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Knebel CNS 1A
PT of Non-malignant pain: focus on Opioid Analgesics
| Question | Answer |
|---|---|
| Pain is? | an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” |
| Pain is HIGHLY subjective in that Clinicians often define as “whatever the patient says it is." Experience of pain is dependent on? | Genetics, Comorbid medical conditions, Prior history, Psychological state, Socioeconomic circumstances, Cultural history |
| Epidemiology: Prevalence of pain? | #1 reason that patients seek medical care |
| Classifying pain | *Type of Pain (nociceptive, neuropathic, or hypersensitivity) Pain Intensity (mild, moderate, or severe) Duration of Pain (acute vs chronic) |
| The classification of pain dictates the treatment of pain, and is the: | logical first step in pain management |
| Types of pain Nociceptive? Neuropathic pain? | -Pain related to damage of somatic or visceral tissue due to trauma or inflammation -Pain related to damage of peripheral or central nerves |
| Predominantly Neuropathic pain, which 2 to know? | PHN (post herpetic neuralgia) pDPN (Painful diabetic peripheral neuropathy |
| Predominanty sensory Hypersensitivity, know which one? | Fibromyalgia |
| examples of Nociceptive pain are? | Sore, Throbbing, Dull, Tender, Aching, Cramping, Sharp |
| Examples of Neuropathic pain are? | Hot, Burning, Electric shocks, Stabbing, Painful cold, Tingling, Prickling, Numbness, Pins & needles, Allodynia, Hyperalgesia |
| Examples of Sensory Hypersensitivty | Widespread pain with neuropathic pain qualities, Fatigue, Nonrestorative sleep, Cognitive dysfunction, Mood disturbance, Hypersensitivity to sensory input such as bright lights, loud noises, and smells |
| Patients can have mixed pain states consisting of: | multiple co-occurring pain pathophysiologies |
| Pain assessment approach: What questions would you want to ask to assess a pt's pain? OPQRST-A | Onset Palliative or precipitating factors Quality of pain Region or pain location Severity (pain assessment instruments) Time related nature of pain Associated Manifestations/symptoms *also have they tried anything? |
| What objective information can assist in assessing pain? | Behaviorla changes; Physioological changes such as: dilated pupils (mydriasis), Paleness (pallor), Sweating (diaphoresis), Tachycardia, Tacypnea |
| Factors influencing Pain Assessment--> Pt parameters such as? | Age, Cognitive/emotional function, cultural background, gender, PMH, SES |
| Factors influencing Pain Assessment--> Pediatric pts? | Cannot communicate or rate their pain Symptoms of pain include fussiness, inconsolability, changes in eating patterns, crying out, or agitation may be signs of pain |
| Factors influencing Pain Assessment--> Elderly pts? | May have difficulty communicating pain Symptoms of pain include changes in eating habits, agitation, calling out, or facial grimacing may be signs of pain Signs of pain include hypertension, tachycardia, and diaphoresis |
| Assessment instruments--> Unidimensial pain intesity scales includes? | verbal, numeric, visual analog scale, Wong-Baker, Face, legs, activity, cry, and consolability (FLACC) |
| Assessment instruments--> Multidimenional pain intensity scales include? | Pain diary/drawing, Wisconsin Brief pain Questionarre, McGill pain Questionarre |
| Pain Intensity Scale: Visual Analgoe Scale (VAS) takes into account: | Visual scale that allows a patient to visually select a point on a 10 cm scale Scale has two anchoring points |
| Pain Intensity Scale: Faces Scale--> | Self-reporting pain scale used mainly for children and adults who cannot understand the other scales Patient chooses a face that describes how he/she is feeling |
| Pain Intensity Scale: Numeric Rating Scale--> | 11-point (0-10 scale) Patient is asked to rate pain from 0 (no pain) to 10 (worst pain) |
| Cultural Specific Tools--> | Faces from no pain to excruciating pain |
| Duration of pain classification: Acute which includes Adaptive? | occurs in response to painful stimuli such as extreme temperature and trauma Acts to warn the individual of potential harm **Lasts less than 3 months |
| Duration of pain classification: Chronic which includes Maladaptive pain? | occurs in response to neural dysregulation due to repeated pain signals or direct nerve damage Does not serve functional role **Lasts longer than 3 months |
| Classifying pain through either what 3 categories? | Sensation. Source, Duration |
| The sensation clasification of pain--> is broken down into ____ and _____ | Nociceptive (tissue); Neuropathic (nerve) |
| when classifying source of the pain it can be either? | malignant or non-malignant |
| Classifying duration of pain can be broken up between acute and chronic. what's the difference? | Acute (<3 months); Chronic (>3 months) |
| Pain Terminology and assessment summary--> Collect and Assess? | Collect--> Determine source of pain (there are no specific laboratory tests for pain. Assess--> Pain severity using appropriate instrumentations *Treatment options will be based off this collection and assessment |
| Goals of Care for pain management--> Limit pharamcotherapy ___ _____ | Side Effects |
| Goals of Care for Acute Nociceptive? | Complete pain relief and return of functional status |
| Goals of Care for Chronic Non-cancer? | -Decrease severity of pain and make it more tolerable -Improve long-term functional status and quality of life |
| Goals of Care for Chronic Cancer? | -Provide adequate pain relief to permit normal functional status -Help patient tolerate therapeutic and diagnostic interventions |
| Non-Pharm Therapies for pain management include? | **RICE**; Surgical intervention (underlying cause); Heat or cold therapy; Massage; Cognitive behavioral therapy; Relaxation; Accupuncture; Exercise; TENS stimulation; Music therapy; Religion/spirituality; Physical therapy *nonpharmacologic therapies can be used alone or in combination with pharamcologic therapies |
| Knebel summary of WHO analgesic ladder | All of these steps include non-pharmacologic therapy As you go up the step you see an increase in side effects Start at the bottom and go up – make sure to give an appropriate amount of time for it to work Severe trauma may cause us to start at step 2 or 3 |
| Describe to me the WHO Analgesic Ladder (slide)? | Step 1: Non-opioid (Aspirin, Acetaminophen, NSAIDs) +/- adjuvant analgesic Step 2: Opioid for mild to moderate pain (tramadol/combo products) +/- non-opioid +/- adjuvant analgesic Step 3: Opioid for moderate to severe pain (fentanyl, morphine) +/- non-opioid +/- adjuvant analgesic *Step up if persisting pain despite adequate analgesic trial *Step down if toxicity or pain has subsided after analgesic trial |
| WHO's Pain relief Ladder for mild pain (1-3) pain persisting or increasing, use what drugs? | Non-opioid +/- adjuvant |
| WHO's Pain relief Ladder for mild pain (4-6) pain persisting or increasing use what drugs? | opioids for mild to moderate pain +/- non-opioid +/- Adjuvant |
| WHO's Pain relief Ladder for mild pain (7-10) free from cancer pain, use what drugs? | Opioid for moderate-severe pain +/- non-opioid +/- adjuvant |
| Type of pain: Nociceptive. Duration Acute-> Chronic. Non opioid ctherapy includes? Opioid therapy? | **Acetaminophen, NSAIDs; Regional Analgesia** Treatment of underlying inflammatory condition may include corticosteroids, biologics, and disease modifying agents **Use opioids when other treatment options are inadequate, or for SEVERE pain |
| Type of pain: Neuropathic/ Sensory Hypersensitivity: Duration Chronic; Non-opioid therapy? Opioid therapy? | **Co-analgesics** (Antiepileptic Drugs, SNRIs, TCAs, muscle relaxants) *Opioids should be avoided |
Created by:
Xander635
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