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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
Q

What class of drug is tramadol?

A

5HT/NA reuptake inhibitor

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26
Q

Example of an antidepressant

A

amitriptyline

duloxetine

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27
Q

Gabapentin is what class of drug?

A

anticonvulsant

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28
Q

Give an example of a topical agent analgesic

A

capsaicin

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29
Q

Non drug treatments for periphery pain

A

RICE

30
Q

Drug treatments for periphery

A

NSAIDs

LA

31
Q

Non drug treatment for spinal cord

A

acupuncture
TENS
massage

32
Q

Drug treatments for spinal cord

A

LA
opioids
ketamine

33
Q

Non drug treatments for the brain

A

psychological

34
Q

Drug treatments for the brain

A

paracetamol
opioids
amitriptyline
clonidine

35
Q

Advantages of paracetamol

A

cheap
safe
can be given oral/rectal/IV

36
Q

What is paracetamol good for?

A

mild pain by itself

mod-severe pain with other drugs

37
Q

Disadvantages of paracetamol

A

Liver damage in overdose

38
Q

Examples of NSAIDs

A

aspirin, ibuprofen, diclofenac

39
Q

Advantages of NSAIDs

A

cheap
generally safe
good for nociceptive pain

40
Q

Disadvantage of NSAIDs

A

GI/Renal side effects

sensitive asthmatics

41
Q

Advantages of codeine

A

cheap, safe

mild-mod acute nociceptive pain

42
Q

Disadvantages of codeine

A

constipation
nausea, sedation
late respiratory depression
not good for chronic pain

43
Q

Advantages of tramadol

A

less respiratory depression
can be used with opioids and simple analgesics
not a controlled drug

44
Q

Disadvantages of tramadol

A

nausea and vomiting

45
Q

Advantages of morphine

A

cheap, generally safe
oral/IV/IM/SC
effective if given regularly

46
Q

What pain is morphine good for?

A

acute nociceptive pain

chronic cancer pain

47
Q

Disadvantages of morphine

A

constipation
respiratory depression in high dose
addiction
controlled drug

48
Q

Oral dose is how many times the IV/IM/SC dose for morphine?

A

2-3

49
Q

Amitriptyline class and how it works

A

TCA

increases descending inhibitory signals

50
Q

Advantages of amitryptiline

A

cheap, safe in low dose
good for neuropathic pain
also treats depression, poor sleep

51
Q

Disadvantages of amitriptyline

A

anti-cholinergic side effects

eg glaucoma, urinary retention

52
Q

3 anticonvulsant drugs

A

sodium valproate
gabapentin
carbamazepine

53
Q

Anti convulsant drugs how they work and what pain they are good for

A

membrane stabilisers - reduce abnormal firing of nerves

neuropathic pain

54
Q

Delivery routes

A 
oral 
rectal 
IV 
IM 
SC 
sublingual 
transdermal
55
Q

Delivery routes for LA

A 
epidural 
intrathecal 
wound catheters 
nerve plexus catheters 
local infiltration of wounds
56
Q

5 ways for pain assessment

A 
verbal rating score 
numerical rating score 
visual analogue scale 
smiling faces 
abbey pain scale
57
Q

Who is the abbey pain scale used on?

A

confused patients

58
Q

Non drug treatments

A

RICE
surgery
acupuncture, physio
counselling, reassurance

59
Q

WHO pain ladder - what pain?

A

acute nociceptive

60
Q

step 1 - WHO ladder

A

non opioids - aspirin, NSAID or paracetamol

61
Q

Step 2 - WHO ladder

A

mild opioids eg codeine with or without non-opiates

62
Q

Step 3 - WHO ladder

A

strong opioids eg morphine with or without non-opioids

63
Q

Stop NSAIDs or paracetamol first and why?

A

NSAIDs as more adverse effects

64
Q

RAT approach to pain

A

Recognise
assess
treat

65
Q

Recognising pain

A

ask and look

patients family and other healthcare workers know?

66
Q

Assessing severity of pain

A

pain score - rest and moving

pain affect patient? eg cough and working

67
Q

Neuropathic features

A

burning or shooting pain
phantom limb pain
pins and needles, numb

68
Q

Assessment of pain

A

severity
type
other factors

69
Q

Assessing pain - other factors

A

physical and psychological

70
Q

What do we do after RAT?

A

reassess the patient

Year 3 specialities (JK) (16 decks)

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