Pharmacological treatment of Pain
|
|
- Kevin Palmer
- 5 years ago
- Views:
Transcription
1 Pharmacological treatment of Pain None Disclosures and Conflict of Interest Dr John F. Flannery Medical Director MSK and Multisystem Rehab Program PMR - FRCPC Objectives At the end of this presentation participants will be able to: List the various pharmacological options for the management of non-cancer pain Describe the main indications and contra-indications of each group of drugs Recall the rationale for choosing a drug based on: 1. The WHO pain ladder adapted for non-cancer pain 2. The 2014 Canadian Pain Society Guideline for pharmacological management of Chronic Neuropathic Pain Case 1 Brittany, 39 yr. old, waitress at a local high-end restaurant 5 months: insidious onset of right shoulder pain, no PHx trauma/dislocation, gradual increase in shoulder pain with overhead activities having increasing difficulties at work ROM preserved, pain with humerus in forward-flexed and internally rotated position Case 1 Think about the? s on the left Case 2 Case 2 Carbamazepine Giuseppe (Joe), 78, retired, DM type 2 for 16 years 5 years numbness of both feet in stocking distribution 6 months of burning, pins and needles, tingling, electric shock like feelings, and hypersensitivity to touch in both hands Impaired fine hand coordination and difficulty with tasks such as opening jars or turning keys Mild cognitive impairment, hypertension, Coronary disease, MI x2, Cr = 140 μmol/litre, benign prostate hypertrophy 1
2 Case 2 Think about the? s on the left Types of Pain In this lecture, we will focus on: Carbamazepine Nociceptive pain (e.g. shoulder bursitis) Neuropathic pain (e.g. painful diabetic neuropathy) Chronic pain syndrome (e.g. fibromyalgia) What s on the Menu and What are Today's Features and Specials! The Menu Pharmacological Options Non-acidic antipyretic analgesics (e.g. acetaminophen) Acidic antipyretic antiinflammatory analgesics, or non-steroidal antiinflammatory drugs (NSAIDs) Selective Cox-2 inhibitor antiinflammatory Muscle relaxants Antidepressant analgesics Anticonvulsant medications in neuropathic pain Opioids Cannabinoids (e.g. nabilone, medical marijuana) Local anesthetics (e.g. lidocaine patch/injections) Topical analgesics (e.g. capsaicin cream) Steroids Non-acidic antipyretic analgesics (e.g. acetaminophen) Acidic antipyretic antiinflammatory analgesics, or non-steroidal antiinflammatory drugs (NSAIDs) Selective Cox-2 inhibitor antiinflammatory Muscle relaxants Antidepressant analgesics Today s Features Anticonvulsant medications in neuropathic pain Opioids Cannabinoids (e.g. nabilone, medical marijuana) Local anesthetics (e.g. lidocaine patch/injections) Topical analgesics (e.g. capsaicin cream) Steroids Outcome of Goals Vague, Unquantifiable, Irrelevant, Impossible & Untimely Goals leave: Anxiety Uncertainty SMART Goals allow for commitment regarding Decisions Trust Collaboration 2
3 What is the intention of Tx? The Underlying Intention of Effective Goal Setting Why? How to measure? Trust Rapport Collaboration Goals Don t Do: Homer type Goals DDOOOHHH! Vague Unquantifiable Impossible Irrelevant No time frame SMART Goals Do : SMART Goals S - Specific M Measurable A Attainable/Achievable R Relevant T Time Based (Paracetamol) Indirect inhibitor of cyclooxygenase (in the brain, not peripherically) Excellent antipyretic Lack of serious adverse effects (provided that dose limit is observed). Hepatotoxicity in adults with chronic use >3.2g/day. Careful in elderly and concomitant use of alcohol Combinations: codeine, tramadol, oxycodone Non-steroidal Anti-inflammatory drugs (NSAIDs - Cox1 and Cox 2) All NSAIDs (selective and non-selective) may increase the risk of myocardial infarction and stroke (Bresalier et al 2005). No clear evidence that one is superior Analgesic potency equal to opiates (2-3/10) is least expensive Fluid retention, HTN, renal failure, asthma Risk of GI bleed lowered with PPI, COX-2 Beware if CVD, HTN, liver or kidney disease. APAP: N-acetyl-para-aminopherol 3
4 NSAIDs Facts Muscle relaxants Fast elimination (1-4 hours) Elimination Low potency High potency Salicylates: aspirin and salicylic acid, Ketoprofen, Diclofenac, Indomethacin, Ketorolac Muscle relaxants Antispasmodics Nonbenzodiazepines: e.g. cyclobenzaprine methocarbamol Benzodiazepines: e.g. diazepam Intermediate elimination (8-12 hours) Slow elimination (12-36 hours) Diflunisal Naproxen Meloxicam, Piroxicam Antispasticity drugs e.g. baclofen, dantrolene botulinum toxin Benzodiazepines have no effect on pain, do not consolidate sleep, can lead to falls, depression, anxiety, & addiction. Antidepressants: Mechanism of Action Analgesic effects independent of antidepressant action Pain inhibiting systems: (S) serotonergic and (N) noradrenergic effects from the brain stem onto the dorsal horn of the spinal cord Tricyclic antidepressants (TCAs): High dose treats depression ( mg/d); Low dose treats sleep cycle disturbance ( mg), consolidates stage IV sleep Antidepressants: Types Tricyclic antidepressants (TCAs): amitriptyline, nortriptyline, Tetracyclic antidepressants: trazodone Selective Serotonin Reuptake Inhibitors (SSRIs): citalopram, paroxetine, fluoxetine Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs): venlafaxine and duloxetine Main indications: Antidepressants: Indication Relief of neuropathic pain symptoms: stabbing pain, steady pain and skin sensitivity. approved for fibromyalgia and chronic lowback pain Trazodone (a tetracyclic antidepressant) helps sleep cycle but no evidence for pain. Antidepressants: Contra indications Contra-indications: glaucoma, prostate hypertrophy, prolongation of QT interval, liver function impairment, Contraindication of duloxetine if CrCl < 30 ml/min 4
