Pain Management pt.1
w/acute or potential
Addiction: Chronic neuro & biological disease include one or
more of following: impaired control over drug use, compulsive
use, continued use despite harm, craving opioids for other use
besides pain
Adjuvant analgesic agent: Primary indication other than pain
but is an analgesic agent for some painful conditions; may be
referred to as a co-analgesic
Agonist-antagonist: Type of opioid (e.g. nalbuphine [nubain]
and butorphanol [stadol] that binds to the kappa opioid
receptor site reacting as an agonist (capable of producing
analgesia) & simultaneously to the mu opioid receptor
(reversing mu agonist effects
Allodynia: Pain due to stimulus that does not normally
provoke pain, such as touch; typically in nerve injury areas,
neuropathic pain syndromes.
Antagonist: Competes with agonist for receptor sites; can
displace agonist inhibiting their action
Breakthrough pain (BTP): transitory increase in pain that
occurs on a background of otherwise controlled persistent
pain
Ceiling effect: Analgesic dose above which further dose
increments produce no change in effect
Central sensitization: Mechanism of neuropathic pain,
hyperexcitablity of central neurons in spinal cord, result of
complex changes by incoming afferent barrages of nociceptors
Comfort-function goal: Pain rating above what the pt wants/
interferes with activities Efficacy: Extend of which a
treatment/med works & can produce ‘effect’
Half-life: Time it takes for plasma concen. (drug in body) to be
reduced by 50% - 4 to 5 half lives are required to approach a
steady-state level in the blood; after 4-5 half lives a drug that
has been discontinued generally is considered mostly
eliminated from body
Hydrophilic: Readily absorbed in aqueous solution
Unpleasant sensory or emotional experience assoc.
tissue damage; exists when & whatever the pt says
Intraspinal: within the spine; spaces around cord where
Opioid induced hyperalgesia (OIH): Phenomenon in
medication can be admin
which exposure to opioids induces increased sensitivity
Lipophilic: Readily absorbed in fatty tissues
or a lower threshold, ‘flip side’ of tolerance’
Metabolite: Product of biochemical reactions during drug
Opioid naïve: pt not taken enough opioid to become
metabolism
tolerant of effects
Mu agonist: Any opioid that binds to mu opioid receptor
Opioid tolerant: Tolerance to high doses, may include
subtype & produces analgesic effects (e.g morphine) used
sedation
interchangeably with terms full agonist, pure agonist, and
Peripheral sensitization: Peripheral mechanism of
morphine.
neuropathic pain that occurs when there is a change in
Neuropathic (pathophysiologic) pain: Pain sustained by
the number and location of ion channels, sodium
injury or dysfunction of the peripheral or central nervous
channels abnormally accumulate in injured nociceptors,
systems & distinctly different from nociceptive pain
producing lower nerve depolarization threshold, ectopic
Neuroplasticity: Ability of peripheral & cns to change
discharges, increase response to stimuli
both structure & function as a result of noxious stimuli
Physical dependence: Bodies normal response if on
Neuropathic (physiologic) pain: Sustained by ongoing
opioid for if 2wks +, withdrawal may occur if stopped
activation of sensory system conducts the perception of
abruptly or antagonist is admin
noxious stimuli; implies the existence of damage to
Placebo: Medication, procedure, surgery that produces
somatic/visceral tissues sufficient to activate nociceptive
an effect in a pt because of its intent not because of
system
physical/chemical properties
Nociceptor: Type of primary afferent neuron that has the
Preemptive analgesic agents: Pre-injury pain treatments
ability to respond to a noxious stimulus
(preop) to prevent pain
Nonopioid: Refers to analgesic agents that include
Refractory: Non responsive or resistant to therapeutic
acetaminophen and nonsteroidal anti-inflammatory drugs
interventions such as analgesic agents
(NSAIDs); term is used instead of ”nonnarcotic”
Self-report: Ability of an individual to give a report-pain,
Opioid: Refers to codeine, morphine, and other natural,
intensity, most essential component of pain assessment
semisynthetic & synthetic drugs that relieve pain by
Titration: Upward or downward adjustment of the
binding to multiple of opioid receptors; term narcotic
amount (dose) of an analgesic agent
Opioid dose sparring effect: Occurs when nonopioid
Tolerance: Need to decrease or increase dependent on
adjuvant is added to an opioid, allowing the opioid dose
effects
to be lowered without diminishing analgesic effect