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Clinical Theraputics > 6 Pain > Flashcards

6 Pain Flashcards

1
Q

Somatic pain

A

from the body or cells. often well localised

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2
Q

Neuropathic pain

A

caused by lesion or disease in the nervous system

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3
Q

Nociceptive pain

A

Normal response to noxious insult or injury

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4
Q

Somatic pain

A

from the body or cells. often well localised

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5
Q

Neuropathic pain

A

caused by lesion or disease in the nervous system

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6
Q

Nociceptive pain

A

Normal response to noxious insult or injury

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7
Q

Neuropathy

A

any neuron disorder

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8
Q

Visceral pain

A

hollow organs and smooth muscle - usually referred pain

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9
Q

Acute

A

3-6 months

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10
Q

Chronic

A

no physiological benefit. Over 3-6 months or persisting after healing

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11
Q

Surgical pain

A

acute but may progress to chronic if poorly managed

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12
Q

eg. chronic pain

A

fybromyalgia or arthritis

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13
Q

Classify: physiology

A

nociceptive, neuropathic, inflammatory

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14
Q

Classify: intensity

A

mild-moderate-severe

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15
Q

Classify: time course

A

chronic or acute

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16
Q

Classify: tissue

A

skin, muscle, visera

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17
Q

Classify: syndroms

A

cancer, migrane, fribromyalgia

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18
Q

Special considerations:

A

phsyiological state, age, gender, culture

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19
Q

Allodynia

A

pain caused by stimulus that does not usually provoke pain

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20
Q

Hyperalgesia

A

heightened response to stimuli that is not normally painful

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21
Q

Paraesthesia

A

Tingling sensation

22
Q

eg. neuropathic pain

A

diabetic neuropathy, spinal chord injury, phantom limb, post-stroke central pain, postherpetic neuralgia

23
Q

Postherpetic neuralgia

A

Nerve pain after shingles rash has cleared

24
Q

Inflammatory pain

A

a result of activation and sensitisation of mociceptive pain pathway

25
Key inflamnatory mediators
TNF, IL-6, IL-1, , ROI...
26
eg. of inflammatory pain
appendicitis, RA, inflammatory bowel disease, shingles
27
Cancer pain classifications
nerve, bone, soft tissue ,phantom pain, reffered pain
28
Reffered pain
Pain felt in a different part of the body. eg. swollen liver pressing nerves resulting in shoulder pain
29
Phantom pain
from part of body that has been removed eg. leg or breast
30
Possible causes of phantom pain
brain can't understand removal. poor pain control after surgery
31
Soft-tissue
from organ or muscle. eg. back pain from kidney damage
32
Fibromyalgia
Chronic condition. Increase in substance P in CSF, less5HT, NA, dopamine
33
Non-pharmacological pain treatements
Balneotherapy (hot pool), +- exercise, CBT, Massage.relaxation techniques
34
Acute-on-chronic
acute pain flare on underlying chronic
35
Break Through Pain
Transient increase in pain in pt with stable pain treated with opioids
36
1st line BTP
Oramorph
37
Other treatments for BTP
Fentanyl, (consider: intolerant to morphine, no swallow, rapid onset & short duration)
38
Assessment scales
Numerical rating 0to10, Visual recognition - faces, McGill pain questionnaire - words from list(e.g. throbbing, sharp)
39
Assessment for non-english speakers
British Pain Society website
40
Patient expectations should be discussed
relief at night?pain free at rest?pain free on movement?
41
Correct use conciderations
oral, regular intervals, evaluation, adapt dosing to individual
42
Choosing conciderations
Safe & effective, Route of admin (formulations avail?), Co-morbidities.interactions, Dose equivalence when changing
43
Oramorph dose
tenth to sixth daily dose
44
Diclofenac
Cardiovascular side-effects
45
Ideal NNT
1
46
Transient morphine s.e
nausea & vomiting
47
Non-transient morphine s.e
constipation, respiratory depression
48
Chronic pain - other treatment
psychological factors,TENs, acupuncture, massage, spinal chord, manipulation, nerve blocks, abalative brain surgery
49
Vicious cycle of chronic pain
Pain -loss of sleep -increased muscle tension-anxiety and depression-pain
50
Neuropathic pain polypharmacy
1st TCA or gabapentinoids, 2nd topicals, 3rd opioids (tramadol or stronger)

Clinical Theraputics (14 decks)

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