Opioid Management and Therapeutics

What is somatic pain?

-dull, aching, throbbing

-scrapes, injuries, cramps

What is used to treat somatic pain?

NSAIDs, Opioids, APAP, muscle relaxants

What is nerve pain?

-burning, electric, pins

-dysfunction or damage to the nerve

What is used to treat nerve pain?

Antidepressants or anticonvulsants

Describe an appropriate pain assessment

-palliative/aggravating factors

-quality of pain

-radiation from focal points

-severity/sleep

-time of day of pain intensity

-personal affects of pain

Examples of non-pharm pain management

physical therapy, psychosocial support, spiritual care

Characteristics of physical therapy

improves strength/flexibility, initial pain increase, and must continue for life

Characteristics of psychosocial support

psychologists/counselors, coping strategies, guided imagery, stress management, break pain/mood connection

characteristics of spiritual care

investing in higher power to start healing process

what is the multi-modal approach?

-implement more agents at low doses

-avoid similar mechanisms

what are short acting opioids?

oxycodone, hydrocodone, oxymorphone, hydromorphone

acute/breakthrough pain

opioid naive patients

what are long acting opioids?

oxycontin, MS Contin, fentanyl, methadone

maintenance therapy

more stable patients

key points of fentanyl

-rapid acting

-most lipophilic

-rotate application every 3 days

-avoid heat

key points of tramadol

-partial mu agonist

-decreases seizure threshold

-serotonergic abilities

key points of tapentadol

-mu agonist

-norepinephrine reuptake inhibition

-normal opioid adverse effects

What is the medication use agreement?

-chronic opioid therapy

-patient/provider safety for optimal care of pain

-random urine screening

-no emergency supplies

Common products in urine screens

Amphetamines

(pseudoephedrine, adderall, meth)

Barbituates

(fioricet)

Opiates

(codeine, morphine, hydrocodone, hydromorphone, heroin)

Special order fentanyl

URINE SCREEN

What may be positive with heroin use?

-only morphine

-codeine and morphine

URINE SCREEN

What may be positive with codeine use?

-only codeine

-codeine and morphine

-only morphine

-hydrocodone with HIGH codeine conc.

URINE SCREEN

What may be positive with hydrocodone use?

-only hydrocodone

-hydrocodone and hydromorphone

-only hydromorphone

URINE SCREEN

What may be positive with hydromorphone use?

-only hydromorphone

URINE SCREEN

What may be positive with morphine use?

-only morphine

-morphine and hydromorphone

-only hydromorphone with HIGH morphine conc.

URINE SCREEN

What may be positive with oxycodone use?

-only oxycodone

-oxycodone and oxymorphone

-only oxymorphone

common opioid adverse effects

-nausea/vomiting

-constipation

-resp depression

-euphoria

Morphine and morphine related products

-list

-allergy

hydrocodone, hydromorphone, codeine

NOT ALLERGY

- itching/rash

- treat with antihistamine

ALLERGY

- avoid oxycodone and hydrocodone

What can be used in a true morphine allergy?

fentanyl, methadone, tapendatol, tramadol

What is used to treat nausea/vomiting?

antiemetics

What is used to treat constipation?

Laxatives

(stimulant or osmotic)

Stool softener

What is used to treat resp. depression?

naloxone

What is opioid induced hyperalgesia?

-nociceptive sensitization from exposure

-more sensitive to painful stimuli

-reduce and stop current opioids

-implement NMDA antagonist