pain management

• related: Medicine, notes

1. Assess Pain

• Using functional status as a guide
• 30% improvement as function

Types of pain:

• acute vs chronic
• malignant vs non-malignant pain
• Somatic
  • tissue damage, muscle, bone
  • aching, deep, dull, sharp, stabbing
  • localized
• Visceral
  • gallbladder, intestines, liver
  • crampy, pressure, bloating, nausea, vomiting, sweating
  • referred
• Neuropathic
  • cause: somatic/visceral coexisting, injury of nerves
  • electric, shooting, radiating, burning
  • radicular, stocking-glove
• Opioid Risk tool: highest risk factors for substance abuse

2. Match treatment to pain

Naproxen: 500mg PO BID, unless AA, can increase BP Tylenol: 1g TID scheduled

Opioids

• PEG scale use for opioids
• chronic nonmalignant: no more than 50 OME/day (oral mili equavalents)

Side Effects

Additional treatment:

Muscle relaxant: use occasionally

Before starting Opioids

• Do not use opiods and benzos. 10x mortality risks