Selective Serotonin And Norepinephrine Reuptake Inhibitors

The pain relief mechanism of the SSNRI group (see Table 5.3) of antidepressants is the inhibition of serotonin and norepinephrine at therapeutic doses. The SNRI medications do not have the same anticholinergic side effect profile as the TCA medications. They are effective for various neuropathic pain conditions, such as diabetic neuropathy, postherpetic neuralgia, and atypical facial pain (Lynch & Watson, 2006). Venlafaxine has shown an effect on hyperalgesia and allodynia preventing the...

Guidelines For Pain Clinic Referral

In general, a pain clinic referral is indicated when the following occurs The patient has had a number of medications that have failed to relieve the pain, even though doses have been adjusted and other medications have been tried. The patient continues to complain of severe level pain and cannot comply with the expected treatment regimen, such as physical therapy sessions. The health care provider is unsure about continuing a treatment regimen or needs confirmation that a certain treatment...

Low Back Pain Syndrome

Back pain can be classified as axial (focused on the low back), referred (pain experienced in the buttock or posterior thigh), or radicular (pain radiating down the leg). Aside from the common muscle strain that can cause LBP, there are several common back pain syndromes, such as HNP, facet disease, degenerative disc disease (DDD), spinal stenosis, and compression fractures (Figure 11.3). Some conditions are the result of degenerative changes, but others can be caused by trauma, poor lifting or...

Prevalence Of Neuropathic Pain

Neuropathic pain is much more common than previously suspected. The overall prevalence of neuropathic pain is thought to be approximately 1,765,000 people, excluding those patients with lower back pain radiculopathy (Irving, 2005). If the back pain patients were included, the numbers would be significantly higher at 3,865,000 patients. The types of neuropathic pain syndromes are generally organized into peripheral neuropathic pain syndromes and central neuropathic pain syndromes. The peripheral...

Chronic Opioid Therapy Guidelines

When the prescriber initiates opioid therapy, there are guidelines and standards that can help provide support for the practice and provide direction for appropriate prescribing. Some of the most commonly used guidelines include the following Department of Defense clinical practice guidelines for the management of opioid therapy for chronic pain. Retrieved from www.guideline.gov (2003). This guideline makes recommendations for opioid therapy for chronic pain, comprehensive assessment, pain...

Coanalgesics For Chronic Pain

Coanalgesics are a varied group of medications that can provide additive pain relief when they are added to nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids (American Pain Society APS , 2008). They can have independent analgesic activity for some painful complaints, and they can counteract select adverse effects of analgesics (APS, 2008). This group of medications was developed to treat a wide variety of conditions, such as seizures or muscle spasms, and was originally intended for...

Other Coanalgesics

There are various other medications that can be used as coanalgesics ranging from cannabinoids and dronabinol that are recommended for neuropathic pain from multiple sclerosis to NMDA receptor blockers, ketamine, dextromethorphan, and amantadine that are used for centrally mediated neuropathic pain and hyperalgesia. These agents are not recommended for first- or second-line use, but, rather, for patients in whom all other attempts at pain relief have failed. They have a high profile for such...

The Compact Clinical Guide Series

Series Editor Yvonne D'Arcy, MS, CRNP, CNS CHRONIC PAIN MANAGEMENT An Evidence-Based Approach for Nurses Yvonne D'Arcy, MS, CRNP, CNS ACUTE PAIN MANAGEMENT An Evidence-Based Approach for Nurses Yvonne D'Arcy, MS, CRNP, CNS CRITICAL CARE, TRAUMA AND EMERGENCY PAIN MANAGEMENT An Evidence-Based Approach for Nurses Liza Marmo, MSN, RN, CCRN An Evidence-Based Approach for Nurses Ann Quinlan-Colwell, PhD, RNC, AHNBC, FAAPM INFANT AND CHILD PAIN MANAGEMENT An Evidence-Based Approach for Nurses Linda...

