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Pain Management

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by

Ami Vora

on 14 February 2013

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Transcript of Pain Management

Ami Vora
Pharmacy Practice Resident-PGY-1 Numbing the Pain "An unpleasant sensory and emotional experience associated with actual or potential tissue damage" ~International Association for the Study of Pain (IASP) What is Pain? > 50% of the time patients seek primary care providers due to pain
15-20% of Americans experience chronic pain per year (~76 million people)
In 1998, NIH estimated financial burden ~$100 Billion per year Prevalence of Pain ACUTE
Cause
(ie: Illness, Injury, Surgery, etc.)
Treat cause, treat pain When Acute Becomes Chronic

CHRONIC

Pain that lasts longer than the expected healing process (or three months)
Affects a person’s activities of daily living
Frequently caused by inadequately treated acute pain Chronic Pain: 76 million
Diabetes: 24 million
Acute Coronary Syndrome: 17.6 Million
Heart Failure: 6 million So What? Why It Hurts Transduction Conduction
(A-delta fibers & C-fibers) Transmission Perception Modulation http://www.rujito-fisioterapi.com/2007/12/konsep-nyeri/ Name That Pain Nociceptive Pain Neuropathic Pain Central Peripheral Somatic Pain Visceral Pain "Structures"
Skin, bones, muscle, joints Well-Localized;
Sharp, Aching, Throbbing Organs (Kidney, Bladder) Poorly Localized; deep, achy Due to lesion or dysfunction in the nervous system
Symptoms: Shooting, burning, tingling, etc Assessing & Reassessing Pain It is “not the responsibility of clients to prove they are in pain; it is the [provider's] responsibility to accept the client’s report of pain” (American Pain Society, 2005). Unidimensional Pain Assessment Multidimensional P
Q
R
S
T
U palliative, precipitating, previous therapy quality region, radiating severity temporal YOU Aberrant behavior? Opioids Non-Opioids Tree-tment of pain Acetaminophen (Tylenol) Use: Works centrally for Analgesic & Anti-pyretic properties
Adverse Reactions: Hepatotoxicty (Both Acute & Chronic)
New Regulations? NSAIDS Aspirin
Ibuprofen (Advil)
Naproxen (Aleve)
Fenoprofen (Nalfon)
Ketoprofen (Orudis)
Flurbiprofen (Ansaid)
Oxaprozin (Daypro) Indomethacin (Indocin)
Sulindac (Clinoril) Diclofenac (Voltaren) Etodolac (Lodine) Piroxicam (Feldene) Nabumetone (Relafen) Ketorolac (Toradol) Celecoxib (Celebrex) MOA: Cox Inhibition
ADRs:
GI: Dyspepsia, Ab pain, GI bleed
CV: Worsened HF, HTN, MI
Respiratory: NSAID + Asthma + Nasal Polyps/Sinusitis
Inc. bleeding in cirrhosis & renal complications Meperidine
Codeine
Tramadol
Hydrocodone
Morphine
Oxycodone
Oxymorphone
Hydromorphone
Buprenorphine
Fentanyl Inhibit transmission
from periphery->spinal cord
within the spinal cord
(descending inhibitory pathways)
Alter limbic system activity http://www.stoppain.org/pcd/_pdf/OpioidChapter2.pdf Side Effects
Nausea
Constipation
Drowsiness
Respiratory depression
Pruritis

Other conditions
Renal Dysfunction
Hepatic Dysfunction
Dementia
Fever TCAs (Amitriptyline, Nortriptyline)
SNRIs (Venlafaxine, Duloxetine)
SSRIs (Citalopram, Sertraline, Fluoxetine)
Anticonvulsants (Gabapentin, Pregabalin) GL is a 55 year old male admitted to the ED with CC of severe chest pain: "squeezing, heavy, elephant sitting on his chest". Pt is sweating, tachycardic and pain: 10/10 MF is a 67 year old male with "sharp, shooting pain" down his leg. PMH: HTN, DM2, CAD, Severe OA. Past MRI shows right foraminal stenosis in L4-5. RS is a 64 year old male, admitted after a MVA. You are called into the room and he asks you for pain medication. ME is a 47 year old female complaining of back and leg pain. References:
Zacharoff KL, Pujol LM, Corsini E. PainEDU.org manual: a pocket guide to pain mangement, 4th Ed. Newton, MA: Inflexxion Inc; 2010.
Baumann T.J., Strickland J.M., Herndon C.M. (2011). Chapter 69. Pain Management. In R.L. Talbert, J.T. DiPiro, G.R. Matzke, L.M. Posey, B.G. Wells, G.C. Yee (Eds), Pharmacotherapy: A Pathophysiologic Approach, 8e.
Fine PG, Portenoy RK. A clinical guide to opioid analgesia. Minneapolis, MN: McGraw-Hill Companies, Inc; 2004. What questions can I answer for you?
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