5 Anticonvulsants: Mechanism of Action Anticonvulsants: Indication and Types Both epilepsy and neuropathic pain are associated with excess neuronal activity (uncontrolled electrical discharge) Voltage-gated Sodium Channel Blockers: phenytoin, carbamazepine, lamotrigine, topiramate, valproic acid. Non voltage-gated sodium channel blockers: gabapentin and pregabalin (structural analogues of GABA) but exact mechanism of analgesia is unknown presumably modulation of calcium channels. Use: trigeminal neuralgia (carbamazepine), postherpetic neuralgia, painful diabetic neuropathy, post-stroke pain, HIV neuropathy, pain post spinal cord injury, complex regional pain syndrome (CRPS), phantom limb pain : pain reduction is modest (<1/10), helps 15% over placebo benefits and harms are about the same at higher cost than gabapentin. Approved for fibromyalgia Anticonvulsants: Contra-indications Contra-indications: Carbamazepine: hepatotoxicity, AV heart block : kidney problems Choosing an Analgesic Issues to consider Type of pain (anticipated NHx, progressing or regressing) Severity and pattern of pain (level of interference in function, ranking of pain level.) Patient characteristics (what risk factors exist) Patient Choice (which do they think would be helpful) Type of pain Choosing an Analgesic Acute/Chronic; acute on chronic; breakthrough Nociceptive/Neuropathic/Mixed/ Fibromyalgia Nociceptive: muscle, bone, inflammatory, tendinitis Severity and pattern of pain Mild/Moderate/Severe Constant/Intermittent Patient characteristics Liver/Kidney function, allergies, previous experience Sleep abnormality Mood disorder Co-morbidities Risk of opioid overdose (e.g. COPD) or addiction WHO Analgesic Ladder Non-opioid analgesics: aspirin and acetaminophen Adjuvants NSAIDs, antidepressants or anticonvulsants 5
6 Consensus statement and guideline for pharmacological management of Neuropathic pain from the Canadian Pain Society Combining analgesics for chronic pain Pain Neuropathic Nociceptive Moulin et al 2014 Start the Canadian Pain Society Algorithm Start the WHO ladder Algorithm for the pharmacological management of neuropathic pain. *Topical lidocaine (second line for postherpetic neuralgia), methadone, lamotrigine, lacosamide, tapentadol, botulinum toxin; + Limited randomized controlled trial evidence to support add-on combination therapy. TCA Tricyclic antidepressants; SNRI Serotonin noradrenaline reuptake inhibitors Exercise Range of motion/stretching Strengthening Aerobic Relaxation techniques Yoga Pilates Psychological & Education Biofeedback Cognitive behavioural therapy Functional restoration Support groups Manual therapies Massage Manipulation Traction Mobilization techniques Never forget the non-pharmacological options for pain? Physical Modalities Local heat Superficial (hot packs) Deep (ultrasonography or diathermy) Local cold Traction Transcutaneous electrical nerve stimulation (TENS) Percutaneous electrical nerve stimulation Other Ergonomic aids Braces Meditation Acupuncture Shoulder impingment Syndrome Nociceptive Acute None Case 1 Carbamazepine Opioids Case Summary slide Painful diabetic neuropathy Neuropathic Chronic Diabetes Cognitive CVD, HTN Prostate Giuseppe Opioids Could try nortriptyline, but watch prostate symptoms Yes Yes Maybe No, kidney involvement After above meds failed Various pharmacological and non-pharmacological options for the management of non-cancer pain Major groups of drugs: acetaminophen, NSAIDs, Cox2 inhibitors, muscle relaxants, antidepressants and anticonvulsants. Opioids are discussed elsewhere Drug selection is based on type and nature of the pain, its severity of pain, and patient s characteristics and choice Combining analgesics may improve efficacy at lower doses, with fewer side effects than with the use of one agent alone 6
7 Resources Wall and Melzack s - Textbook of Pain 5 th edition Moulin et al. Pharmacological management of chronic neuropathic pain:revised consensus statement from the Canadian Pain Society WHO pain ladder ( Canadian Opioid Guideline ( ) Demeules et al, Eur J Anesthesiology, Clinical Pharmacology and rationale of analgesic combinations. 7
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Neuropathic pain pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist
More informationIF I M NOT TREATING WITH OPIOIDS, THEN WHAT AM I SUPPOSED TO USE?