Medications

Short-Acting Combination Medications Intermittent Pain and Breakthrough Pain Codeine-Containing Medications Codeine and Tylenol 3 (Codeine 30 mg Combined With Acetaminophen 325 mg) Used to treat mild to moderate pain, codeine1 is noted to have a number needed to treat of 11. That means the first effective analgesic effect would be seen in the 12th patient who was given the medication for pain relief. About 10 of the people lack the enzyme needed to activate codeine (APS, 2008). Codeine has a...

Sample Opioid Treatment Agreement

Opioid (narcotic) treatment for chronic pain is used to reduce pain and improve what you are able to do each day. Along with opioid treatment, other medical care may be prescribed to help improve your ability to do daily activities. This may include exercise, use of non-narcotic analgesics, physical therapy, psychological counseling or other therapies or treatment. Vocational counseling may be provided to assist in your return to work effort. To the doctor Keep signed originals in your file...

Short Form McGill Pain Questionnaire2 SFMPQ2

In the original McGill Pain Questionnaire used to assess pain in chronic pain patients, there is a list of 15 verbal descriptors rated on a 4-point scale, a visual analog scale for pain intensity, and verbal rating scales. The original scale established reliability and validity for measuring pain in chronic pain conditions. Although some chronic pain conditions are neuropathic, a tool that can distinguish both the pain of a chronic no-ciceptive condition and neuropathic pain is considered...

Neuropathic Pain Scale

Thie NPS (Exhibit 15.1) was developed as a result of two research protocols in which pain descriptors were assessed for four different pain conditions PHN, CRPS, PDN, and traumatic peripheral nerve injury. A second, more diverse group of patients being treated with either lidocaine or phentolamine infusions used the scale to rate their pain. Interestingly, the second protocol outcome identified a positive response for pain that was described as unpleasant or deep. This finding led researchers...

Pain Society And Diseasespecific Websites

The American Chronic Pain Association (www.theacpa.org) has information of support groups for patients with chronic pain and general information on chronic pain. American Pain Society (www.ampainsoc.org) has information on low-back pain, cancer pain, fibromyalgia pain, acute pain, chronic opioid therapy, and pain management in primary care. The American Society of Anesthesiologists (www.asahq.org) hosts perioperative guidelines. The American Pain Foundation (www.painfoundation.org) provides...

Additional Resources

Chou, R., Fanciullo, G., Fine, P., Adler, J., Ballantyne, J., Davies, P., . . . American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. (2009). Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. The Journal of Pain, 10(2), 113-130. Fine, P. G. (2004). Opioid-induced hyperalgesia and opioid rotation. Journal of Pain & Palliative Care Pharmacology, 18(3), 75-79. Institute for Clinical Systems Improvement. (2008). Assessment and...

Documenting With The Padt

The PADT is a specialized chart note designed to aid clinicians in monitoring outcomes during long-term therapy for noncancer patients on opioid therapy. It takes only minutes to complete and should supplement existing documentation. The elements of the four A's are the foundation of the tool, and a final section requires the interpretation of the data to formulate an assessment of the risks e.g., side effects and benefits e.g., pain relief, improved functioning ofcontinued therapy and...

Phantom Limb Syndrome

When a limb is amputated, especially a lower extremity, the patient is at risk for a neuropathic pain called phantom limb syndrome. Patients may feel the amputated limb is still there and feel pain in the amputated extremity as if it were still attached to the body. About 30 to 80 of all patients who undergo amputation of a limb, either leg or arm, will experience phantom limb pain Eichenberger et al., 2008 . With this syndrome, the patient will report feeling the leg even though they can look...

Info

Basic Intravenous conversion Morphine 1 milligram Dilaudid 0.2 milligrams Fentanyl 10 micrograms NR not recommended When switching from one opioid to another, reduce the dose by 25 to 50 with adequate breakthrough medication When switching to methadone, reduce the equianalgesic dose by 75 to 90 Breakthrough medication should be available when controlled release medications are being used All opioid medications should be carefully dosed and titrated with consideration for the individual patient...