Faculty LEARNING OBJECTIVES

LEARNING OBJECTIVES:

KNOWLEDGE:

Know the International Association for the Study of Pain (IASP) definition of pain.
(an unpleasant sensory and emotional experience associated with actual tissue damage, or described in terms of such).
Describe 3 ways to assess pain.
(numerical scale, category scale, visual analog scale, Wong-Baker Faces Pain Rating Scale, Oucher scale )
Know the maximum recommended daily doses of acetaminophen and aspirin .
(4000 mg/day for both)
State the 7 necessarycomponents of writing a PCA order.
(drug name, concentration, loading dose, demand dose, lock-out interval, four hour limit, basal infusion)
Know why meperidine is NOT the opioid of choice for chronic pain management.
(normeperidine is not an active metabolite, normeper. has a longer half-life than the parent drug = 8 hours, normeper. is renally excreted, therefore in renal insufficient patients, it hangs around longer leading to toxicity. Neuroexcitability is a sign of toxicity and ranges from myoclonic jerks to full blown seizures)
Describe the common side effects of opioids.
(nausea, vomiting, constipation, pruritis)
Describe the uncommon side effects of opioids.
(respiratory depression, nystagmus, myoclonus, peripheral edema) .
Describe abstinence syndrome.
(A set of symptoms such as sweating, mydriasis, increase pain, abdominal cramping, diarrhea, elevated temperature, hypertension, tachycardia, myalgias, hallucinations, and goose flesh that signifies the body’s drop in serum opioid level or mu receptor occupancy, causing an alarm state and release of catecholamines.)
Know that 10 mg MSO4 IV/IM is the gold standard for comparison of opioid equivalency in regards to analgesia.
The studies used acute pain model of dental extraction, or infraumbilical gynecological surgery. It used the patient’s subjective report of the ability of one drug to control the pain and compared it to another drug. Equal analgesia does not equal serum level, but rather serves as a guideline for initiation of therapy and converting from one opioid to another. One must occasionally swith to a different opioid because of severe side effects or tolerance. If so, it is recommend to start with a slightly lower dose and retitrate.

SKILLS:

Be able to convert from parental opioids to oral opioids to transdermal opioids by using 10 mg MSO4 IV/IM as the gold standard while utilizing the equianalgesic chart.
Take a complete pain assessment including the chief complaint which includes location, duration, intensity, quality, associated symptoms, aggrevating and relieving factors, and the HPI.
Incorporate VAS (visual analog scale) as part of routine vital signs when documenting notes, and when presenting to your intern, resident, fellow, and/or attending physician
Be able to write MSO4, hydromorphone, fentanyl PCA orders.
Write out the IASP’s definition of pain.
Describe the common side-effects of opioids, and their treatment.
Instruct patients in the importance of communicating about their pain using the VAS scale, where 0= no pain and 10= worst possible pain.
Write out the definition of addiction.
(Addiction is a pattern of compulsive drug-use behaviors characterized by a continued craving for an opioid and a need to use the opioid for effects other than pain relief.)

ATTITUDES:

Understand the psychosocial components of acute and chronic pain, and it’s potential impact on family dynamics.
Understand and respect cultural and spiritual differences and how this may impact history taking, physical exam, and response to treatment.
Recognize how personal biases and judgments may limit appropriate assessment and treatment of pain. Develop strategies to avoid this.
(Maintain listening presence, don’t minimize patient’s report, maintain eye contact, examine involved area, go to patient’s bedside and evaluate situation when nurse calls you to tell patient is having severe pain.)
Pain management should be considered a priority.
(if it was you or family member in pain, you would want timely assessment and treatment)
Accept scheduled dosing of opioids as the norm.
Don’t confuse opioid tolerance and physiologic dependence as addiction.
Identify potential barriers to effective pain management.
(physician’s personal biases/judgement; patient’s, family’s, and physician’s unsupported fears of addiction leading to under treatment, lack of universal assessment tool, reliance on objective signs of pain, fear of sanctions by regulatory agencies, inadequate training in pain management)

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