NON-OPIOID TREATMENT OPTIONS FOR CHRONIC PAIN Alison Knutson, PharmD, BCACP Medication Management Pharmacist Park Nicollet Creekside Clinic Dr. Knutson indicated no potential conflict of interest to this
More informationNeuropathic Pain Treatment Guidelines
Neuropathic Pain Treatment Guidelines Background Pain is an unpleasant sensory and emotional experience that can have a significant impact on a person s quality of life, general health, psychological health,
More informationIf Not Opioids then LEAH EDMONDS CSHP OCTOBER 26, 2017
If Not Opioids then what LEAH EDMONDS CSHP OCTOBER 26, 2017 Disclosure Nothing to disclose Objectives Identify various non-opioid options for the treatment of chronic non cancer pain Choose appropriate
More informationCHAPTER 4 PAIN AND ITS MANAGEMENT
CHAPTER 4 PAIN AND ITS MANAGEMENT Pain Definition: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Types of Pain
More informationNeuropathic Pain. Scott Magnuson, MD Pain Management of North Idaho, PLLC
Neuropathic Pain Scott Magnuson, MD Pain Management of North Idaho, PLLC Pain is our friend "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described
More information3/1/2018. Disclosures. Objectives. Clinical advisory board member- Daiichi Sankyo
Adjuvant pain medications in geriatrics Thomas B. Gregory, Pharm.D., BCPS, CPE, FASPE Clinical Pharmacy Specialist Pain Management CoxHealth Springfield, MO Disclosures Clinical advisory board member-
More information21 st June BDS BASHD Therapeutics Pain and Analgesia. BASHD Therapeutics Analgesics and Pain Management. Links to other BASHD content
Volume of Prescribing by Dentists 2011 ( a reminder) BASHD Therapeutics Analgesics and Pain Management Analgesics account for 1 in 80 dental prescriptions made A lot more analgesics will be suggested for
More informationGateshead Pain Guidelines for Chronic Conditions
Gateshead Pain Guidelines for Chronic Conditions Effective Date: 13.2.2013 Review Date: 13.2.2015 Gateshead Pain Guidelines: Contents PAIN GUIDELINES Chronic Non-Malignant Pain 5 Musculoskeletal Pain 6
More informationSUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP)
9 SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP) SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF ACUTE PAIN NONOPIOID TREATMENTS
More informationNeuropathic Pain. Griffith Research Online. Author. Published. Journal Title. Copyright Statement. Downloaded from. Link to published version
Griffith Research Online https://research-repository.griffith.edu.au Neuropathic Pain Author Hall, Tony Published 2010 Journal Title Australian Journal of Pharmacy Copyright Statement Copyright 2010 Australian
More informationNeuropathic Pain in Palliative Care
Neuropathic Pain in Palliative Care Neuropathic Pain in Advanced Cancer Affects 40% of patients Multiple concurrent pains are common Often complex pathophysiology with mixed components Nocioceptive Neuropathic
More informationDisclosures. Management of Chronic, Non- Terminal Pain. Learning Objectives. Outline. Drug Schedules. Applicable State Laws
Disclosures Management of Chronic, Non- Terminal Pain No financial disclosures or conflicts of interest to report Michael A. Smith, PharmD, BCPS Clinical Assistant Professor, University of Michigan College
More informationNeuropathic Pain and Pain Management Options. Mihnea Dumitrescu, MD
Neuropathic Pain and Pain Management Options Mihnea Dumitrescu, MD www.austinppc.com International Association for the Study of Pain (IASP): Definition of Pain Pain is an unpleasant sensory and emotional
More informationManaging Pain in the Elderly
Managing Pain in the Elderly MILES BELGRADE, MD COMPREHENSIVE PAIN CENTER MINNEAPOLIS VA The Pain Deck is Stacked Against the Elderly Osteoporosis Fractures 1 Zoster & PHN Trigeminal Neuralgia Verne 81-year-old
More informationPractical Management Of Osteoporosis
Practical Management Of Osteoporosis CONFERENCE 2012 Education Centre, Bournemouth.19 November The following companies have given funding towards the cost of this meeting but have no input into the agenda
More informationTreatment of Neuropathic Pain: What Does the Evidence Say? or Just the Facts Ma am
Treatment of Neuropathic Pain: What Does the Evidence Say? or Just the Facts Ma am Tim R Brown, PharmD, BCACP, FASHP Director of Clinical Pharmacotherapy Cleveland Clinic Akron General Center for Family
More informationPharmacological and Nonpharmacological Approaches
Pharmacological and Nonpharmacological Approaches NAS Workshop December 4, 2018 Kurt Kroenke, MD, MACP Indiana University School of Medicine Regenstrief Institute, Inc. Balanced Treatment Options Medications
More informationOptimizing Non-Opioid Therapy for Chronic Pain
