Pain Management Strategies Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

At what step in the pain management ladder is an opioid indicated for moderate to severe pain?

Step 4

Step 1

Step 3 (correct)

Step 2

Which scale would be most appropriate for assessing pain in a non-verbal patient?

Numerical Rating Scale (NRS)

McGill Pain Questionnaire

Visual Analog Scale (VAS)

Wong-Baker FACES Scale (correct)

What additional therapies might be considered alongside opioids in Step 3?

Physical therapy

Non-opioid medications (correct)

Surgery

Complementary therapies

Which component of pain assessment focuses on the pain's location?

PQRSTU Signup and view all the answers

Which of the following is a primary focus in the assessment of pain's impact on a patient?

Understanding of pain's effect on daily activities Signup and view all the answers

What is the primary characteristic of acute pain?

It is related to a specific injury or cause. Signup and view all the answers

Which of the following best describes nociceptive pain?

Pain that arises from tissue injury. Signup and view all the answers

What role do prostaglandins play in pain sensation?

They enhance the pain signal by sensitizing nociceptors. Signup and view all the answers

How do anti-inflammatory agents affect pain stemming from inflammation?

They decrease inflammation and associated pain. Signup and view all the answers

Which type of pain persists beyond typical healing time, often lasting over three to six months?

Chronic pain Signup and view all the answers

Which non-pharmacological therapy is particularly beneficial for chronic conditions by combining movement, breathing, and mindfulness?

Yoga Signup and view all the answers

What physiological phenomenon requires higher drug doses over time to achieve the same effect?

Tolerance Signup and view all the answers

Which type of pain therapy involves redirecting attention through creative activities?

Distraction techniques Signup and view all the answers

What condition is characterized by psychological reliance on a substance despite negative consequences?

Addiction Signup and view all the answers

What best explains the concept that pain can be influenced by past experiences and perceived threat?

Pain as protection Signup and view all the answers

Which of the following is NOT a common indication for acetaminophen use?

Acute liver failure Signup and view all the answers

What is the mechanism of action of acetaminophen?

Blocking peripheral pain impulses Signup and view all the answers

Which of the following adverse effects is associated with acetaminophen overdose?

Hepatotoxicity Signup and view all the answers

What is the maximum recommended daily dose of acetaminophen to avoid liver toxicity?

4000 mg Signup and view all the answers

Which of the following conditions would contraindicate the use of acetaminophen?

Severe liver impairment Signup and view all the answers

Which of the following medications is commonly used in conjunction with acetaminophen for enhanced pain relief?

Ibuprofen Signup and view all the answers

What is the role of N-Acetylcysteine (NAC) in acetaminophen toxicity management?

Antidote for acetaminophen overdose Signup and view all the answers

Which symptom should patients taking acetaminophen monitor for that could indicate potential liver distress?

Jaundice Signup and view all the answers

What does Step 3 of the pain management ladder focus on?

Opioids for moderate to severe pain Signup and view all the answers

Which components can be added to opioid treatment in Step 3?

Non-opioid and adjuvant therapies Signup and view all the answers

What is the primary purpose of the pain management ladder?

To provide a structured approach to pain management Signup and view all the answers

What should be considered alongside medication for effective pain management?

An individual's psychosocial and spiritual needs Signup and view all the answers

Which statement about adjuvant therapies in pain management is accurate?

Adjuvant therapies can be incorporated at any step for increased effectiveness. Signup and view all the answers

Which substance has an increased risk of hepatotoxicity when taken with acetaminophen?

Alcohol Signup and view all the answers

Which class of drugs is NOT considered an adjuvant analgesic for neuropathic pain?

NSAIDs Signup and view all the answers

What therapy uses techniques like meditation and cognitive reframing to manage pain?

Mind-Body Therapy Signup and view all the answers

Which of the following is a non-pharmacological method for managing acute pain?

