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Pain Classification
Categories include acute, chronic, nociceptive, neuropathic, and
malignant pain, each with distinct characteristics and treatment
approaches.
Non-pharmacological Pain Approaches
Methods such as stretches, ice, and heat used as alternatives or
complements to medication for pain management.
Adjuvant Analgesics
Medications with non-pain indications but useful for pain
management, especially for chronic and neuropathic pain, including
examples like gabapentin and antidepressants like duloxetine
Equianalgesic Doses and Opioid Rotation
,Converting total daily opioid dose to morphine equivalents,
considering incomplete cross tolerance and the need for opioid
rotation in some cases.
Migraine and Cluster Headache Classification
Classification of migraine headaches with and without aura, and
cluster headaches according to the International Headache Society
(IHS).
Migraine Management Approach
Stepwise approach involving NSAIDs, triptans, and preventative
strategies, considering factors like contraindications and
comorbidities.
Opioids Mechanism of action
Opioids stimulate CNS opioid receptors for analgesia. Pure agonists
(morphine) bind to u-receptors to produce analgesia that increases
with dose and does not have ceiling effects. Partial agonists such as
tramadol at the u-receptor cause less conformational change and
receptor activation than full antagonists.
Osteoarthritis (OA) Presentation and Goals
,Typical presentation includes joint pain and morning stiffness, with
therapy goals focused on pain relief, mobility maintenance, and
quality of life improvement.
WHO Three-Step Ladder Approach
1. Non-opioid plus optional adjuvant analgesic
2. Weak opioid plus non-opioid and adjuvant analgesics
3. Strong opioid plus non-opioid and adjuvant analgesics
NSAID Mechanism and Precautions
Nonselective NSAIDs inhibit COX-1 and COX-2, with COX-2 inhibition
responsible for anti-inflammatory effects. Precautions include
increased GI and renal toxicity and peptic ulcers.
Acetaminophen (APAP) Use and Precautions
Indicated for mild-moderate pain, inhibits prostaglandin synthesis,
with restrictions for maximum daily doses and contraindications for
certain health conditions and alcohol use. Overdose and liver issues
can happen.
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OA Treatment Approach
Stepwise treatment including non-pharmacological interventions,
NSAIDs as first-line therapy, and opioids for severe pain or
contraindications to other treatments.