Optimizing Non-Opioid Therapy for Chronic Pain Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means
More informationMedications for the Treatment of Neuropathic Pain
Medications for the Treatment of Neuropathic Pain February 23, 2011 Jinny Tavee, MD Associate Professor Neurological Institute Cleveland Clinic Foundation Neuropathic Pain Pain, paresthesias, and sensory
More informationRational Polypharmacy
Rational Polypharmacy Thomas B. Gregory, PharmD, BCPS, CPE, FASPE Disclosures Clinical advisory board: Daiichi Sankyo 1 Introduction Cox Health Ambulatory Pain Clinic Pharmacy Specialist Learning Objectives
More informationMANAGEMENT OF DIABETIC NEUROPATHY. Chungnam University Hospital Soo-Kyung, Bok, M.D., Ph.D.
MANAGEMENT OF DIABETIC NEUROPATHY Chungnam University Hospital Soo-Kyung, Bok, M.D., Ph.D. The Diabetic neuropathy cannot be reversed Not to restore function to damaged nerve Slowly progress no initial
More informationUCSF Pediatric Hospital Medicine Boot Camp Pain Session 6/21/14. Cynthia Kim and Stephen Wilson
UCSF Pediatric Hospital Medicine Boot Camp Pain Session 6/21/14 Cynthia Kim and Stephen Wilson Rules Buzz first and player answers If answer correct, then the player asks teammates if they want to keep
More informationSpinal Cord Injury Pain. Michael Massey, DO CentraCare Health St Cloud, MN 11/07/2018
Spinal Cord Injury Pain Michael Massey, DO CentraCare Health St Cloud, MN 11/07/2018 Objectives At the conclusion of this session, participants should be able to: 1. Understand the difference between nociceptive
More informationOther classical forms of neuropathic pain include diabetic peripheral neuropathy, trigeminal neuralgia and postherpetic
Guideline Name: Neuropathic Pain Neuropathic pain is defined by the International Association for the Study of Pain, Neuropathic Special Interest group as pain arising as a direct consequence of a lesion
More informationPain Management. University of Illinois at Chicago College of Nursing
Pain Management University of Illinois at Chicago College of Nursing 1 Learning Objectives Upon completion of this module, participants will be better able to: 1. Define pain management 2. Explore various
More informationCHAPTER 4 PAIN AND ITS MANAGEMENT
CHAPTER 4 PAIN AND ITS MANAGEMENT Pain Definition: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Types of Pain
More informationDisclosures. Objectives 9/8/2015
The Aftermath of the Decade of Pain: Alternatives to Opioids in Chronic Pain Management Julie Cunningham, PharmD, BCPP Disclosures No relevant financial disclosures I will discuss off-label uses of antiepileptics,
More informationPain after Spinal Cord Injury
Pain after Spinal Cord Injury Authors: SCIRE Community Team Reviewed by: Patricia Mills, MHSc, MD, FRCPC Last updated: Oct 18, 2017 This page provides information about pain and outlines common treatments
More informationPain CONCERN. Medicines for long-term pain. Antidepressants
Pain CONCERN Medicines for long-term pain Antidepressants Many people living with long-term pain (also known as chronic or persistent pain) are worried about using medicines like antidepressants. They
More information8/6/18. Definitions. Disclosures. Technician Objectives. Pharmacist Objectives. Chronic Pain. Non-Opioid Alternatives for Chronic Pain Management
Disclosures Non-Opioid Alternatives for Chronic Management Nicholas Cox, PharmD, BCACP Clinical Pharmacist, Intensive Outpatient Clinic, University of Utah Health Pharmacist, Population Health, University
More informationAnalgesics: Management of Pain In the Elderly Handout Package
Analgesics: Management of Pain In the Elderly Handout Package Analgesics: Management of Pain in the Elderly Each patient or resident and their pain problem is unique. A complete assessment should be performed
More informationOverview of Neuropathic pain
Overview of Neuropathic pain Kongkiat Kulkantrakorn,M.D. Neurology division Thammasat University 1 Contents Overview of pain New concepts and mechanism Treatment options New data in management 2 3 Breaking
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Acetaminophen in chronic pain management, 225 Acupuncture in chronic pain management, 251, 338 339 Ajurvedic medicine in chronic pain management,
More informationAlternative Treatments for Chronic Pain
Alternative Treatments for Chronic Pain MICIS Workshop Speakers: Peter Michaud, RN, JD Elisabeth Fowlie Mock, MD, MPH Gordon Smith, JD Disclosures MICIS does not accept any money from pharmaceutical companies
More informationPain Management: A Comprehensive Review
Pain Management: A Comprehensive Review 1) Pain related issues currently account for approximately of doctor s visits. a) 60% b) 70% c) 80% d) 90% 2) Which pain scale is frequently utilized with children?
