Acute & Chronic Pain Flashcards
Describe the features of acute pain.
Usually obvious tissue damage
Pain resolves upon healing
Serves a protective function
Describe the features of chronic pain.
Pain for 3-6 months or more
Beyond expected period of healing
No protective function, degrades health and function
Give examples of severe acute pain dealt with in secondary care.
Trauma/burns Myocardial infarction Kidney stones Childbirth Post-operative pain Sickle cell crisis
Describe the assessment for acute pain.
Where is the pain
Consider colloquial terms, i.e. stomach could be anywhere on the chest/abdomen
Intensity
Aggravation
Other symptoms
Co-morbidities
Other medications including those already tried for pain control
What is SOCRATES?
Site Onset Character Radiation Associations Time course Exacerbating/relieving factors Severity
Describe the 5 steps to managing mild-moderate acute pain.
- Paracetamol
- Substitute for ibuprofen
- Add paracetamol to ibuprofen
- Substitute ibuprofen for naproxen, keep paracetamol
- Weak opioid with paracetamol (with or without NSAID)
Red flags in joint pain.
Deformity associated with pain
Too painful to move/cannot bear weight
Severe swelling, discolouration, bleeding or hot to touch
Persistent joint pain, tenderness or swelling
Prolonged or severe morning stiffness
Feeling unwell
Tingling/numbness
Child’s dosing of paracetamol
3 months-12 years.
3-6 months- 2.5ml of infant suspension
6-24 months- 5ml of infant suspension
2-4 years- 7.5ml of infant suspension
4-6 years- 10ml of infant suspension
6-8 years- 5ml of paracetamol 6 plus suspension
8-10 years- 7.5ml of paracetamol 6 plus suspension
10-12 years- 10ml of paracetamol 6 plus suspension
Adult weight related maximum dosing of paracetamol.
Maximum 4g daily if >50kg
Maximum 3g if 40-49kg
Maximum 2g if under 40kg
Give 5 commonly used opioids in acute pain with their formulations.
Codeine oral or IM Tramadol oral, IV or IM Morphine oral, PR, IV or IM Oxycodone oral or IV Fentanyl IV, buccal, sublingual or nasal
Describe use of patient controlled analgesia.
Most effective 24-48 hours after an acute pain episode
Self-administration of a small IV bolus opioid dose
Have a predetermined ‘lockout’ period that doesn’t change (5 minutes)
Usually morphine, fentanyl or oxycodone
Usually set up by anaesthetic staff in recovery
Reduced risk of sedation and respiratory depression
All patients should have paracetamol and NSAID, if suitable, alongside PCA
Describe process of stepping down from PCA,
Usually onto oral opioid such as morphine or oxycodone
Weak opioid may be given if use has been low
Starting dose should consider PCA use over last 24 hours i.e. 30mg IV PCA morphine equivalent to 5-10mg oral morphine every 3 hours
Dose may still need to be titrated to effect
Adjuncts should be used where appropriate, opioids sparing effects
Describe the use of epidurals.
Used in childbirth or as infusions after major surgical procedures
Form of regional anaesthesia with drugs delivered via catheter directly into epidural space
Use combination of local anaesthetic and strong opioid- Levobupivicaine 0.125% and fentanyl 2mcg/ml
Infusion rate dependent on position of epidural, pain score and clinical observations
Patients able to mobilise with infusion in-situ
Give side effects of an epidural.
Itching N+V Drowsiness Respiratory depression Urinary retention Hypotension Bradycardia Headache (dural puncture) Motor block, monitored with essam (arms) or broomage (lower limb) scores
Give 4 alternative managements of acute pain and their uses.
LA infusions- acute post op pain or trauma
Transversus abdominis plane (TAP) block- newer technique in abdominal surgery
Ketamine infusion- difficult pain cases, both hypnotic and amnesic
Entonox (nitrous oxide)- used in childbirth, wound dressings and joint manipulations
