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*Nociceptive *Neuropathic *Peripheral sensitization (hyperalgesia, allodynia)

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*Nociceptive *Neuropathic *Peripheral sensitization (hyperalgesia, allodynia)

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  1. Aging Q3 Pain Management ACOVEPharmacological treatment with analgesics for pain is the most common in the elderly, however, the use of alternative medications and non-pharmacological interventions should also be considered. Treatment decisions require continuous weighing of risks and benefits. (Etzioni, et al. JAGS 2007 55:S403-S408) Mechanisms of Chronic Pain Level 3 (Severe pain): strong opioids – morphine, hydromorphone, fentanyl, oxycodone +/- adjuvants Level 2 (moderate to severe pain): acetaminophen plus opioid (hydrocodone, codeine, oxycodone): tramadol +/1 adjuvants Level 1 (mild to moderate pain): acetaminophen, aspirin, NSAIDS (cox-2) +/- adjuvants WHO Ladder *Nausea and vomiting (central) *Delayed gastric emptying *Constipation *Hypotension *Myoclonus *Respiratory depression *CNS *GU *Pruritus Opioid Side Effects *Nociceptive *Neuropathic *Peripheral sensitization (hyperalgesia, allodynia) *Central sensitization (NMDA) *Desensitization (tolerance) *Disinhibition (GABA) aEquianalgesic doses listed were obtained from a variety of studies and experiences and are meant only as guidelines bDose interval: q4h, except for: meperidine=q2-3h, levorphanol=q4=6h, methadone=q6-12h. MS Contin=q8-12h, Kadian=q12-24h, Avinza=q24h, OxyContin=q12h, Duragesic=q48-72h. cNot recommended for severe pain – neurotoxic with repeated dosing. dTylenol #2=15mg codeine, Tylenol #3=30 mg codeine, Tylenol #4=60mg codeine. All contain 325 mg acetaminophen. eCombination tablets contain 2.5-10 mg hydrocodone plus 325 750 mg acetaminophen or 200 mg ibuprofen. fRectal suppositories available. Per rectum (P.R.) dose is equal to PO dose. gCombination tablets contain 2.5-10 mg oxycodone+325-650 mg acetaminophen or 325 mg aspirin. hCaution: Risk of toxicity from delayed accumulation. In opioid rotation, start methadone at 25-50% of equianalgesic dose calculated from table FCCC PMC 3/23/0

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