More information16 year old with Disabling Chest Wall Pain after Thoracoscopic Talc Pleurodesis for Treatment of Recurrent Spontaneous Pneumothoraces
16 year old with Disabling Chest Wall Pain after Thoracoscopic Talc Pleurodesis for Treatment of Recurrent Spontaneous Pneumothoraces Moderators: Kendra Grim, MD, Robert T. Wilder, MD, PhD Institution:
More informationNon-Opioid Drugs to Treat Neuropathic Pain. March 2018
Non-Opioid Drugs to Treat Neuropathic Pain Final Report March 2018 This report is intended only for state employees in states participating in the Drug Effectiveness Review Project (DERP). Do not distribute
More informationNon-opioid and adjuvant pain management
Non-opioid and adjuvant pain management ALLISON JORDAN, MD, HMDC MEDICAL DIRECTOR OF PALLIATIVE CARE SERVICES CHRISTIAN AND ALTON MEMORIAL HOSPITALS ASSOCIATE MEDICAL DIRECTOR, BJC HOSPICE ASSISTANT PROFESSOR
More informationFran Pulver, MD - PM&R Laurie Bell, PT - Physical Therapy Gregg Weidner, MD - Anesthesia Steven Severyn, MD, MBA, MSS - Anesthesia
Fran Pulver, MD - PM&R Laurie Bell, PT - Physical Therapy Gregg Weidner, MD - Anesthesia Steven Severyn, MD, MBA, MSS - Anesthesia Case Presentation-Fibromyalgia 30 year old female Chief complaint of back
More informationINTERNATIONAL SPINAL CORD INJURY PAIN EXTENDED DATA SET (Version 1.0)
Note: It is recommended that this Data Set have two additional key variables: - SITE (to distinguish the location where the data are recorded) and - SUBJECT (to distinguish the patient/study participant)
More informationAssociate Professor Supranee Niruthisard Department of Anesthesiology Faculty of Medicine Chulalongkorn University January 21, 2008
Associate Professor Supranee Niruthisard Department of Anesthesiology Faculty of Medicine Chulalongkorn University January 21, 2008 PAIN MECHANISMS Somatic Nociceptive Visceral Inflammatory response sensitizes
More informationPain Management: A Comprehensive Review
Pain Management: A Comprehensive Review 1) Pain related issues currently account for approximately of doctor s visits. a) 60% b) 70% c) 80% d) 90% 2) Which pain scale is frequently utilized with children?
More informationNeuropathic pain (pain due to nerve damage)
Neuropathic pain (pain due to nerve damage) Clinical Guideline Pain can be nociceptive, neuropathic or mixed. The neuropathic component of pain generally responds poorly to conventional analgesics. Consider
More informationA PATIENT GUIDE FOR MANAGING PAIN
A PATIENT GUIDE FOR MANAGING PAIN PAIN MANAGEMENT Knowing the Facts Pain can be controlled. Pain is common after surgery and with many types of illnesses. Most patients with acute and chronic pain can
More informationMoving On : Non-Opioid Alternatives for Chronic Pain Management
Winter Meeting February 10, 2018 Moving On : Non-Opioid Alternatives for Chronic Pain Management Nicholas Cox, PharmD, BCACP Clinical Pharmacist, Intensive Outpatient Clinic, University of Utah Health
More informationDiabetic Peripheral Neuropathy: Assessment and Treatment
Diabetic Peripheral Neuropathy: Assessment and Treatment Denise Soltow Hershey PhD, FNP-BC Michigan Council of Nurse Practitioners Annual Conference March 17, 2018 Objectives 1) Describe the clinical features
More informationTreating Pain and Depression
Treating Pain and Depression Without Getting Depressed Joseph P, Arpaia, MD www.jparpaiamd.com More than 50% of patients with chronic pain also have clinically significant depression. Interestingly that
More informationDescribe Identify Compare Recognize
Goal To educate nurses about the challenges associated with treating chronic pain and the safety and efficacy of alternative therapy options in relation to Opioids. Objectives Describe the challenges associated
More informationNEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES
NEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES GENERAL PRINCIPLES Neuropathic pain may be relieved in the majority of patients by multimodal management A careful history and examination are essential.
