Pain

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Author:
timothy.pdlt
ID:
211826
Filename:
Pain
Updated:
2013-04-06 16:46:30
Tags:
acute pain chronic analgesics
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Description:
therapeutics, side-effects, drug interactions
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  1. Types of pain
    • 1. nociceptive: graded
    • a. somatic (bone, joints): aching, throbbing, well localized
    • b. visceral (organs): aching and well localized in organ capsules OR cramping and poorly localized if obstructive
    • 2. neuropathic: PNS/CNS dysfunction, continuous+burning OR spontaneous+shooting
    • 3. acute: associated with injury
    • 4. chronic: >3months beyond normal healing time
  2. Pain measurement
    • 1. verbal rating scale (VRS): 4 point
    • 2. numeric rating scale (NRS):
    • a. 0-5=none to mild
    • b. 5-7= moderate
    • c. >7= severe
    • 3. picture scale
    • 4. McGill pain questionnaire
    • 5. visual analogue scale (VAS):
    • a. 0-5mm= none
    • b. 5-44mm= mild
    • c. 45-74mm= moderate
    • d. >70mm= severe
  3. Special pain situations
    • 1. dental pain: NSAIDs>>APAP+codeine
    • 2. renal colic: NSAIDs>>opioids
    • 3. biliary colic: NSAIDs=opioids
  4. Causes of cancer pain
    • 1. cancer: infiltration, compression
    • 2. related to cancer: muscle spasms, bedsores, DVT/PE
    • 3. related to cancer Tx: post-operative, post-radiation, post-chemotherapy
  5. WHO Analgesic ladder
    • 1. Mild (1-3)= APAP, NSAIDs
    • 2. Mild-Mod (4-6)= codeine, dihydrocodeine, hydrocodone, oxycodone
    • 3. Mod-Severe (7-10)= morphine, fentanyl, oxycodone, hydromorphone
  6. S/E of opioids
    • 1. can be tolerated: N/V, sedation, pruiritis, respiratory depression
    • 2. cannot be tolerated: constipation (esp. >2-3d), dry mouth, myoclonus/hallucinations
  7. Causes of non-cancer pain
    • 1. peripheral neuropathy: DM, nerve compression, PHN, trigeminal neuralgia, complex regional pain syndrome
    • 2. central neuropathic pain: post-stroke, PD, MS, myelopathies
    • 3. non-neuropathic pain: arthritis, low back pain, neck pain, fibromyalgia, post-trauma
    • 4. other: myofascial pain, HA, chronic pelvic pain, surgery
  8. Canadian Pain Society guidelines for neuropathic pain
    • 1. first: TCA, GBP, PGB
    • 2. second: venlafaxine, topical lidocaine
    • 3. third: tramadol, CR opioid
    • 4. fourth: cannabanoids, methadone, LTG, TPM, VPA
  9. Neuropathic pain dose regimens
    • 1. Antidepressants
    • a. ami/imi 25mg QHS-->150mg/d
    • b. nor/desi 25mg QAM/QHS-->150mg/d
    • c. bupropion 100mg QD-->200mg BID
    • d. venlafaxine 37.5mg QD-->300mg/d
    • 2. AEDs
    • a. CBZ 200mg QD-->400mg QID
    • b. GBP 100-300mg QHS-->1300-3600mg div TID
    • c. PGB 150mg QHS for DM neuropathy
    • d. PGB 300mg BID for PHN

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