain
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muscle, myofascial (somatic)
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what treatments are used for bone mets
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radiation
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TCAs treat what type of pain
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neuropathic
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COX2 and biphosphanates treat what type of pain
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somatic - bone
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a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drugs effects over time
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tolerance
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is a state of adaptation that is manifested by a drug class specific to withdrawl syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug or administration of an antagonist
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physical dependence
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is a primary, chronic, neurobiologic disease with genetic, psychological and enviromental factors. Characterized by behaviors that include one or more: impaired control over drug use, compulsive use, continued despite harm and craving
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addiction
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this behaviors indicative of uncontrolled pain or fear.
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pseudo addiction
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what are some treatments for opiod induced constipation
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all patients must be on bowel protocol -
softner bulk laxative Methylnaltrexone is SQ and only for opiod use - Mu Antagonist increase fiber and h2o |
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what are some other SE of opiods
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dry mouth, sedation
respiratory depression urinary retention dry mouth constipation itching n/v |
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how is mophine and oxycodone metabilized
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liver
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what can occur when using comined preparations of pain medications
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ceiling affect
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why should you avoid darvocet, and what is an alternative
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it is cardio toxic, can increase respiratory depression, sedation, and cognitive impairment with the use of other medications.
its strength is equivalent to 1000mg of tylenol use tramadol instread |
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why should you aviod codiene
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not metabolized by 15% of the population, by genetic CYP 450. causes constipation and is a poor analgesic
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why should you avoid Demerol
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neurotoxic
half life 32 hours no antidote risk for addiction contraindicated with renal impairment |
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when should PRN medications only be prescribed
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for break through or incident pain,
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if someone is in constant pain what type of medication should be prescribed
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ATC, sustained release. should have PRN medication as well, do not use multiple mu-agonists
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why should you avoid darvocet, and what is an alternative
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it is cardio toxic, can increase respiratory depression, sedation, and cognitive impairment with the use of other medications.
its strength is equivalent to 1000mg of tylenol use tramadol instread |
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why should you aviod codiene
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not metabolized by 15% of the population, by genetic CYP 450. causes constipation and is a poor analgesic
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why should you avoid Demerol
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neurotoxic
half life 32 hours no antidote risk for addiction contraindicated with renal impairment |
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when should PRN medications only be prescribed
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for break through or incident pain,
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if someone is in constant pain what type of medication should be prescribed
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ATC, sustained release. should have PRN medication as well, do not use multiple mu-agonists
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