More informationPregabalin Prescribing in Primary Care Audit Results 2012/13
Executive summary Pregabalin Prescribing in Primary Care Audit Results 2012/13 Pregabalin is extensively used across Aneurin Bevan Health Board (ABHB). It is the second highest medicine in terms of primary
More informationElements for a Public Summary
VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Generalised anxiety disorder Generalised anxiety disorder (GAD) is an umbrella term that covers a wide range of anxiety disorders
More informationPharmacotherapy of Pain SUPHAT SUBONGKOT, PHARM.D. BCOP, BCOP CLINICAL PHARMACY DIVISION KHON KAEN UNIVERSITY, THAILAND
Pharmacotherapy of Pain SUPHAT SUBONGKOT, PHARM.D. BCOP, BCOP CLINICAL PHARMACY DIVISION KHON KAEN UNIVERSITY, THAILAND Therapeutic Strategies for Pain and Disability Pharmacotherapy Rehabilitative approaches
More informationIndex. Prim Care Clin Office Pract 31 (2004) Note: Page numbers of article titles are in boldface type.
Prim Care Clin Office Pract 31 (2004) 441 447 Index Note: Page numbers of article titles are in boldface type. A Abscess, brain, headache in, 388 Acetaminophen for migraine, 406 407 headache from, 369
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Lyrica) Reference Number: HIM.PA.64 Effective Date: 12/14 Last Review Date: 08/17 Line of Business: Health Insurance Marketplace Revision Log See Important Reminder at the end of this
More informationAvailable Strengths. Cost per Rx 325 mg tablet - $ mg tablet - $ mg ER tablet - $ mg capsule - $ mg chewable tablet
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY Non-Opioids LAST REVIEW 5/9/2017 THERAPEUTIC CLASS Pain REVIEW HISTORY 2/16, 5/15 LOB AFFECTED Medi-Cal (MONTH/YEAR) This
More informationManaging the Chronic Pain Patient. (and some stuff about opioids)
Managing the Chronic Pain Patient. (and some stuff about opioids) C. Patrick Carroll, M.D. Assistant Professor Johns Hopkins University School of Medicine Department of Psychiatry and Behavioral Sciences
More informationTips for Pain Management
Tips for Pain Management Going for the 3 Increases: Increase in Health, Increase in Happiness & Increase in Energy Strategies for Success in Health Management By: James J. Messina, Ph.D. What are the medical
More informationCHAMP: Bedside Teaching TREATING PAIN. Stacie Levine MD. What is the approach to treating pain in the aging adult patient?
CHAMP: Bedside Teaching TREATING PAIN Stacie Levine MD Teaching Trigger: An older adult patient is identified as having pain. Clinical Question: What is the approach to treating pain in the aging adult
More informationApproaches to Managing Neuropathic Pain. Nov 7, 2017
1 Approaches to Managing Neuropathic Pain Nov 7, 2017 3 Learning objectives Review the current Canadian Guidelines on Neuropathic Pain Review the diagnosis and options available for the management of Neuropathic
More informationUnderstanding pain and mental illness Impact on management principles
Understanding pain and mental illness Impact on management principles Chris Alderman Consultant Psychopharmacologist Pain and mental illness - context PAIN MENTAL ILLNESS OTHER FACTORS (personality, history.
More informationPain Management in Older Adults. Mary Shelkey, PhD, ARNP
Pain Management in Older Adults Mary Shelkey, PhD, ARNP Cause of Death/ Demographic and Social Trends Early 1900s Current Medicine's Focus Comfort Cure Cause of Death Infectious Diseases/ Communicable
More informationWinter Meeting February 10, 2018
Winter Meeting February 10, 2018 Moving On : Non-Opioid Alternatives for Chronic Pain Management Nicholas Cox, PharmD, BCACP Clinical Pharmacist, Intensive Outpatient Clinic, University of Utah Health
More informationOpioid Analgesic Treatment Worksheet
Opioid Analgesic Treatment Worksheet Aetna Better Health of Louisiana Fax: 1 844 699 2889 www.aetnabetterhealth.com/louisiana/providers/pharmacy LA Legacy Fee for Service (FFS) Medicaid Fax: 1 866 797
More informationPOST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS
POST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS November 9, 2018 Aimee LaMere, CNP Molly McNaughton, CNP Leslie Weide, MSW, LICSW, ACM Disclosures: Conflict of interest statement: We certify that,
More informationLearning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16
Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center
More informationPain. Christine Illingworth. Community Nurse St Luke s Hospice 17/5/17
Pain Christine Illingworth Community Nurse St Luke s Hospice 17/5/17 What is pain? Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage Pain is whatever
