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Year 3 specialities (JK) > Anaesthetics - pain > Flashcards

Anaesthetics - pain Flashcards

1
Q

Pain definition

A

unpleasant sensory and emotional experience

actual or potential tissue damage

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2
Q

Why bother to treat pain?

A

1 in 4 have persistent pain
QOL, years lost to disability (back pain)
basic human right

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3
Q

Benefits of treating pain - patient

A

physical: increased sleep and appetite, fewer medical conditions
Psychological: decreased suffering, depression, anxiety

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4
Q

Benefits of treating pain - family

A

improved functioning as family member, working

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5
Q

Benefits of treating pain - society

A

lower health costs and contribute to community

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6
Q

Classifying pain - 3 main categories

A

duration
cause
mechanism

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7
Q

classifying pain - duration

A

acute, chronic, acute on chronic

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8
Q

Classifying pain - cause

A

cancer or non-cancer

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9
Q

Classifying pain - mechanism

A

nociceptive or neuropathic

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10
Q

Acute and chronic pain

A

acute - recent onset and probable limited duration

chronic more than 3 months

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11
Q

Cancer pain

A

cancer pain is progressive, acute on chronic

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12
Q

nociceptive pain characteristics

A

obvious tissue injury or illness
protective function
physiological or inflammatory pain
sharp+/- dull, well localised

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13
Q

Neuropathic pain characteristics

A

nervous system damage or abnormality

burning, shooting, numb, pins and needles, not well localised

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14
Q

Pain physiology - periphery

A

tissue damage leads to stimulating nociceptors

A delta and C fibres to spinal cord

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15
Q

1st relay station of pain

A

dorsal horn

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16
Q

Tract for pain

A

spinothalamic

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17
Q

2nd relay station

A

thalamus

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18
Q

What parts of the brain does the thalamus connect to?

A

cortex
limbic system
brainstem

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19
Q

What part of the brain perceives pain?

A

cortex

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20
Q

Modulation of pain

A

descending inhibitory pathways from brain to dorsal horn

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21
Q

Pathology of neuropathic pain and examples

A

abnormal processing of pain signal
nervous system damage or dysfunction
eg nerve trauma, diabetes, fibromyalgia, chronic tension headache

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22
Q

The biological changes in neuropathic pain

A

increased receptor number
abnormal sensitisation of nerves
chemical changes in dorsal horn
loss of normal inhibitory modulation

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23
Q

Simple analgesics

A

paracetamol and NSAIDs

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24
Q

Examples of opioids

A

morphine, codeine, fentanyl

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25
What class of drug is tramadol?
5HT/NA reuptake inhibitor
26
Example of an antidepressant
amitriptyline | duloxetine
27
Gabapentin is what class of drug?
anticonvulsant
28
Give an example of a topical agent analgesic
capsaicin
29
Non drug treatments for periphery pain
RICE
30
Drug treatments for periphery
NSAIDs | LA
31
Non drug treatment for spinal cord
acupuncture TENS massage
32
Drug treatments for spinal cord
LA opioids ketamine
33
Non drug treatments for the brain
psychological
34
Drug treatments for the brain
paracetamol opioids amitriptyline clonidine
35
Advantages of paracetamol
cheap safe can be given oral/rectal/IV
36
What is paracetamol good for?
mild pain by itself | mod-severe pain with other drugs
37
Disadvantages of paracetamol
Liver damage in overdose
38
Examples of NSAIDs
aspirin, ibuprofen, diclofenac
39
Advantages of NSAIDs
cheap generally safe good for nociceptive pain
40
Disadvantage of NSAIDs
GI/Renal side effects | sensitive asthmatics
41
Advantages of codeine
cheap, safe | mild-mod acute nociceptive pain
42
Disadvantages of codeine
constipation nausea, sedation late respiratory depression not good for chronic pain
43
Advantages of tramadol
less respiratory depression can be used with opioids and simple analgesics not a controlled drug
44
Disadvantages of tramadol
nausea and vomiting
45
Advantages of morphine
cheap, generally safe oral/IV/IM/SC effective if given regularly
46
What pain is morphine good for?
acute nociceptive pain | chronic cancer pain
47
Disadvantages of morphine
constipation respiratory depression in high dose addiction controlled drug
48
Oral dose is how many times the IV/IM/SC dose for morphine?
2-3
49
Amitriptyline class and how it works
TCA | increases descending inhibitory signals
50
Advantages of amitryptiline
cheap, safe in low dose good for neuropathic pain also treats depression, poor sleep
51
Disadvantages of amitriptyline
anti-cholinergic side effects | eg glaucoma, urinary retention
52
3 anticonvulsant drugs
sodium valproate gabapentin carbamazepine
53
Anti convulsant drugs how they work and what pain they are good for
membrane stabilisers - reduce abnormal firing of nerves | neuropathic pain
54
Delivery routes
``` oral rectal IV IM SC sublingual transdermal ```
55
Delivery routes for LA
``` epidural intrathecal wound catheters nerve plexus catheters local infiltration of wounds ```
56
5 ways for pain assessment
``` verbal rating score numerical rating score visual analogue scale smiling faces abbey pain scale ```
57
Who is the abbey pain scale used on?
confused patients
58
Non drug treatments
RICE surgery acupuncture, physio counselling, reassurance
59
WHO pain ladder - what pain?
acute nociceptive
60
step 1 - WHO ladder
non opioids - aspirin, NSAID or paracetamol
61
Step 2 - WHO ladder
mild opioids eg codeine with or without non-opiates
62
Step 3 - WHO ladder
strong opioids eg morphine with or without non-opioids
63
Stop NSAIDs or paracetamol first and why?
NSAIDs as more adverse effects
64
RAT approach to pain
Recognise assess treat
65
Recognising pain
ask and look | patients family and other healthcare workers know?
66
Assessing severity of pain
pain score - rest and moving | pain affect patient? eg cough and working
67
Neuropathic features
burning or shooting pain phantom limb pain pins and needles, numb
68
Assessment of pain
severity type other factors
69
Assessing pain - other factors
physical and psychological
70
What do we do after RAT?
reassess the patient

Year 3 specialities (JK) (16 decks)

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