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Transcript of Pain Management
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
(ie: Illness, Injury, Surgery, etc.)
Treat cause, treat pain When Acute Becomes 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
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
Oxaprozin (Daypro) Indomethacin (Indocin)
Sulindac (Clinoril) Diclofenac (Voltaren) Etodolac (Lodine) Piroxicam (Feldene) Nabumetone (Relafen) Ketorolac (Toradol) Celecoxib (Celebrex) MOA: Cox Inhibition
GI: Dyspepsia, Ab pain, GI bleed
CV: Worsened HF, HTN, MI
Respiratory: NSAID + Asthma + Nasal Polyps/Sinusitis
Inc. bleeding in cirrhosis & renal complications Meperidine
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
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?