More informationManagement of Pain related to Spinal Cord Lesion
Management of Pain related to Spinal Cord Lesion A Neurologist s Perspective Vincent Mok, MD Associate Professor Division of Neurology Department of Medicine and Therapeutics The Chinese University of
More informationA Patient s Guide to The Medication Approach to Chronic Pain
A Patient s Guide to The Medication Approach to Chronic Pain 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com DISCLAIMER: The information in this booklet is
More informationOpioid Analgesic Treatment Worksheet
Opioid Analgesic Treatment Worksheet Aetna Better Health of Louisiana Fax: 1 844 699 2889 www.aetnabetterhealth.com/louisiana/providers/pharmacy LA Legacy Fee for Service (FFS) Medicaid Fax: 1 866 797
More informationDr. Joel Bordman November, 2013
Dr. Joel Bordman November, 2013 1 Faculty: Dr. Joel Bordman Relationship with commercial interest: has been on an advisory board or a speaker for the following companies in the last 24 months: Janssen-Ortho
More informationVolume 4; Number 5 May 2010
Volume 4; Number 5 May 2010 CLINICAL GUIDELINES FOR ANTIDEPRESSANT USE IN PRIMARY AND SECONDARY CARE Lincolnshire Partnership Foundation Trust in conjunction with Lincolnshire PACEF have recently updated
More informationBEYOND OPIOIDS: ADJUNCTS FOR TREATING PAIN
BEYOND OPIOIDS: ADJUNCTS FOR TREATING PAIN Ronald Januchowski, D.O. 2017 Objectives By the end of the presentation, the learner should be able to: Summarize the risks of opiates when used for non-cancer
More informationNational Horizon Scanning Centre. Pregabalin (Lyrica) for fibromyalgia. September 2007
Pregabalin (Lyrica) for fibromyalgia September 2007 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a definitive
More informationI s s u e 1,
I s s u e 1, 2 0 1 4 Guidelines for the Pharmacological Treatment of Peripheral Neuropathic Pain: Expert Panel Recommendations for the Middle East Region EFNS guidelines on the pharmacological treatment
More informationCurrent Pharmacotherapy of Chronic Pain
S16 Journal of Pain and Symptom Management Vol. 19 No. 1(Suppl.) January 2000 Proceedings Supplement NMDA-Receptor Antagonists: Evolving Role in Analgesia Current Pharmacotherapy of Chronic Pain Russell
More informationALTERNATIVES TO OPIOIDS FOR CHRONIC PAIN & OPIOID TAPERING
ALTERNATIVES TO OPIOIDS FOR CHRONIC PAIN & OPIOID TAPERING Karen Hulbert, MD Associate Professor Department of Family & Community Medicine Medical College of Wisconsin Winter Refresher January 31, 2018
More informationCOMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING FOR PAIN MANAGEMENT
JANUARY 2012 COMPOUNDING PHARMACY SOLUTIONS PRESCRIPTION COMPOUNDING WWW.CPSRXS. COM We customize individual prescriptions for the specific needs of our patients. INSIDE THIS ISSUE: Osteoarthritis Pain
More informationScottish Medicines Consortium
Scottish Medicines Consortium pregabalin, 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg capsules (Lyrica ) No. (389/07) Pfizer Limited 6 July 2007 The Scottish Medicines Consortium has completed
More informationPalliative Prescribing - Pain
Palliative Prescribing - Pain LAURA BARNFIELD 21/2/17 Aims To understand the classes of painkillers available in palliative care To gain confidence in counselling regarding opiates To gain confidence prescribing
More informationOld and New Drugs in Chronic Pain Management
Old and New Drugs in Chronic Pain Management Andrea Furlan, MD PhD Associate Professor, Division of Physiatry, University of Toronto Scientist, Institute for Work & Health Staff physician and Senior Scientist,
More informationKnock Out Opioid Abuse in New Jersey:
Knock Out Opioid Abuse in New Jersey: A Resource for Safer Prescribing GUIDELINE FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN IMPROVING PRACTICE THROUGH RECOMMENDATIONS CDC s Guideline for Prescribing Opioids
More informationEvidence-based Clinical Practice Guidelines on Management of Pain in Older People Aza Abdulla, Margaret Bone, Nicola Adams, Alison M.
Evidence-based Clinical Practice Guidelines on Management of Pain in Older People Aza Abdulla, Margaret Bone, Nicola Adams, Alison M. Elliott, Derek Jones, Roger Knaggs, Denis Martin, Elizabeth L. Sampson,
More informationEnhanced Community Palliative Support Services. Lynne Ghasemi St Luke s Hospice
Enhanced Community Palliative Support Services Lynne Ghasemi St Luke s Hospice Learning Outcomes Define the different types of pain Describe the process of pain assessment Discuss pharmacological management
More informationSteven Richeimer, M.D.
