April 11

Lecture 10 - Guest Lecture

silence

chronic non-cancer pain patients suffer in ________

contribute

pain has an emotional, social and physical components that all ______ to chronic pain experience

dimensional

chronic pain is a multi-_______ disease

ethical

treating pain is an ________ obligation embedded in the relation between the provider and person, and between the healing professions and society at large

tell, knowledge, license, effects, time, disease, symptom, expectations

barriers to pain management - **physician**:

* believing patients always _____ when they have pain
* lack of training/_________
* fear of regulatory scrutiny such as losing your _______
* concerns about addiction and side _________
* it is ________ consuming
* pain management is secondary to disease management → FALSE: pain is a _______ by itself
* believing pain is a _______, not a disease
* failure to define goals and ____________

normal, doctor, side, prevent, depression, passive

barriers to pain management - **patient**:

* misconception that pain is ________
* unwillingness to report pain and go to a _______
* fear of _______ effects and addiction
* believing that therapy may ________ control of more severe pain in the future
* cognitive impairments and _______
* _______ coping strategies and external locus of control

magnitude, resources, use, lack, disabled

barriers to pain management - **system**:

* failure to recognize/admit the ______ of the problem
* lack of ___________
* wrongful _______ of existing resources
* ______ of education
* permissive compensatory system → being regarded as _______ = $

fibromyalgia, traumatic, surgical, musculoskeletal

major CNCP categories:

* primary pain = ________
* post-_______ pain
* post-_______ pain
* headache
* orofacial pain
* ________ pain

musculoskeletal pain

which CNCP is the most common?

neuropathic pain

pain caused by a lesion or disease of the somatosensory nervous system

goals

the 1 step is to define therapeutic _____

balance

when defining therapeutic goals, you have to make the _______ between palliation and rehabilitation

quality, pain, sleep, activity, mood

the main therapeutic goals are always to improve the ______ of life by:

* decreasing ____
* recuperating _______
* increasing _________ and work
* improving _______

data

there is not enough scientific _________ on chronic pain therapy

team

________ work between specialists is essential

palliative therapy

what is the traditional approach to CNCP

pharmacotherapy, interventions, therapy, therapy, alternative

5 pillars of **palliative therapy**:

* _________: drugs burrowed from other diseases
* invasive ________
* behavioural _______
* hands-on ______
* complementary and ______ medicine (not enough data)

calculation

**pharmacotherapy**: the administration of medication is always a risk-benefit _________

significant

%%example%% of duloxetine for OA knee pain:

* even though duloxetine decreased the pain more than the placebo, it’s only a 0.8 difference, which is not _________

not

%%example%% of pregabalin for fibromyalgia:

* the difference in pain ratings between pregabalin and placebo was ______ statistically significant

opioids, non-opioids, adjuvants

3 types of pain pharmacology:


1. __________
2. __________
3. __________

adjuvants

drugs not created for pain but used in pain treatment

routes of administration

examples: oral, rectal, IV, sub-cutaneous, cutaneous, spinal, nasal

characteristics, onset, provocation, quality, region, severity, time

**analgesic selection** should be based on pain _______ such as:

* _______: when it started
* _______/palliation: what makes it worse
* ________ of the pain/intensity
* ________ and radiation
* ________ and its progression
* ________: how much per day, week

questions

physicians have many _________ regarding opioids and cannabis

point, blocks, axis

**invasive** measures:

* trigger ________ injections
* nerve ________
* spinal _______ interventions

nerve

spinal axis interventions occur in the ________ roots of the spinal canal

stimulation, pump

**super-invasive** measures:

* peripheral nerve, spinal cord and brain _______
* implanted spinal ______

nothing

**super-invasive** measures are used when ________ else works

outcomes

invasive interventions don’t have clear positive ________

complementary and alternative medicine

methods neither taught widely in medical schools nor generally available in hospitals and are underutilized due to lack of scientific evidence/funding

acupuncture

what is the only complementary and alternative medicine method that has good evidence?

none

in a study with CNCP patients, ________ had recovered with palliative therapeutic treatments

preventable

according to Shir, CNCP is a _______ disease

prevention

we learned about cancer medicine that massive funding toward palliation and not _______ decreased death rates from cancer only by 5%

detection, factor

palliation for cancer has minimal effects and ranks behind prevention, consisting of:

* early ________
* risk-_______ modification

high, factorial, therapeutic, failed

similarities between cancer and chronic pain:

* ________ prevalence
* multi-_________ etiologies
* multitude of palliative ________ approaches
* most current approaches have so far _______ to change the outcome

environmental, risk, analgesia

the future preventing CNCP:


1. identify _________ factors and phenotype/genotype of patients at _________
2. explore preventive ______
3. prevention of CNCP

reduced

early vaccination for **post-herpetic neuralgia** resulted in ________ incidence of HZ, burden of illness, incidence of PHN by 2/3!

anterior cingulate, reduction

with fMRI-guided training:

* humans learned how to control the activation of rostral ________ ________ cortex
* chronic pain patients saw one day training result in a significant pain ________ (50%)