Medication Pain ManagementDaniel Alves MD, MPHBoard CertifedPain ManagementDiplomate, Academy of Physical Medicine and Rehabilitationhy !earn abo"t MedicationsCDC #actsEach day, 46 people die from an overdose of prescription painkillers* in the US.Health care providers wrote 25 million prescriptions for painkillers in 2!"2, eno#$h for every %merican ad#lt to have a &ottle of pills."! of hi$hest prescri&in$ states for painkillers are in the So#th.'(' we&sitePain $reatment Contin"m$reatments%onpharmacalogical & '('RC)*'Pharmacological)nterventionalPsychological+BehavioralAc"p"nct"reMechanistic Approach to $reatment(escendin$ )nhi&ition%'+,H$-piate receptorsBrain$CA.s**R).s*%R).s-piates$ramadol*eripheral sensiti+ation%a/CB0-(CPH$$CA$PM!$1Me2illetine!idocaine'entral sensiti+ation1BP3-(C4etamine, $PMDe2tromethorphanMethadone-thersCapsacian%*A)D*C-(56 inhibitors!evodopa*pinal CordCA//%MDABeydo"n A, 6778Pharmacological $reatments%*A)D*Mobic, %apro2en, )b"profen-pioidsM"scle Rela2antsAntidepressantsAnticonv"lsants*edative$opical%e"roleptics%*A)D*hich is the best9%o concl"sions can be dra:n as to :hich is the best;)s it e for stro>e or heart attac>hat abo"t $ylenol9As eing behaviors'scalation of medications$a>ing medications for symptoms other than painAn2iety or sleepAddictionPersistent pattern of dysf"nctional opioid "se involving?Adverse conseH"ences associated :ith opioid "se!oss of control over opioid "seContin"ed opioid "se despite harmPreocc"pation :ith obtaining opioids despite adeH"ate pain control5craving@Dependency not eH"al to Addiction Pse"doaddiction*imilar behavior as addictionMay act"ally have tr"e pathology b"t behave as if they have an addictionBndermedicated analgesicProgression of diseasePatient may "se street dr"gs, et-H, doctor shopping b"t behavior s"bsides once pain is managed)mportant to complete f"ll e2am=A F,5year5old man :ho has a 875year history of H)J infection and intraveno"s dr"g "se has recent onset of b"rning pain and dysesthesias in both feet@ %erve cond"ction st"dies sho: a primary sensory symmetric peripheral ne"ropathy@ Administration of :hich of the follo:ing medications is the most appropriate initial step in management9 CAD De2amethasone CBD 'tanerceptCCD MethadoneCDD Pregabalin C'D $ramadol hich of the follo:ing receptors mediates the :ind"p phenomenon9 CAD ,5H$8D CBD M"5opioid CCD %icotinic CDD %5methyl5D5aspartic acid C%MDAD C'D Janilloid Addiction is characteriGed by all of the follo:ing e2cept9Cloc> :atching, hoarding of opioid analgesics, reH"esting e2tra pills for fear of r"nning o"t and demanding behavior@ )mpaired control over dr"g "se and comp"lsive "se@Contin"ed dr"g "se despite harm@Bse of opioid e