Steven Richeimer, M.D. Associate Professor of Anesthesiology & Psychiatry Chief, Division of Pain Medicine Keck School of Medicine, USC Los Angeles, CA 323-442-6202 www.helpforpain.com Pain Light touch
More informationMid Essex Locality Guideline for Management of Adult Acute and Chronic Non-Cancer Pain in Primary care
Guideline for Management of Adult Acute and Chronic Non-Cancer Pain in Primary care If possible patients should be assessed using a simple visual analogue scale VAS to determine the most appropriate stage
More informationA Pain Management Primer for Pharmacists. Jessica Geiger-Hayes, PharmD, BCPS, CPE Andrea Wetshtein, PharmD, BCPS, CPE
A Pain Management Primer for Pharmacists Jessica Geiger-Hayes, PharmD, BCPS, CPE Andrea Wetshtein, PharmD, BCPS, CPE Objectives Discuss the differences between somatic, visceral, and neuropathic pain Design
More informationCancer patients at End-of-Life: Multidimensional Pain Requiring Multimodal Therapy
Cancer patients at End-of-Life: Multidimensional Pain Requiring Multimodal Therapy Presented by: Marsha Farrell BSN, RN-BC, CHPN Pathways to Success Conference by the Bay November 12, 2014 Conflict of
More informationPainful Diabetic Neuropathy Effective Management. Ketan Dhatariya Consultant in Diabetes NNUH
Painful Diabetic Neuropathy Effective Management Ketan Dhatariya Consultant in Diabetes NNUH Neuropathic Pain Prevalence varies between 10 and 90% depending on classification Accounts for 50-75% of non-traumatic
More informationAvera ecare Chronic Pain Management Janell Simpkins MD, FACP Avera ecare Specialty Clinic Medical Director
Chronic Pain Management Janell Simpkins MD, FACP Avera ecare Specialty Clinic Medical Director Burden of Pain 100 million Americans report ongoing pain 25 million with daily pain Pain impacts health status,
More informationAmber D. Hartman, PharmD Specialty Practice Pharmacist James Cancer Center & Solove Research Institute Ohio State University Medical Center
Pharmacologic Management of Pain Amber D. Hartman, PharmD Specialty Practice Pharmacist James Cancer Center & Solove Research Institute Ohio State University Medical Center Objectives Identify types of
More informationManagement of Pain. Agenda: Definitions Pathophysiology Analgesics
C. Brian Warriner, MD, FRCPC Professor and Past Chair UBC Department of Anesthesiology, Pharmacology and Therapeutics brian.warriner@vch.ca Agenda: Definitions Pathophysiology Analgesics Gases(N 2 O) Opiates
More informationPain Management in the
Pain Management in the Elderly Meri Hix, PharmD, CGP, BCPS Associate Professor of Pharmacy Practice Midwestern University Chicago College of Pharmacy No conflicts of interest to declare Objectives Discuss
More informationDiagnosis (Please be specific & provide as much information as possible):
Please complete this entire form and fax it to: 866-940-7328. If you have questions, please call 800-310-6826. This form contains multiple pages. Please complete all pages to avoid a delay in our decision.
More informationChronic Pain Mechanisms and Management principles
Chronic Pain Mechanisms and Management principles Dr Nick Shenker PhD FRCP Addenbrooke s Hospital What is pain? International Association for the Study of Pain (IASP) An unpleasant sensory and emotional
More informationAppendix 4B - Guidance for the use of Pharmacological Agents for the Treatment of Depression in Adults (18 years and over)
Appendix 4B - Guidance for the use of Pharmacological Agents for the Treatment of Depression in Adults (18 years and over) Introduction / Background Treatment comes after diagnosis Diagnosis is based on
More informationDiabetic Peripheral Neuropathic Pain: Evaluating Treatment Options
Diabetic Peripheral Neuropathic Pain: Evaluating Treatment Options Ramon L. Cuevas-Trisan, MD Disclosures Speakers Bureau/Honoraria: Allergan, Ipsen 1 Learning Objectives Discuss practical approaches to
More informationPain Management Dilemmas. Five Pain Dilemmas. Barriers: Meet Loretta. Daniel Johnson, MD, FAAHPM
Pain Management Dilemmas Daniel Johnson, MD, FAAHPM Kaiser Permanente University of Colorado Five Pain Dilemmas 1. Barriers to Pain Management 2. Selecting and Titrating Opioids 3. Managing PCAs 4. Using
More informationGUIDELINES AND AUDIT IMPLEMENTATION NETWORK
GUIDELINES AND AUDIT IMPLEMENTATION NETWORK General Palliative Care Guidelines The Management of Pain at the End Of Life November 2010 Aim To provide a user friendly, evidence based guide for the management
More informationStrategies in Migraine Care
Strategies in Migraine Care Julie L. Roth, MD Rhode Island Hospital Assistant Professor, Neurology The Warren Alpert Medical School of Brown University March 28, 2015 Financial Disclosures None. Objectives
More information