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Introduction
Common
Misconceptions
I should expect to have pain
Ill hold off so the medicine will
work when I really need it
Pain is for wimps
I dont want to get hooked
Barriers
Diagnosing and
Documenting Pain
Examples of Pain
Scales
Documenting Pain
Onset
What relieves?
Location
What worsens?
Intensity
Effects on Daily Activities
Quality
Treatment History
Neurological
Classification
Nociceptive Pain
Neuropathic Pain
Nociceptive Pain
Neuropathic Pain
Physical Examination
Treating Pain
Treatment of Pain
Standard Approach
Non-Narcotic
Analgesics
2. Timed Doses
5. Consider Adjuvants
Narcotic Analgesics:
Morphine
Morphine
SC- 30 minutes
PO: -I hr.
Using Concentrates
DOSING
Extended Release
Better Compliance
More Expensive
Dose q 8,12, or 24
Extended Release
Breakthrough Pain
Continuing Use
Other Options:
Methadone
Inexpensive
Neuropathic Pain
A.
B.
C.
D.
Answer C.
A.
Referred Pain
Nociceptive Pain
Neuropathic Pain
Visceral Pain
Answer B.
Nociceptive Pain
Answer C.
1 hour
Warning signals
Dominating Concerns over Availability
Non-Provider Sanctioned Increases
Ignoring Major Side Effects
Warning signals
Multiple Sources
Unaccounted Medication
Fluids, Bran
Pericolace or Senicot-S
Naloxone
Answer A.
Acetaminophen hepatic toxicity
1 mg.
5 mg.
10 mg.
50 mg.
Answer C.
10 mg.
Sedation
Nausea
Pain relief
Obstipation/constipation
Answer D.
Obstipation/constipation
Adjuvant Use
Adjuvant Use
Gabapentin
Special Situations
Terminal Events
Cant Swallow: Go to
Concentrate
Hydromorphone (Dilaudid): up to 5 X
dose
Non-Drug Treatments
Complementary
Medicine:
acupuncture,
chiropractic,
massage
Spiritual Therapy
Diversions: Pets,
Music, Art, Humor
SUMMARY
Optimizing well-being of the
patient and loved ones
Improving control over ones life
Can reduce uncontrolled pain to
less than 1 in 20.
We primary care physicians can,
and must, get better at this.
Answer B.
10% of total daily dose
Answer B.
Fax a prescription for the regular
medication to the local
pharmacist.
Answer A.
Titrate to pain, using rescue
doses only