Term
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Definition
| generalized physiological & psychological response to noxious stimuli; can warn us that some physiologic process has gone awry; often serves no purpose other than to make a person miserable |
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Term
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Definition
| 1) physiological process; 2) emotional & psychological reaction to that sensation - represents it as "suffering" |
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Term
| Approaches to Pharmacological Management of Pain |
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Definition
| 1) remove cause; 2) decrease inflammation, irritation, & sensitivity of nerve endings; 3) block conduction of impulses by pain fibers; 4) modify processing of pain information in CNS |
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Term
| Aspirin, ibuprofen, NSAIDs |
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Definition
| inhibitors of prostaglandin synthesis (COX-1 & COX-2); acts at nerve endings and in CNS; antiinflammatory effects may contribute to pain relief; GI side effects; potential for serious CV side effects |
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Term
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Definition
| inhibits prostaglandin synthesis in nerve endings & CNS, but NOT in periphery; exact mechanism of action is still not clear; NO antiinflammatory activity; does NOT usually cause GI irritation; potential for hepatotoxicity at high doses |
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Term
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Definition
| injectable NSAID; useful alternative to opioids for pain; can cause GI irritation; OK for short term (<1-2 days) but not chronic use |
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Term
| Selective COX-2 Inhibitors |
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Definition
| celecoxib (Celebrex), rofecoxib (Vioxx), & valdecoxib (Bextra) |
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Term
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Definition
| pain pathways in CNS; gastric protection in stomach (increased mucous production, decreased acid secretion); increased renal perfusion (slight); increase thromboxane A2 (platelet aggregation) |
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Term
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Definition
| causes inflammation in periphery; pain pathways in CNS; increases renal perfusion (larger); increases prostacyclin causing vasodilation & decreased platelet aggregation |
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Term
| Local Anesthetics (lidocaine, etc.) |
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Definition
| block sodium channels in nerve endings & axons & stop generation & conduction of action potentials; powerful pain relief with spinal, regional, & nerve block techniques; small, unmyelanated pain fibers are most sensitivebut other neurons can be affected as well |
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Term
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Definition
| physiologic state resulting from chronic exposure to a drug |
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Term
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Definition
| pattern of behavior in which use of a drug assumes a central role in a person's life |
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Term
| Adjuvant Drugs for Pain Management |
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Definition
| corticosteroids, Disease Modifying Antirheumatic Drugs (DMARDs), & immunomodulators; muscle relaxants; antidepressants; anticonvulsants; clonidine |
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Term
| Use of muscle relaxants in pain management |
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Definition
| by relaxing skeletal muscle, they can break muscle spasms & are useful in management of low back pain (cyclobenzaprine, metaxalone, diazepam) |
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Term
| Use of Antidepressants as Adjuvant Drugs for Pain Managment |
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Definition
| alleviate symptoms of depression that commonly occur in pts with chronic pain & can enhance analgesic effects of opioids & may be beneficial in treatment of neurogenic pain (amitriptyline, imipramine, desipramine, fluoxetine) |
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Term
| Anticonvulsants used in Pain Management |
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Definition
| useful in management of various types of neurogenic pain (carbamazepine, valproic acid, gabapentin [Neurontin] & pregabalin [Lyrica]) |
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Term
| Use of Clonidine in Pain Management |
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Definition
| alpha-2 agonist originally used as antihypertensive med; enhances analgesic effects of opioids; preparation approved for spinal analgesia; may be beneficial in pain syndromes involving activaiton of sympathetic nervous system |
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Term
| General Principles for Drug Selection in Pain Management |
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Definition
| proper assessment of patient; if possible, treat or remove pain; select drugs that are appropriate for type & level of pain; consider health status; use medications at proper dosage levels; consider legal issues |
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Term
| Drug Selection for Mild Pain |
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Definition
| acetaminophen, aspirin, ibuprofen, ketoprofen, naproxen |
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Term
| Drug Selection for Moderate Pain |
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Definition
| oral NSAIDs (especially for arthritis, musculoskeletal, postsurgical, & dental pain); intermediate potency opioids (codeine, hydrocodone, usually in combo with acetaminophen or aspirin); also mixed agonist-antagonists would be appropriate (i.e. tramadol) |
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Term
| Drug Selection for Severe Pain |
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Definition
| strong opioids (morphine, oxycodone, fentanyl, hyrdomorphone, methadone); NSAIDs; adjuvant drugs such as antidepressants, anticonvulsants |
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