Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
28 Cards in this Set
- Front
- Back
|
Appropriate pain mgmt referrals
|
1. Spinal/neuro-surgeon for specific guided tx/injection
2. any chronic pain pt 3. intolerance of PT 4. non healing wounds 5. end of life/comfort care |
|
|
Chronic pain
|
-slow healing
-continual, reocurring or persistent -difficult to tx -frustrating to live with -pt may seem fearful, tense, fatigued -depressed -social withdrawal -wt changes |
|
|
acute pains
|
-serve a physiologic function that something is wrong
|
|
|
nociceptive pain
|
-pain arising from activation of nociceptors
|
|
|
neuropathic pain
|
-pain caused by injury or disease, or by involvement of nerves in other disease processes
|
|
|
A-delta fibers
|
-transmit quicker than smaller C-delta fibers
-perceived as sharp, localized pain |
|
|
C-delta fibers
|
impulses are perceived as a diffused, dull, aching pain, such as the residual pain of a bruised nose.
|
|
|
Low back pain and neck pain
|
-disc related
-sciatica -facet joint pain -sacroiliac joint pain -muscle spasm pain -post back surgery syndrome |
|
|
Trigeminal neuralgia
|
-sudden, usually unilat, severe, brief, stabbing, reccurent pain felt in the distribution of 1 or more braches of the 5th cranial nerve
-electric-shoild like symptoms -usually from root compression, vascular loops -typically aggravated by touch, chewing, stress |
|
|
Trigeminal neuralgia tx
|
1. Anticonvulsant meds (tegretol_
2. local anesthetics 3. narcotic pain meds 4. gamma knife 5. Klonopin and Baclofen |
|
|
Fibromyalgia
|
-musculoskeletal pain disorder characterized by diffuse pain and abnml soft tissue tenderness
-multiple tender "trigger points" -reduced pain threshold -fatigue, sleep disturbances! -depression -anxiety -psychosocial distress |
|
|
Fibromyalgia dx
|
-mainly clinical
-chronic widespread pain -Trigger points in at least 11 of 18 characteristic locations ** -more common in females -pain and fatigue -aggravated by stress, anxiety and depression |
|
|
Fibromyalgia txs
|
1. r/o underlying conditions
2. pt education 3. cognitive behavioral changes 4. exercise therapy, aqua therapy, PT 5. NSAIDs 6. Antidepressants 7. muscle relaxants 8. Sleep aids 9. Narcotics usually C/I |
|
|
fibromyalgia new meds
|
1. Lyrica- thought to be the result of overactive nerves that cause chronic, widespread pain
2. Cymbalta (SNRIs) 3. Savella (SNRIs) |
|
|
Headache
|
-The brain itself is not sensitive to pain, because it lacks pain-sensitive nerve fibers.
-Areas of the head can hurt, including a network of nerves which extends over the scalp and certain nerves in the face, mouth, and throat |
|
|
Types of HA
|
1. Vascular: migraine, cluster, toxic
2. Muscular/ myogenic 3. Cervicogenic |
|
|
Dx of HA
|
1. careful history
2. CT scan/ MRI 3. blood tests- rarely confirmatory 4. Keeping a "headache diary" |
|
|
HA txs
|
1. not all require medical attention
2. Analgesia such as tylenol or NSAIDs 3. Caffeine products, meds like Fioricet 4. Prevention with B-blockers 5. Antidepressants 6. Triptains- bind toserotonin 5-HT1B and 5-HT1D receptors in cranial blood vessels (causing their constriction) (not a cure or prevention) |
|
|
treatments
|
1. PT
2. Massage therapy, chiropractic 3. Acupunture 4. Injections: nerve blocks, epidural steroid injections (space right above the dura), facet injections, intra-articular injections, trigger point injections |
|
|
Intrathecal pumps
|
-blocks pain by directing small doses of meds (narcotics and anesthetics) directly into the CSF
-consists of an intrathecal drug infusion pump and an intraspinal catheter that is implanted into abd -good for cancer pts |
|
|
Spinal stimulation/ neurostimulation
|
-delivers low voltage electrical stimulation to the spinal cord or peripheral nerve to inhibit or block the sensation of pain
-wire goes in epidural space along the spine -for RSD, back pains, radiculopathies |
|
|
Medications
|
1. Narcotics and Non narcotic pain killers
2. NSAIDs 3. Antidepressants work to raise serotonin and NE in spinal canal 4. Neuroleptic meds reduce firing of abnml or damaged nerves |
|
|
Delivery systems
|
1. IV- rapid directly to vascular system; doesnt last
2. SubQ/IM- rapid 3. Transdermal- applied to skin, slow absorption (patch,gel) 4. Sulingual/sub mucosal- fast & easy 5. Intrathecal- directly into spine (1:100 oral) 6. Epidural - above spinal canal 7. Oral- slow |
|
|
Actiq
|
-put in gums and let it dissolve
-in about 15 min meds absorbs -only for cancer pain |
|
|
Fentora
|
-tablets, put in gums
-fast acting |
|
|
Onsolis
|
-small, bioerodible polymer film for application to the buccal membranes (inner lining of the cheek).
-for breakthru cancer pain |
|
|
Prialt
|
-non-opiod analgesic
|
|
|
Embeda
|
- extended release morphine sulfate
-taken 1/day -NOT intended for usa as a prn analgesic -for mgmt of moderate to severe when a continuous opiod analgesic is needed for an extended period |
