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Pharmacology- pain management
Terms in this set (16)
the absence of feeling, sensation or pain) either through the skin as topical drugs, through injection, through nerve blocks or through inhalation as used in the operating room. Central nervous system depressants may be general in that that depress the entire CNS or they can be more specific; affecting one or more centers of the brain.
To relieve certain painful conditions such as RSD with medication administered directly to the sympathetic ganglia.
For analgesia during surgery through application to a specific region such as the brachial plexus for UE arthroscopy or biopsy.
Sympathetic Ganglion Block
Epidural Steroid Block
Brachial Plexus Block
General Anesthetic Drugs
produce a loss of sensation throughout the body which leads to unconsciousness most utilized for surgery. The drugs of this category are most often administered by inhalation. Anesthetic drugs used today have a shorter duration of effect than in previous years, allowing prompt recovery and a low incidence of nausea or vomiting.
indicated to manage the pain that often accompanies the various orthopedic conditions (OA, HNP, Tendonitis, rib fractures, post surgical conditions, etc.) afflicting patients receiving physical therapy.
as Lidocaine are typically administered via subcutaneous injection or topically to block pain.
typically managed with OTC medications. Often pain is associated with inflammatory conditions of NSAIDs covered in the Musculoskeletal System are often utilized. Pain medications such as acetaminophen work peripherally to limit pain without any anti-inflammatory effects and are considered non-narcotic analgesics.
(producing stupor/sleep with CNS depression) are controlled substances often utilized derived from opium and used today to effectively treat moderate to severe pain. While effective, these medications carry the risk of addiction with prolonged use. Medications in this category can be delivered orally, intravenously or via a transdermal patch.
PCA pump (patient-controlled analgesia)
allows the patient to administer his/her own medication. The patient receives an IV in the arm which is attached to a small pump that provides continuous infusion of the medication or delivery of a dose of the medication each time that the patient presses a button on the pump. The unit is preset to a specific dose and time frame between dosages to avoid overdose
often requires medication which will at on the central nervous system to affect the patient's perception of pain while promoting a sense of well-being. Often, this type of medication will be used in combination with aspirin, acetaminophen or other analgesic drugs. Codeine and Percocet are examples of this type of medication.
Severe and unrelenting pain
often warrants medications that will act to suppress the central nervous system by blocking the pain pathways thereby dulling all sensation of pain as well as the perception of pain. Additionally, anxiety and apprehension regarding the pain will disappear as the patient will experience euphoria. The patient often will appear markedly drowsy. This type of medication is most effective if it is administered prior to the onset of the pain. Medications such as Morphine, Demerol, Vicodin and Oxycodone are examples of the medications used in this type of clinical situation.
Lidocaine can be delivered in physical therapy through the skin via Phonophoresis (US) or Iontophoresis (Estim) for deeper local effects. More often anti-inflammatory medications such as Hydrocortisone are utilized to manage the pain via controlling the inflammatory process.
Drugs that can effectively control pain are also the most addicting. While short-term use does not necessarily lead to addiction if the doses are monitored closely. Severe withdrawal symptoms are experienced with cessation of its use.
After repeated doses tolerance may develop with continual increase of the dose occurring to obtain the same level of pain relief.
Many narcotic medications act as CNS depressants with depression of the respiratory system a common side effect which patients should be monitored for as it can be potentially fatal.
Acetaminophen utilized over prolonged periods of time may contribute to liver and kidney damage as the medication is metabolized by those organs. This risk is increased when combined with alcohol consumption.
Considerations for the PT Assistant
When performing data collection relative to pain, the PTA should ask when the last dose of pain medication was administered.
Patient education should occur related to appropriate activity level as medications may mask pain.
When post operative patients are recovering from anesthesia, they will present with lethargy and often nausea as the sedative effects are diminishing. Care should be taken when performing mobility activities with these patients as participation may be limited.
General anesthesia limit ciliary clearance of mucus in the airways. Following surgery, patients should be encourage to perform deep breathing exercises, incentive spirometry and coughing splinted if necessary to assist in clearing sections which may have settled in the airways.
Many pain medications can cause a patient to be markedly drowsy which may be combined with decreased cognitive function (problem solving, ability to follow commands, etc.) decreasing participation in therapy. The PTA should attempt to schedule therapy at a time when pain relief is at its peak but this lethargy side effect is minimal should be attempted.
Anti-anxiety medications and sedative which promote relaxation are often utilized in combination with analgesics to manage pain. Patients should additionally be monitored for the considerations covered in the Psychiatric Unit.
For patients with PCA pumps, the PTA should be cautious of the IV line as well as being aware of whether the unit is set to continuous infusion of the medication of delivery is dependent upon the patient pressing the handheld button. If the latter is the case, determination of the most appropriate time during the session to initiate the dosage will be related to the level of pain relief required based on activities performed.
Patients who are taking morphine may experience decreased motor coordination. Misjudging distances and staggering may occur during gait.
Patient's taking narcotics should be monitored for orthostatic hypotension and dizziness with mobility.
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