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3rd Year Medical Specialties > Anaesthetics - Pain > Flashcards

Anaesthetics - Pain Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the benefits of treating pain?

A

Physical - improved sleep, appetite, fewer complications
Psychological - Reduced depression, anxiety
Family - functioning
Society - Lower health costs

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2
Q

What are the classifications of pain?

A

Duration - acute/chronic
Cause - cancer/non-cancer
Mechanism - nociceptive/neuropathic

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3
Q

What is nociceptive pain?

A

Obvious injury/illness
Physiological or inflammatory
Protective function
Sharp, well localised

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4
Q

What is neuropathic pain?

A 
NS damage/abnormality 
Not obvious tissue injury 
Not protective 
Burning/shooting + numbness
Not well localised
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5
Q

What are the steps in pain physiology?

A

Periphery
Spinal cord
Brain
Modulation

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6
Q

What is the function of the periphery in pain?

A

Tissue injury
Release of chemicals (prostaglandins, substance P)
Stimulates pain receptors
Adelta and C fibres to spinal cord

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7
Q

What is the function of the spinal cord in pain?

A

Second nerve travels up opposite side of cord

Dorsal horn is first relay station

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8
Q

What is the function of the brain in pain?

A

Thalamus is second relay station

Pain perception in cortex

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9
Q

What is the function of modulation in pain?

A

“Gate theory”
Descending pathway
from brain -> dorsal horn
Usually decreases the signal

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10
Q

What are the mechanisms for neuropathic pain?

A

Increased receptors
Abnormal nerve sensitisation
Chemical changes in dorsal horn
Loss of normal inhibitory modulation

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11
Q

What are the simple analgesics?

A

Paracetamol

NSAIDs

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12
Q

What are the opioids?

A

Mild - Codeine

Strong - Morphine, Fentanyl

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13
Q

Name some other drugs for analgesia not simple/opioid?

A 
Tramadol
Nefopam
Antidepressants
Anticonvulsants 
Ketamine
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14
Q

What pain treatments affect pain in the peripheral step?

A

RICE
NSAIDs
Local anaesthetics

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15
Q

What pain treatments affect pain in the spinal cord step?

A

TENS
Local anaesthetic
Opioids
Ketamine

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16
Q

What pain treatments affect pain in the brain step?

A 
Psychological therapy
Paracetamol
Opioids
Amitriptyline
Clonidine
17
Q

What are the advantages/disadvantages of paracetamol?

A

Adv: Cheap, safe, oral/rectal/IV
Dis: Liver damage in overdose

18
Q

What are the advantages/disadvantages of NSAIDs?

A

Adv: Cheap + safe, nociceptive pain (+paracetamol)
Dis: GI/Renal/Bronchospasm

19
Q

What are the advantages/disadvantages of Codeine?

A

Adv: Cheap, mild/moderate
Dis: Constipation, no use in chronic pain

20
Q

What are the advantages/disadvantages of Tramadol?

A

Adv: less resp depression, used with analgesics
Dis: N+V

21
Q

What are the advantages/disadvantages of morphine?

A

Adv: Cheap, safe, multi-routes
Good for chronic and severe acute pain
Dis: Constipation, resp depression, addiction

22
Q

What are the advantages/disadvantages of amitriptyline?

A

Adv: cheap, safe, neuropathic pain, depression
Dis: Anti-cholinergic sides (glaucoma, urinary retention)

23
Q

What are the advantages/disadvantages of anticonvulsant drugs for pain?

A

Adv: Neuropathic pain

24
Q

Which anticonvulsants are used as pain med?

A

Carbamazepine
Sodium valproate
Gabapentin

25
Q

What is the RAT approach to pain?

A

Recognise
Assess - severity, type
Treat - Drug/non-drug

26
Q

How do you Recognise pain?

A

Ask patient
Look at patient
Ask people who know them

27
Q

What are the pain assessment scores?

A 
Verbal rating
Numerical rating
Visual analogue 
Smiling faces 
Abbey pain scale
Functional pain
28
Q

What pain scale is used in confused patients?

A

Abbey pain scale

29
Q

How is pain assessed?

A 
Pain score (at rest vs movement) 
How is pain affecting the patient
30
Q

How do you assess pain type?

A

Acute or Chronic
Cancer or non-cancer
Nociceptive or neuropathic

31
Q

What are the non-drug treatments for pain?

A

RICE
Nursing care
Surgery, TENS
Psychological

32
Q

Outline the WHO pain ladder?

A 
Mild = Paracetamol (+NSAIDs)
Moderate = Paracetamol (+NSAIDs) + codeine/alternative
Severe = Paracetamol (+NSAIDs) + morphine
33
Q

How is neuropathic pain managed?

A

Don’t use WHO ladder
Other drugs
Non-drug treatments

3rd Year Medical Specialties (18 decks)

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