2: Pain management Flashcards
What is pain?
Unpleasant sensory or emotional experience
Associated with actual tissue damage OR described in terms of it
Different individuals have different ___ to pain.
sensitivities
What is the function of pain?
Protective
Stops you from exposing yourself to dangerous stimuli
When does acute pain resolve?
Once healing has occurred
Chronic pain is (adaptive / maladaptive).
maladaptive
i.e there’s no point to it
How is pain measured?
Why is this problematic?
Scales / ratings
Pain is subjective, different people have different sensitivities
What are physiological responses to pain?
Hypertension
Tachycardia
___ and ___ are physiological responses to pain.
(brady/tachycardia, hypo/hypertension)
Tachycardia
Hypertension
Patients must be allowed to ___-___ the severity of their pain.
self-report
Which brain structures receive nociceptive signals?
Amygdala
Hypothalamus
Thalamus
Which brain structures are responsible for
a) attention
b) sensation
in response to nociceptive signals?
a) Amygdala and hypothalamus
b) Thalamus (spinothalamic tract, to post-central gyrus i.e sensory strip)
What is nociceptive pain?
Appropriate response to painful stimuli by an intact nervous system
What is neuropathic pain?
Inappropriate response to stimuli by a dysfunctional nervous system
What history should you take from anyone complaining of pain?
SOCRATES
Allodynia and hyperalgesia are types of neuropathic pain.
What do these words mean?
Allodynia - pain in response to non-painful stimuli e.g cotton wool
Hyperalgesia - exaggerated pain in response to a painful stimulus e.g pin prick
What is a chronic pain condition often seen after shingles?
Post-herpetic neuralgia
What is a chronic pain condition sometimes seen after back surgery?
Failed back syndrome
Which endocrine disease causes peripheral neuropathy, of which chronic pain can be a symptom?
Diabetes
What is phantom pain?
Chronic pain in amputees, felt where the limb should be
Which pathway should be used when managing pain conditions?
WHO pain ladder
What are some examples of non-opioid drugs used to manage low grade pain?
Aspirin, Ibuprofen, Naproxen, Diclofenac (i.e NSAIDs, which act on cycloxygenase 1, lots of side effects)
Paracetamol
Name three examples of NSAIDs.
Which enzyme do they inhibit?
Which inflammatory mediator does this action affect?
Aspirin, ibuprofen, diclofenac, naproxen, indomethacin
COX (cyclo-oxygenase 1 or 2, depends on the drug)
Prostaglandin (so NSAIDs dampen down inflammation)
What are some of the side-effects of NSAIDs?
Peptic ulceration
Renal toxicity
(COX-2 inhibitors, -coxibs, have cardiovascular side effects)
What is an important side effect of paracetamol?
Hepatotoxicity
ESPECIALLY with alcohol
