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Treatment principles
- 1. pain is subjective - based on patient's own report and using pain scales as guide
- 2. treat severe pain at initial onset
- 3. non-opioids and nonmedication techniques are preferred
- 4. distinguish between physiological adaptation and addiction
- 5. don't scold the patient - determine aspect of pain that is inadequately controlledÂ
- 6. convert to longer acting vs combo and short acting
- 7. tolerance - distinguish if condition worsened or medication is decreased in effectiveness
- 8. opioid hyperalgesis - chronic opioid use may worsen pain sensitivity
- 9. see how often breakthrough pain occurs
- 10. give constipation prophylaxis
- 11. IV opioids - monitor for sedation = predicting respiratory depression and overdose
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acetaminophen
- mild pain
- DI: DOC with warfarin, but alter INR over time
- - avoid/limit ETOH = hepatotoxicity
- Counseling: 1) many products contain acetaminophen - NTE limits 4 g/day
- 2) avoid ETOH (1 women, 2 men) - kidney damage and harm the liver
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Aspirin and NSAIDs
- mild pain
- DI: additive bleeding risk with antiplatelet and anticoagulants, and ginko biloba
- - don't double up
- - INC levels of lithium and methotrexate
- - caution aspirin with ototoxic agents (AMG, IV loop)
- Counseling: 1)
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