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3rd Year - Specialties > 1.1. Anaesthetics - Pain > Flashcards

1.1. Anaesthetics - Pain Flashcards

1
Q

What is Pain?

A

An unpleasent Sensory and Emotional Experience associated with Actual / Potential Tissue Damage, or Described in terms of such Damage

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2
Q

With Regards to Treating Pain, what are the

  1. Physical benefits?
  2. Psychological benfits?
A
  1. a) Improved Sleep
  2. b) Better Appetite
  3. c) Fewer Medical Complications - M.I. / Pmeumonia
  4. a) Reduced Siffering
  5. b) Less Depression / Anxiety
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3
Q

With Regards to Treating Pain, what are the benefits for:

  1. The Family?
  2. Society?
A
  1. a) Improved functioning as a Family Member
  2. b) Able to keep working
  3. a) Lower Health Costs - Shorter Hospital Stays
  4. b) Able to contribute to the community
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4
Q

What are the Classifications of Pain under:

  1. Duration?
  2. Cause?
  3. Mechanism?
A
  1. Acute / Chronic / Acute on Chronic
  2. Cancer / Non-Cancer
  3. Nociceptive / Neuroathic
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5
Q

What is the difference between:

  1. Acute Pain?
  2. Chronic Pain?
A
  1. Pain of Recent Onset and probable Limited Duration
  2. Pain > 3 months / Lasting after normal Healing
    Note - There is often no identifiable cause of Chronic Pain
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6
Q

What is the difference between:

  1. Cancer Pain?
  2. Non-Cancer Pain?
A
  1. Progressive - May be a mixture of Acute and Chronic

2. Many different causes - Acute or Chronic

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7
Q

What are the Features of Nociceptive Pain?

A
  1. Obvious Tissue Injury / Illness
  2. Protective Function
  3. Described as Well Localised and Sharp / Dull
    Note - Also called Physiological / Inflammatory Pain
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8
Q

What are the Features of Neuropathic Pain?

A
  1. Nervous System Damage / Abnormality
  2. Tissue Injury may not be Obvious
  3. Does not have a Protective Function
  4. Described as:
  5. a) Burning, Shooting +/- Numbness / Pins and Needles
  6. b) Not Well Localised
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9
Q

What us the Physiology of Pain?

A
  1. Periphery = Tissue Injury - Chemical Release - Stimulation of Nociceptors - Signals in A-Delta / C Fibres
  2. Spinal Cord = Dorsal Horn - Nerve Synapse with Second Nerve - Ascend up opposite side of Spinal Cord
  3. Brain = Thalamus - Connection to Cortex / Limbic System / Brainstem - Pain Perception is in the Cortex
  4. Modulation - Descending Pathway (Brain - Dorsal Horn) - Decreases Pain signal
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10
Q

What is the Gate Theory of Pain?

A

Distraction Stimulus (Rubbing) Reduces pain by Inhibiton of Neurons

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11
Q

What is Neuropathic Pain?

A

Abnormal Processing of Pain Signal due to Nervous System Damage / Dysfunction, e.g.:

  1. Nerve Trauma
  2. Diabetic Pain
  3. Fibromyalgia
  4. Chronic Tension Headache
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12
Q

What are the Pathological Mechanisms for Neuropathic Pain?

A
  1. Increased Receptor Numbers
  2. Abnormal Sensitisation of Nerves - Peripheral / Central
  3. Chemical Changes in the Dorsal Horn
  4. Loss of Inhibitor Modulation
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13
Q

What are the Drug Classifications?

A
  1. Simple Analgesics - Paracetamol / NSAID’s
  2. Mild Opioids - Codeine / Morphine / Oxycodone / Fentanyl / Tramadol
  3. Antidepressants - Amitriptyline / Duloxetine
  4. Anticonvulsants - Gabapentin
  5. Ketamine - NMDA Receptor Antagonist
  6. Local Anaesthetics
  7. Topical Agents
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14
Q

What are the Treatments for Pain from the Periphery?

A
  1. Non-Drug Treatments - R.I.C.E.
  2. NSAID’s
  3. Local Anaestetics
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15
Q

What are the Treatments for Pain from the Spinal Cord?

A
  1. Non-Drug Treatments - Acupuncture / Massage / TENS
  2. Local Anaesthetic
  3. Opiods
  4. Ketamine
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16
Q

What are the Treatments for Pain from the Brain?

A
  1. Non-Drug Treatments - Psychological

2. Drug Treatments - Paracetamol / Opiods / Amitriptyline / Clonidine

17
Q

What are the Advantages / Disadvantages of Paracetamol?

