ARTICLE AND QUESTIONS FOR INTERNET MEDICAL ASSOCIATION MIDWINTER CONFERENCE, FEBRUARY 23, 2002
AGGRESSIVE PHARMACOLOGIC TREATMENT OF PAIN. Papagallo, M. Rheumatic Clinics of North America. Volume 25, Number 1. February 1999. W.B. Saunders Company.
This article does a nice job summing up some of the current principles in treating people with chronic severe pain. The author defines several terms that are often ms-used in pain management such as tolerance, pseudo-addiction, and addiction. The use of narcotic contracting with a sample contract is included with the article and abuse and diversion issues are discussed.
More importantly, the use of narcotics, particularly the less well understood long acting opiates are discussed. Use of non-narcotics and adjuvants are also reviewed as well as a brief discussion about the pain types. Pain is divided into nociceptive and neuropathic. The basic pathophysiology of these pain types is discussed and the use of appropriate pharmacology is outlined. This is a must read for all physicians who handle anything but the most rudimentary of acute pain situations.
QUESTIONS:
1.)
Except for ___ all of the following are untoward opiate side affects that usually
subside over time.
A. Nausea
B. Vomiting
C. Constipation
D. Respiratory
depression
2.) The following are all long acting opiates except for _____.
A.
Oxycontin
B. Methadone
C. Duragesic
D. Oxycodone
3.)
Abnormal ectopic activity of nociceptors can be inhibited by sodium channel blockers
such as local anesthetics, anti-convuslsants, and NMDA antagonists.
TRUE FALSE
4.)
Long acting opiates on an around the clock dosing schedule represent the mainstay
for treatment of stable, chronic pain.
TRUE FALSE
5.) In patients with chronic pain, the following is/are part of a comprehensive pain treatment program.
A.
Medication management
B. Behavioral therapy
C. Rehabilitation
D. Surgical
or interventional treatment
E. All of the above
6.)
Narcotic titration is carried out until adequate pain control is achieved or until
unwanted side affects occur.
TRUE FALSE
7.)
For a given age or weight, a standard dose of narcotic can be expected to react
similarly in most patients.
TRUE FALSE
8.) All of the following are not recommended for long-term pain management except
A.
Meperidine
B. Methadone
C. Propoxyphene
D. Buprenorphjine
E. Pentazocine