1 / 16

Pain Management 1 st of 3 Lectures September 18, 2017

Introduction to pain management, discussion of CAPC modules, comprehensive pain assessment, and pain cases. Learn about pain characteristics, functional history, and optimal dosing. Explore real-life scenarios and appropriate pain management strategies.

ctinker
Télécharger la présentation

Pain Management 1 st of 3 Lectures September 18, 2017

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pain Management1st of 3 LecturesSeptember 18, 2017 John Hopper, MD L. Raquel Clary-Lantis, DO

  2. Outline • Introduction • CAPC modules • Pain Assessment • Pain Cases

  3. Introduction • 116 million affected by pain • Opiophobia: irrational fear by clinicians and patients related to appropriate use of opioids • Prescription Painkiller OD since 1999 • Up 265% in men • Up 400% in women • Increased misuseundertreatment of pain • Importance of a structured protocol

  4. CAPC Modules • www.capc.org • create an account if you don’t have one • Go to CAPC Centraltraining curriculum • 41 modules altogether • we will focus on the 14 pain modules for these lectures

  5. 14 CAPC Pain Modules • Course 1: Comprehensive Pain Assessment • Course 2: Matching the Drug Class to the Pain • Course 3: Patient Factors that Influence Prescribing Decisions • Course 4: Assessing Risk for Opioid Substance Use Disorder • Course 5: Opioid Trials - Determining Design, Efficacy and Safety • Course 6: Prescribing an Opioid • Course 7: Prescribing Short-Acting Opioids - Four Case Studies • Course 8: Monitoring for Opioid Efficacy, Side Effects and Substance Use Disorder • Course 9: Converting from Short-Acting to Long-Acting Opioids • Course 10: Prescribing Practice and Opioid Conversions • Course 11: Advanced Conversions & Opioid Side Effects • Course 12: Special Populations & Patient-Controlled Analgesia • Course 13: Managing Pain in Patients at Risk for Substance Use Disorder • Course 14: Pain Management - Putting it All Together

  6. Structured Protocol Course 1: Comprehensive Pain Assessment 1. Elicit pain characteristics: OP2QRST a. O=onset, acute versus persistent b. P2=palliative and provocative factors c. Q=quality of the pain i) Somatic: tissue damage, localized ii) Visceral: visceral organs, referred (nausea/sweats) iii) Neuropathic: injury & inflammation nerves, radicular d. R=radiation and region e. S=severity, pain intensity scale f. T=timing 2. Assess functional history -most useful measure of severity of pain is impact on fxn

  7. Comprehensive Pain Assessment • Review prior drug and nondrug treatment • Not all pain needs an opiate or even a medication • WHO stepladder • Caution with polypharmacy 4. Examine patient and review data

  8. Optimal Dose • Dose that will improve function or reduce intensity by at least 30% without major side effects or complications • Hand that writes the opiate is the hand that does the disimpaction

  9. Pain Cases

  10. 36 y woman with RUQ pain X 6 hours • Severe crampy pain, like childbirth • Comes in “waves”, doubled over • Started after eating chicken and waffles • Getting worse over last few hours • Now accompanied by nausea • Feels bloated, vomited once

  11. 36 y woman with biliary colic • What would you give for pain? • Drug • Dose • Route • When would you reassess for effect? • What is an effect anyway??? • What would the interval be for the next dose?

  12. 63 y man with hip pain • Stage 4 NSCLC pain in left hip from metastasis • Deep aching pain in hip and groin for weeks • Pain ranges from moderate to severe • Interferes with sleep and walking • Getting worse • Affecting mood • Irritable, short tempered

  13. 63 year old man with hip pain • What would you give for pain? • Drug • Dose • Route • When would you reassess for effect? • What would the interval be for the next dose? • Stage 4 NSCLC • Deep aching pain in hip and groin for weeks • Pain ranges from moderate to severe • Interferes with sleep and walking • Getting worse • Affecting mood • Irritable, short tempered

  14. 46 y man with acute arm pain • Fell from a ladder an hour ago • Severe, sharp, stabbingright arm pain • History of diabetic neuropathy on opioids • Outpatient Pain Regimen: • Oxycodone ER 60 mg BID • Duloxetine 60 mg daily

  15. 46 y man with fracture of humerus • What would you give for pain? • Drug • Dose • Route • When would you reassess for effect? • What would the interval be for the next dose? • Fell from a ladder an hour ago • Severe, sharp, stabbing right arm pain • History of diabetic neuropathy on opioids • Outpatient Pain Regimen: • Oxycodone ER 60 mg BID • Duloxetine 60 mg daily

More Related