43 Questions
What are first line recommendations for patients experiencing MILD acute pain?
Acetaminophen, NSAIDS, and RICE
What is the first line recommendation for patients experiencing MODERATE to SEVERE acute pain?
Opioids
In the management of chronic pain, opioids are indicates as a first line treatment.
False
When it comes to Chronic pain management, continue therapy only if there is clinically meaningful improvement in pain and function.
True
Nonopioid therapies are at LEAST as effective as opioids for many common types of acute pain.
True
Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy.
True
For acute pain management, use longer acting immediate release opioids if opioid are indicated for the patient.
False
What are examples of rehabilitative non-pharmaceutical therapies that can be used for patients?
Physical and occupational therapy
What are examples of psychological non-pharmaceutical therapies that can be used for patients?
Cognitive-behavioral therapy
What are examples of interventional non-pharmaceutical therapies that can be used for patients?
Surgical, Implant therapies, Neural blockade or Injection therapies
What are examples of Complementary and Alternative non-pharmaceutical therapies that can be used for patients?
Chiropractic and Osteopathic
Sickle cell crisis or acute pancreatitis patients are candidates for short term opioid use.
True
What receptor do opioids work on?
Mu
What is the GOLD standard opioid?
Morphine
Morphine is a CNS depressant
True
What patient should avoid oxycodone?
Hepatic Dysfunction
Hydromorphone is __x more potent than morphine. It is a good agent for digestive pain.
4
What opioid contains acetaminophen?
Hydrocodone
What opioid has an immediate onset but is VERY potent? It also functions as a Serotonergic (serotonin syndrome).
Fentanyl
What opioid may be use to augment therapy, but is also serotonergic?
Tramadol
What more minor opioid can be prescribed and works additionally as a cough suppressant?
Codeine
You should always prescribe NARCAN to any patients that are being prescribed an opioid.
True
What tool should be administered to patients upon an initial visit prior to beginning opioid therapy for pain management?
Opioid Risk tool
What opioid would you use for a patient with renal dysfunction, patients taking too many tablets, unbearable side effects of high dose opioids?
Hydromorphone
What opioid agent can be used for moderate to severe pain but has a ceiling effect that decreases the risk of CNS depression?
Buprenorphine
ALL opioids have the same MME (morphine mg equivalence)
False
How do you calculate equianalgesic doses for opioids?
determine total daily dose, convert to MME with converting agent, determine MME to agent being changed to, and reduce dose by 50% for DAILY dose of new agent
Avoid prescribing opioids and benzodiazepines concurrently
True
You should review patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PMP) before starting a opioid
True
The lowest starting dose for opioid-naïve patients is
20–30 MME/ day
___ day for Acute/ 7-day surg, ___day for chronic pain, ____ day reviewed by DO/MD
5, 30, 90
When patients have been taking opioids for longer durations (e.g., for ≥1 year), tapers of ____% per month or slower are likely to be better tolerated than more rapid tapers.
10
What is the max dose for acetaminophen?
3-4 gm daily
How are drugs classified?
Schedule 1 = Drugs with no currently accepted medical use and a high potential for abuse. They are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence. Schedule 2 = Drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. Schedule 3 = Drugs with a moderate to low potential for physical and psychological dependence. Schedule 5 = Drugs with lower potential for abuse than Schedule 4 and consist of preparations containing limited quantities of certain narcotics. Schedule 5 drugs are generally used for antidiarrheal, antitussive, and analgesic purposes.
Ketamine is only indicated for in-patient treatment
True
What types of drug can be used for purposes such as mild to moderate pain management, osteoarthritis, rheumatoid arthritis, gout, cardiovascular disease prevention, post-stent care, colorectal cancer risk reduction, migraine relief, pericarditis treatment, polycythemia vera prevention, preeclampsia management, valvular disease management, thromboembolism prevention, and arthroplasty prevention?