A

Advantages:

  1. Cheap / Safe
  2. Orally / Rectally / I.V.
  3. Good for Mild - Moderate / Severe Pain

Disadvantages:
1. Liver Damage in Overdose

18
Q

What are the Advantages / Disadvantages of NSAID’s?

A

Advantages:

  1. Cheap / Generally Safe
  2. Good for Nociceptive Pain
  3. Works Synergisticly with Paracetamol

Disadvantages:
1. G.I. / Renal Side effects and Sensitive Asthmatics

19
Q

What are the Advantages / Disadvantages of Codeine?

A

Advantages:

  1. Cheap / Safe
  2. Good for Mild-Moderate Acute Nociceptive Pain

Disadvantages:

  1. Constipation
  2. Not good for Chronic Pain
20
Q

What are the Advantages / Disadvantages of Tramadol?

A

Advantages:

  1. Less Respiratory Depression
  2. Can be used with Opioids / Simple Anagesics
  3. Not a controlled Drug

Disadvantages:
1. Nausea and Vomiting

21
Q

What are the Advantages of Morphine?

A
  1. Cheap / Generally Safe
  2. Can be given Orally / I.V. / I.M. / S.C.
  3. Effective if given regularly
  4. Good for:
  5. a) Moderate - Severe Acute Nociceptive Pain
  6. b) Chronic Cancer Pain
22
Q

What are the Disadvantages of Morphine?

A
  1. Constipation
  2. Respiratory Depression in High Dose
  3. Misunderstandings about Addiction
  4. Controlled Drug
23
Q

What are the Advantages / Disadvantages of Amitriptyline?

A

Advantages:

  1. Cheap / Safe in low dose
  2. Good for Neuropathic Pain
  3. Also treats Depression / Poor Sleep

Disadvantages:
1. Anti-Cholinergic Side Effects - Glaucoma / Urinary Retention

24
Q

What are the potential Delivery Routes for Medication?

A
  1. Oral
  2. Rectal
  3. Sublingual
  4. Subcutaneous
  5. Transdermal
  6. Intramuscular
  7. Intravenous
25
Q

What are the Delivery Routes for Local Anaesthetics?

A
  1. Epidural (+/- Opiates)
  2. Intrathecal (+/- Opiates)
  3. Wound Catheters
  4. Nerve Plexus Catheters
  5. Local Infiltration of Wounds
26
Q

What are the different methods of Pain Assessment?

A
  1. Verbal Rating Score
  2. Numeral Rating Score
  3. Visula Analogue Score
  4. Smiling Faces
  5. Abbey Pain Scale - for Confused Patients
27
Q

What are the Non-Drug Treatment Options?

A
  1. Physical - R.I.C.E. / Surgery / Acupuncture / Massage / Physiotherapy
  2. Psychological - Explanation / reassurance / Counselling
28
Q

How are Drug Treatments decided?

A
  1. Neuropathic Pain - use alternative Analgesics +/- Psychological and Non-Drug treatments
  2. Acute Pain - WHO Pain Ladder:
    Step 1 - Non-Opioids (Aspirin / SNAID’s / Paracetamol)
    Step 2 - Mild Opioids (Codeine) +/- Non-Opioids
    Step 3 - Strong Opioids (e.g. Morphine) +/- Non-Opioids
29
Q

What is involved in the RAT Approach to Pain?

A
  1. Recognize
  2. Assess - Severity / Type / Other Factors
  3. Treat - Non-Drug / Drug Treatments
30
Q

How is Pain Recognized?

A
  1. Ask
  2. Look - Frowning / Moving Easily / Sweating
  3. Other Know - Health Workers / Patient’s Family
31
Q

How is Pain Assessed?

A
  1. Pain Score - At Rest / With Movement
  2. How it is Affecting the Patient - Move / Cough / Work
  3. Type of Pain - Acute vs Chronic / Cancer vs Non-Cancer / Nociceptive vs Neuropathic
  4. Physical Factors - other illnesses
  5. Psycholigical / Social Factors
32
Q

How is Pain Treated with Non-Drug Methods?

A
  1. R.I.C.E.
  2. Nursing Care
  3. Surgery / Acupuncture / Massage / TENS
  4. Psychological
33
Q

How is Pain Treated with Drug Methods?

A
  1. Mild - Paracetamol (+/- NSAID’s)
  2. Moderate - Paracetamol (+/- NSAID’s) + Codeine
  3. Severe - Paracetamol (+/- NSAID’s) + Morphine

3rd Year - Specialties (13 decks)

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