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Year 3 > Anaesthetics Pain > Flashcards

Anaesthetics Pain Flashcards

1
Q

what are the patient benefits for treating pain?

A

physical - better sleep and appetite
fewer medical complications
psychological - reduced suffering, less depression and anxiety

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2
Q

what are the family benefits for treating pain?

A

improved functioning as a family member

able to keep working

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3
Q

what are the societal benefits for treating pain?

A

lower health costs

able to contribute to community

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4
Q

how can you classify pain?

A

duration - acute/chronic/acute on chronic
cause - cancer/non-cancer
mechanism - nociceptive/neuropathic

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5
Q

compare acute and chronic pain

A

Acute - recent onsent, probably limited duration

Chronic - lasts > 3 months, beyond normal healing, no identifiable cause

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6
Q

compare nociceptive and neuropathic pain

A

In nociceptive pain there is obvious tissue injury or illness. It is also called physiological or inflammatory pain. Nociceptive pain serves a protective function. This type of pain is sharp or dull and well localised.

Neuropathic pain results from nervous system damage or abnormality. Tissue injury may not be obvious. Neuropathic pain does not serve a protective function. This type of pain may be described as: burning, shooting ± numbness, pins and needles. It is not well localised.

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7
Q

what are the 4 steps of pain physiology?

A

periphery
spinal cord
brain
modulation

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8
Q

describe the periphery part of pain physiology

A
  • Tissue injury
  • Release of chemicals e.g. PGs, substance P
  • Stimulation of nociceptors
  • Signal travels in A𝛿 or C nerve to spinal cord•
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9
Q

describe the spinal cord part of pain physiology

A
  • Dorsal horn is the first relay station
  • A𝛿 or C nerve synapses with second nerve
  • Second nerve travels up on contralateral side of spinal cord
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10
Q

describe the brain part of pain physiology

A 
• Thalamus is the second relay station
• Connections to many parts of the brain
o Cortex – expecting it to hurt
o Limbic system
o Brainstem – pain response
• Pain perception occurs in the cortex
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11
Q

describe the modulation part of pain physiology

A
  • Descending pathway from brain to dorsal horn
  • Usually decreases pain signal
  • People who do this more effectively experience less pain
  • Serotonin and dopamine reuptake
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12
Q

how does neuropathic pain come about. give examples of it

A 
• Abnormal processing of pain signal
• Nervous system damage or dysfunction
• Needs to be treated differently
• Examples
o Nerve trauma, diabetic pain (damage)
o Fibromyalgia, chronic tension headache (dysfunction)
• Common after thoracic surgery
o Intercostal nerves pulling and retraction
• Breast surgery
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13
Q

examples of simple analgesics

A

paracetamol

NSAIDs

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14
Q

examples of mild opioids

A

codeine, dihydrocodeine

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15
Q

examples of strong opioids

A

morphine, oxycodone, fentanyl

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16
Q

what other drugs (classes) can be used to treat pain?

A 
tramadol
antidepressants - amitriptyline, duloxetine
anticonvulsants - gabapentin
ketamine
local anaesthetics
topical agents - capsaicin
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17
Q

what class of drug is tramadol?

A

mixed opiate and 5HT/NA reuptake inhibitor

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18
Q

what class of drug is ketamine?

A

NMDA receptor antagonist

19
Q

treatments for periphery pain causes

A

non-drug RICE
NSAIDS
local anaesthetics

20
Q

treatments for spinal cord pain causes

A

non-drug acupuncture, massage, TENS
local anaesthetics
opioids
ketamine

21
Q

treatments for brain pain causes

A 
non-drug psychological, CBT
paracetamol
opioids
amitriptyline
clonidine
22
Q

describe paracetamol

A 
• Cheap, safe
• Oral, IV, rectal
• Good for
o Mild pain – alone
o Mod-severe pain – in combination
• Liver damage in overdose
23
Q

give examples of NSAIDs

A

aspirin
ibuprofen
diclofenac

24
Q

what are NSAIDs useful for?

A

nociceptive pain give with paracetamol

25
Q

why must NSAIDs be used with care in asthmatics?

A

o Prostaglandin synthase inhibitor can go down into prostacyclin cycle resulting in wheeze
o Can push into status asthmaticus (rare) but if on lots of nebs etc don’t

26
Q

what kind of pain is codeine useful for

A

mild-moderate acute nociceptive pain best with paracetamol

27
Q

what are the side effects of codeine?

A

constipation

nausea

28
Q

what is codeine not good for?

A

chronic pain

29
Q

describe tramadol

A
  • Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake
  • Less respiratory depression
  • Can be used with opioids and simple analgesics
  • Controlled drug
  • N+V
30
Q

describe morphine

A 
• Cheap, generally safe
• Oral, IV, IM, SC
• Effective if given regularly
• Good for
o Mod-severe active nociceptive pain e.g. post-op
o Chronic cancer pain
• Constipation
• Respiratory depression in high dose
• Misunderstandings about addiction – possibility but if taking for pain and stop then unlikely
to be an issue
• Controlled drug
• Oral dose is 2-3 times IV/IM/SC dose
31
Q

what class of drug is amitriptyline?

A

TCA

32
Q

what does amitriptyline do?

A

increases descending inhibitory signals

33
Q

what kind of pain is amitriptyline good for?

A

neuropathic pain

34
Q

apart from pain what does amitriptyline also treat?

A

depression

poor sleep

35
Q

side effects of amitriptyline

A

Anti-cholinergic
glucoma
urinary retention

36
Q

Give examples of anticonvulsant drugs used for pain

A 
o Carbamazepine (tegretol)
o Sodium valproate (Epilim)
o Gabapentin (Neurontin)
37
Q

what do anticonvulsant drugs do in regards to pain?

A

reduce abnormal firing of nerves

38
Q

what kind of pain are anticonvulsant drugs good for?

A

neuropathic

39
Q

how can pain be assessed?

A
  • Verbal rating score
  • Numerical rating score – doesn’t really equate to anything
  • Visual analogue scale
  • Smiling faces
  • Abbey pain scale (for confused patients)
40
Q

physical non drug treatments for pain

A

RICE
surgery
acupuncture, massage, physiotherapy
positioning

41
Q

psychological non drug treatments for pain

A

explanation
reassurance
counselling

42
Q

describe the WHO pain ladder

A

see notes

43
Q

describe the RAT approach to pain management

A 
• Recognise
o Ask
o Look (frowning, moving easily, sweating)
o Do other people know the patient has pain: health workers, family
• Assess
o Severity
§ Pain score at rest and moving
§ How is it affecting the patient – move, cough, work
o Type
§ Acute vs chronic
§ Cancer vs non-cancer
§ Nociceptive vs neuropathic
o Other factors
§ Physical factors (other illnesses)
§ Psychological and social factors
• Anger, anxiety, depression
• Lack of social supports
• Treat
o Non-drugs
§ RICE
§ Nursing care
§ Surgery, acupuncture, massage, TENS etc
§ Psychological – explanation and reassurance, input from social worker/pastor
o Drugs

Year 3 (164 decks)

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