ASPIRIN
Which drug profiles may be suitable candidates for aspirin in managing moderate to severe acute pain, addressing conditions such as opioid pain, migraines, post-operative cataracts, corneal refractive surgeries, and seasonal allergic conjunctivitis?
KETOROLAC
What pain medication should not be used for patients with sulfa allergies?
CELECOXIB
NSAIDS have an increased risk of CVA
True
What drug can be used for managing diabetic neuropathy, post-herpetic neuralgia, chronic neuropathic pain, fibromyalgia, cough, restless leg syndrome, seizures, generalized anxiety disorder (GAD), social anxiety disorder (SAD), vasomotor symptoms of menopause, and pruritus?
GABAPENTIN
What medication addressing conditions like diabetic peripheral neuropathy, post-herpetic neuralgia, fibromyalgia, osteoarthritis, and chronic pain management?
ANTIDEPRESSANTS like Cymbalta
What can be used as adjunct therapy for acute musculoskeletal conditions?
ANTISPASMODICS
What can acetaminophen cause in the long-term?
Liver damage
Study Notes
Acute Pain Management
- For mild acute pain, first-line recommendation is nonopioid therapy.
- For moderate to severe acute pain, first-line recommendation is not opioids.
- Nonopioid therapies are at least as effective as opioids for many common types of acute pain.
- Before prescribing opioid therapy, clinicians should discuss realistic benefits and known risks with patients.
- For acute pain management, use longer acting immediate release opioids if opioid is indicated.
Chronic Pain Management
- Opioids are not indicated as a first-line treatment for chronic pain.
- Continue therapy only if there is clinically meaningful improvement in pain and function.
Non-Pharmaceutical Therapies
- Examples of rehabilitative therapies:
- Examples of psychological therapies:
- Examples of interventional therapies:
- Examples of Complementary and Alternative therapies:
Opioids
- Opioids work on the mu receptor.
- Morphine is the gold standard opioid and a CNS depressant.
- Hydromorphone is 2-4 times more potent than morphine and is a good agent for digestive pain.
- Percocet contains acetaminophen.
- Fentanyl has an immediate onset but is very potent and also functions as a Serotonergic (serotonin syndrome).
- Methadone may be used to augment therapy but is also serotonergic.
- Codeine is a more minor opioid that can be prescribed and works additionally as a cough suppressant.
- NARCAN should always be prescribed to patients being prescribed an opioid.
- The tool that should be administered to patients upon an initial visit prior to beginning opioid therapy is the Opioid Risk Tool (ORT).
Safe Opioid Prescribing
- When patients have been taking opioids for longer durations (e.g., for ≥1 year), tapers of 10% per month or slower are likely to be better tolerated than more rapid tapers.
- Avoid prescribing opioids and benzodiazepines concurrently.
- Review patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PMP) before starting a opioid.
- The lowest starting dose for opioid-naïve patients is 3-day for Acute/ 7-day surgical, 7-day for chronic pain, and 7-day reviewed by DO/MD.
Other Medications
- The maximum dose for acetaminophen is 3,000 mg/day.
- Drugs are classified by their mechanism of action.
- Ketamine is only indicated for in-patient treatment.
- NSAIDS have an increased risk of CVA and are suitable for purposes such as mild to moderate pain management, osteoarthritis, rheumatoid arthritis, and more.
- Aspirin is suitable for managing moderate to severe acute pain, addressing conditions such as opioid pain, migraines, and more.
- Sulfa allergic patients should not use sulfonamide-containing medications like celecoxib.
- Gabapentin can be used for managing diabetic neuropathy, post-herpetic neuralgia, chronic neuropathic pain, and more.
- Duloxetine can be used for addressing conditions like diabetic peripheral neuropathy, post-herpetic neuralgia, fibromyalgia, and osteoarthritis.
- Cyclobenzaprine can be used as adjunct therapy for acute musculoskeletal conditions.
- Long-term use of acetaminophen can cause liver damage.
This quiz covers the initial steps healthcare providers recommend for patients experiencing sudden onset of pain. Test your knowledge on the immediate actions to take for managing acute pain.
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