Hot or Cold Packs Signup and view all the answers

What is the main purpose of using muscle relaxants in pain management?

To relieve muscle spasms Signup and view all the answers

Which of the following is specifically indicated for inflammation when used as an adjuvant analgesic?

Glucocorticoids Signup and view all the answers

Which technique allows patients to gain control over physiological responses to manage pain?

Biofeedback Signup and view all the answers

Which of the following therapies is NOT classified under non-pharmacological pain management?

Opioids Signup and view all the answers

What is the primary rationale for using a stepped approach in pain management?

To adapt to individual experiences of pain Signup and view all the answers

What additional components can be considered in Step 3 of the pain management ladder?

Psychosocial support and adjuvant therapies Signup and view all the answers

Which step of the pain management ladder involves opioid medications for mild to moderate pain?

Step 2 Signup and view all the answers

What role do adjuvant therapies play in pain management according to the ladder?

They assist in addressing psychosocial and spiritual issues Signup and view all the answers

In which scenario is it indicated to add non-opioid medications in conjunction with opioids?

At any stage to enhance pain relief Signup and view all the answers

What is the primary role of anti-inflammatory medications in pain management?

To reduce inflammation and associated pain Signup and view all the answers

Which type of pain is often associated with a specific injury and has a sudden onset?

Acute pain Signup and view all the answers

Which chemical is primarily involved in sensitizing pain receptors during an inflammatory response?

Prostaglandins Signup and view all the answers

What is the typical duration of acute pain?

Short-term, related to injury Signup and view all the answers

In what circumstances is psychogenic pain most likely to occur?

Without a clear physical cause, often linked to emotional factors Signup and view all the answers

Which method involves redirecting attention to reduce the perception of pain?

Distraction Techniques Signup and view all the answers

What best describes the concept of tolerance in pain management?

The body's reduced response to a drug over time Signup and view all the answers

Which of the following therapies combines movement, breathing, and mindfulness to assist with chronic conditions?

Yoga Signup and view all the answers

Which statement accurately describes dependency in the context of drug use?

It occurs when withdrawal symptoms manifest upon sudden cessation of a drug. Signup and view all the answers

What role does education about pain play in managing chronic pain conditions?

It helps patients understand their pain, reducing its impact and improving coping mechanisms. Signup and view all the answers

What is the primary mechanism of action of anti-inflammatory medications?

Block the arachidonic acid pathway Signup and view all the answers

Which of the following is a potential adverse effect associated with NSAID use?

Hypertension Signup and view all the answers

What patient population requires caution when prescribing NSAIDs due to a risk of Reye's syndrome?

Children with viral infections Signup and view all the answers

Which of the following adverse effects should be specifically monitored in patients using opioids?

Constipation Signup and view all the answers

What is a common gastrointestinal issue related to NSAID use?

Peptic ulcer disease Signup and view all the answers

Which group of medications can be considered adjuvant therapies for pain management?

Antidepressants Signup and view all the answers

Which medication class is indicated for acute inflammatory conditions?

Corticosteroids Signup and view all the answers

In which situation should NSAIDs be avoided?

Patients with vitamin K deficiency Signup and view all the answers

What is one of the clinical uses of NSAIDs?

Pain relief Signup and view all the answers

Which of the following is a contraindication for NSAIDs?

Known drug allergy Signup and view all the answers

Which condition is a contraindication for glucocorticoid therapy?

Hypertension and cardiovascular disease Signup and view all the answers

What is a potential adverse effect associated with glucocorticoid use?

Gastrointestinal bleeding Signup and view all the answers

Which nursing management strategy should be employed when administering glucocorticoids?

Monitor blood glucose levels Signup and view all the answers

What is a crucial aspect of patient teaching regarding glucocorticoid therapy?

Patients should recognize signs of infection Signup and view all the answers

Which type of drug interaction is possible with glucocorticoids?

