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:
__________
__________
__________
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:
identify _________ factors and phenotype/genotype of patients at _________
explore preventive ______
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%)