Anaesthetics - pain Flashcards
What are health benefits to the patient for treating pain?
Improved sleep, better appetite
Fewer medical complications ie MI
reduced suffering
Less depression/anxiety
What are benefits to the family of the patient if we treat pain?
Improved functioning as a family member (mother/father)
Able to keep working
What are societal benefits to treating the patient’s pain?
Lower health costs - shorter hospital stay
Able to contribute to the community
How is pain classified in terms of duration?
Acute
Chronic
Acute on Chronic
How is pain classified in terms of cause?
Cancer
Non-cancer
How is pain classified in terms of mechanism?
Nociceptive
Neuropathic
What is nociceptive pain?
Obvious tissue injury or damage - physiological pain
How would nociceptive pain be described?
Sharp/dull
Well localised
What is neuropathic pain?
Nervous system damage or abnormality
How would neuropathic pain be described?
Burning, shooting, numbness, pins and needles
Not well localised
What are pathological mechanisms for neuropathic pain?
Increased receptor numbers
Abnormal sensitisation of nerves - peripheral or central
Chemical change in dorsal horn
Loss of normal inhibitory modulation
What are simple analgesics?
Paracetamol
NSAIDs
What are examples of mild opioids?
Codeine
Dihydrocodeine
What are examples of strong opioids?
Morphine
Oxycodone
Fentanyl
How is pain treated at the periphery?
Non drug treatments - Rest, ice, compression, elevation
NSAIDs
Local anaesthetics
How is pain treated at the spinal cord?
Non drug treatments - Acupuncture, massage, TENS
Local anaesthetic
Opioids
Ketamine
How is pain treated at the brain?
Psychological treatment Paracetamol Opioids Amitriptyline Clonidine
What are advantages to paracetamol use?
Cheap and safe
Can be given orally, rectally, IV
Good for mild pain or moderate-severe pain if used with other drugs
What is the main disadvantage of paracetamol?
Liver damage in overdose
What are advantages of NSAIDs?
Cheap and generally safe
Good for nociceptive pain
What are disadvantages of NSAIDs?
GI and renal side effects
Bronchospasm in sensitive asthmatics
What are advantages of codeine?
Cheap and safe
Good for acute nociceptive pain
What are disadvantages of codeine?
Constipation
Not good for chronic pain
What are advantages of tramadol?
Less respiratory depression than other opiates
Used with opioids and simple analgesics
Not a controlled drug
What is the main disadvantage of tramadol?
Nausea and vomiting
What are advantages to using morphine?
Cheap and generally safe
Can be given orally, IV, IM, SC
Effective if given regularly
Good for severe acute nociceptive pain and chronic cancer pain
What are disadvantages of morphine?
Constipation
Respiratory depression in high dose
Misunderstandings about addiction
Controlled drug
What type of drug is amitriptyline?
Tricyclic antidepressant
What are advantages to amitriptyline?
Cheap and safe in low doses
Good for neuropathic pain
Treats depression and poor sleep
What is the main disadvantage of amitriptyline?
Anti-cholinergic side effects
What is the RAT approach to pain management?
Recognise
Assess
Treat
How can you recognise patient pain?
Ask the patient
Look at the patient - frowning, restricted movement, etc
Ask people who know the patient
How is pain assessed?
Find out pain score at rest and during movement
Is the patient restricted in movement
Pain classification
What should be done after RAT?
Reassess patient - Is treatment working and are other treatments needed?