Increased risk of hyperglycemia with antidiabetic medications Signup and view all the answers

Which statement regarding the mechanism of action of opioids is accurate?

Opioids mimic natural endorphins to block pain perception Signup and view all the answers

Which opioid action is characterized by blocking specific receptors?

Antagonistic action Signup and view all the answers

What should be monitored closely during opioid therapy?

Therapeutic and adverse effects Signup and view all the answers

What is the primary mechanism by which acetaminophen alleviates pain?

Blocks peripheral pain impulses by inhibiting prostaglandin synthesis Signup and view all the answers

Which of the following is a common adverse effect of acetaminophen usage?

Hepatotoxicity Signup and view all the answers

Acetaminophen should generally not be used in which of the following patient conditions?

Severe liver impairment or liver disease Signup and view all the answers

Which of the following indicates acetaminophen toxicity?

Acute ingestion resulting in liver toxicity Signup and view all the answers

What should patients taking acetaminophen be advised to monitor for potential signs of liver distress?

Jaundice Signup and view all the answers

What is the primary purpose of N-Acetylcysteine (NAC) in the context of acetaminophen toxicity management?

To restore glutathione levels and protect the liver Signup and view all the answers

Which type of pain is acetaminophen particularly effective for relieving?

Mild to moderate pain Signup and view all the answers

Study Notes

Analgesic and Anti-inflammatory Medications

Fall 2024 Nursing 488 course
Instructors: Catherine Fox RN, MN, CON(C), Shelley de Boer, RN, MN, Bemi Lawal RN,MSN/ADM, Hillary Selkirk RN, MN, NP

Lesson Objectives

Students will develop an understanding of the nursing process across the lifespan for individuals experiencing acute pain.
Students will explore, discuss, and identify common pharmacological interventions for individuals experiencing acute pain, including anti-inflammatory medications and analgesics.

Pain Classification

Acute pain: Sudden onset, short-term pain related to a specific injury or cause.
Chronic pain: Long-lasting pain that often persists beyond typical healing time (over 3-6 months). Often difficult to treat. Pain is defined by the individual and is a complex sensory and emotional experience.

Pain Pathways

Nociceptive Pain
Neuropathic Pain
Central Pain
Psychogenic Pain
Referred Pain

Inflammation and Pain

Inflammation is a protective response to injury, serving to destroy, dilute, or wall off the injurious agent.
Chemicals like prostaglandins and bradykinin are released, increasing pain sensation.
Pain encourages rest and protection of the injured area, allowing healing.
Anti-inflammatory agents reduce both inflammation and pain, making them key in pain management from inflammatory conditions like arthritis and injuries.

WHO Pain Management Ladder

Presents a stepped approach to pain management for mild to severe pain starting with non-opioids, and progressing to stronger opioids.
Includes adjuvant therapies to address psychosocial and spiritual issues.

Pain Assessment and Tools: Review

PQRSTU method for evaluating subjective pain; Location, Provoking, Quality, Radiates, Severity, Time, Understanding/Impact
Common scales include Numerical Rating Scale (NRS), Visual Analog Scale (VAS), and Wong-Baker FACES Scale.

Monitoring and Evaluating Pain Management

Monitor response to medication(s) including vital signs and therapeutic/subtherapeutic responses.
Give medication with meals to avoid gastrointestinal (GI) upset.
Monitor adverse effects and treat accordingly.
Consider dose reduction for the elderly and children to manage medication effects.

