Download click here - part 1

Medication Management of the
Chronic Pain Patient
Benjamin Meeks, CFNP
Pain Medicine Associates
Disclosures
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Speakers Bureau for Pfizer Pharmaceutical and
Endo Pharmaceutical
Overview
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Overview of Pain Transmission
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Rational Poly-pharmacy
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NASIDS
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Antidepressants
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Anti-Seizure Medications
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Topical Medications
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Opiates
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Cannabinoids
Transmission of Pain
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Peripheral Sensitization
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Peripheral Neurons
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Ascending Spinal Cord
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Brain Structures/Mechanisms
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Descending Spinal Cord
Peripheral Sensatization
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Painful Stimuli
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Sodium and Calcium Channel Depolarization
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Glutamate
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Substance P
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Bradykinin
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Prostaglandin
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Tumor Necrosis Factor Alpha
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Glial Cells, Schwann Cells, Microglia, Astrocytes
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Nitric Oxide
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Arachidonic Acid
Ascending Spinal Cord
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Dorsal Horn
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NMDA, AMPA G-Protein and Tyrosine Receptors
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Summation Response
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Spinothalamic Tract
Brain
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Singnal from Spinothalamic Tract
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Concioius perception of pain
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Serotonin/Norepinephrine
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Endogenous Opioids in Periaqueductal Gray
Descending Spinal Cord
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Norepinephrine (Inhibitory)
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Serotonin (Inhibitory and Excitatory)
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Dopamine (Inhibitory and Excitatory)
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Norepinephrine
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Opiate Receptors – Peripheral and Central Afferents
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Peripheral Sensitization
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COX-2/Acid Sensitive Channels
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Subsbstance P
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Calium and Sodium Channels
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Prostaglandins
“Multidrug analgesic approaches take advantage
of complementary mechainisms of different drug
classes to enhance analgesia”
NSAIDS
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Inhibit Cyclooxygenase, prostaghaldins and
acid-sensative ion channels
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GI, Kidney Risk, Coronary Risk
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Opiate Sparring