Pharmacological Management of Inflammation and Pain

Anti-inflammatory Medications: NSAIDs, Corticosteroids
Acute Pain Medication: Opioids, Non-Opioids, Adjuvant Analgesic Therapies

Anti-inflammatory Medications

Mechanism of Action: Blocking the arachidonic acid pathway
Types: Nonsteroidal or Corticosteroids

Anti-inflammatory Medications: NSAIDs

Clinical Uses: Pain relief, anti-inflammatory uses, antipyretic, anti-arthritic effects, post-surgical or injury-related pain.
Types: Salicylates (e.g., aspirin), Cyclooxygenase-2 Inhibitors (e.g., Celecoxib), Acetic Acid Derivatives (e.g., Diclofenac), Enolic Acid Derivatives (e.g., Meloxicam), Propionic Acid Derivatives (e.g., Ibuprofen, Naproxen)

NSAIDs: Contraindications

Known drug allergy
Conditions that place the patient at risk for bleeding such as epistaxis, vitamin K deficiency, or peptic ulcer disease.
Children and teenagers with viral infections (risk of Reye's syndrome).
Not recommended for breastfeeding mothers.
Exercise caution during pregnancy and use.

NSAIDs: Adverse Effects

Gastrointestinal Issues (most frequently reported): Include nausea, vomiting, abdominal pain, ulcers, and bleeding.
Cardiovascular Risks: Increased hypertension, heart attack (MI), and stroke.
Renal Impairment: Can reduce blood flow to kidneys, potentially leading to acute kidney injury (AKI) or fluid retention.
Hematologic Effects: Altering blood clotting, increasing risk of bleeding, especially with concurrent anticoagulants..

NSAIDs: Drug Interactions

Anticoagulants (e.g., Warfarin, Heparin)
ACE Inhibitors, ARBs, and Diuretics
Lithium
Methotrexate
Corticosteroids
SSRIs and SNRIs (e.g., Sertraline, Venlafaxine)

NSAIDs: Important Lab Values

Hemoglobin, Hematocrit, Platelets
Creatinine and BUN
AST and ALT
Potassium

Anti-Inflammatory Medications: Corticosteroids

Types: Mineralocorticoids, Glucocorticoids
Actions: Anti-inflammatory, Immunosuppressive; Stabilizes blood vessels, Increases blood glucose, and Catabolic effects.

Glucocorticoids: Indications

Inflammatory Conditions
Allergy Reactions
Autoimmune Disorders
Respiratory Conditions
Endocrine Disorders
Oncology and Hematologic Disorders

Glucocorticoids: Contraindications & Drug Interactions

Drug allergy
Active infections
Systemic fungal infections
Live vaccinations
Uncontrolled diabetes
Hypertension and cardiovascular disease
Osteoporosis
Pregnancy
Psychiatric conditions
Glaucoma
NSAIDs
Antidiabetic medications
Anticoagulants
Diuretics
Vaccines (especially live vaccines)

Glucocorticoids: Adverse Events

Metabolic/endocrine effects
Immune system effects
Musculoskeletal effects
Gastrointestinal effects
CNS effects
Other: cardiovascular, ocular, and integumentary effects

Glucocorticoids: Patient Teaching and Nursing Management

Do not stop abruptly.
Take with food.
Surgery considerations
Recognize signs of infection
Monitor blood glucose
Support bone health if on long-term therapy
Administration routes: oral, IM, IV, intranasal, and inhalational.
Tapering
Avoid concurrent NSAIDs and Aspirin.
Administer with food or milk
Monitor for therapeutic and adverse effects

Acute Pain Medication

Opioids and Non-opioids

Opioids

Mechanism of Action: Bind to specific receptors (mu, delta, kappa) in the CNS and PNS. They can act as agonists, partial agonists, antagonists, or mimic natural endorphins.
Types: Strong (full agonists), Moderate (full agonists), Mild (weak agonists or partial agonists).

Opioids: Examples

Fentanyl
Morphine
Hydromorphone (Dilaudid)
Methadone
Oxycodone
Tramadol
Codeine

Opioids: Adverse Effects

CNS: Sedation, dizziness, euphoria/dysphoria, respiratory depression
GI: Constipation, nausea/vomiting
Cardiovascular: Hypotension, bradycardia
Urinary: Urinary retention
Other: Pruritus, tolerance, dependence, anaphylaxis

Opioids: CNS Depression

Mechanism: Binding to opioid receptors, slowing down brain activity, leading to sedation, slowed breathing, and loss of consciousness in severe cases.
Overdose treatment: Naloxone, administered intranasally, intravenously, or intramuscularly.

Opioids: Drug Interactions

CNS Depressants
Monoamine Oxidase Inhibitors (MAOIs)
Anticholinergics
Serotonergic Drugs
CYP3A4 Inhibitors and Inducers
Other Opioids and Mixed Agonists/Antagonists

Opioids: Lab Values to Monitor

Liver Function (ALT, Alk Phos, Bilirubin)
Renal Function (Creatinine, BUN)

Patient Controlled Analgesic (PCA)

Method allowing patients to self-administer small doses of opioids through an IV pump
Programmed variables include concentration of opioid solution, dose size (amount opioid per dose), lockout intervals (minimum time between doses), and total drug dose limit (max amount of drug over period of time).

Non-Opioids

Pain-relieving medications that work through mechanisms other than opioid receptors. Effective for mild to moderate pain.
Commonly used for pain associated with inflammation, headaches, minor injuries, and musculoskeletal conditions.
Types: Acetaminophen, Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Non-Opioids: Acetaminophen

Mechanism of Action: Blocks peripheral pain impulses, inhibits prostaglandin synthesis, antipyretics effects.
Indications: Mild to moderate pain, alternative to aspirin, antipyretic effect.
Contraindications: Drug allergy, severe liver impairment or liver disease.
Adverse Effects: Hepatotoxicity, gastrointestinal distress, renal impairment (high, prolonged doses), rash, urticaria
Overdose/Toxicity: Life-threatening, acute ingestion results in liver toxicity, long-term ingestion in nephrotoxicity, major cause of serious liver injury. Use activated charcoal, N-acetylcysteine (NAC), and liver function monitoring to manage.
Drug Interactions: Alcohol-increased risk of hepatotoxicity; Warfarin- enhanced bleeding risk; Phenytoin, Rifampin, Barbiturates-potential interactions.

Acetaminophen: Monitoring and Patient Education

Regularly assess liver function tests (e.g., ALT, Alk Phos, bilirubin) for patients on acetaminophen, especially those with existing liver conditions.
Watch for signs of gastrointestinal distress and renal impairment during therapy.
Advise patients to not exceed a maximum daily dose (4 grams).
Encourage reporting of unusual symptoms, especially signs of liver distress and gastrointestinal issues.

Adjuvant Analgesic Therapy

Definition: Drugs added to enhance existing pain management for types of pain that don't respond well to traditional analgesics.
Examples: Antidepressants, Antiseizure agents, Glucocorticoids, Muscle relaxants, Local anesthetics, NSAIDs, Bisphosphonates

Non-Pharmacological Management of Pain

Physical Therapies: Hot or cold packs, massage, transcutaneous electrical nerve stimulation (TENS), physiotherapy.
Mind-Body and Psychological Therapies: Cognitive behavioral therapy (CBT), biofeedback, relaxation techniques, mindfulness and meditation.
Complementary Therapies: Acupuncture and acupressure, yoga.
Distraction and Sensory Techniques: Distraction, music therapy, art therapy, pet therapy, therapeutic exercises and communication.
Comfort: Frequent repositioning, cold/ice, warm blanket, verbal reassurance, deep breathing( exercises), and presence by the nurse.

Understanding Tolerance, Dependence, and Addiction

Tolerance: Body requiring higher doses of medication to achieve the same effect over time.
Dependence: Body adapting to the drug, resulting in withdrawal symptoms if the drug is suddenly stopped.
Addiction: Psychological condition characterized by compulsive drug-seeking behavior, despite harm.

Why Things Hurt

Pain as protection
Brain constructs pain
Neuroplasticity and chronic pain
Education and perspective on pain helps