Anaesthetics - Pain Management

Question 1

Benefits of pain management

Answer 1

• Physical → improvement of sleep, appetite and fewer complications
• Psychological → reduced suffering, depression. and anxiety
• Family → improved functioning as a family and ability to work
• Social → lower health costs, shorter hospital stays

Question 2

How can pain be classified

Answer 2

• Acute or chronic pain
• Causes → cancer or non-cancerous
  
  • Mechanism → nociceptive or neuropathic

Question 3

Acute vs chronic pain

Answer 3

• Acute → pain of recent onset and probable limited duration
• Chronic
  
  • Pain longer than 3 months
  • Pain lasting after normal healing
    
    • No identifiable cause

Question 4

Define nociceptive pain

Answer 4

• Obvious tissue injury/ illness
• AKA physiological/ inflammatory pain
• Protective function
  
  • Sharp or dull → well localised

Question 5

Define neuropathic pain

Answer 5

• Nervous system damage or abnormality
• No protective function
• Burning, shoot, numbness, pins and needles, poorly localised

Question 6

4 steps of pain transmission

Answer 6

Peripheries → spinal cord → brain → modulation

Question 7

4 steps of pain transmission

Answer 7

Peripheries → spinal cord → brain → modulation

Question 8

What is the function of pain modulation

Answer 8

• Descending pathway from the brain to the dorsal horn
  
  • Usually decreases pain signalling

Question 9

Why does neuropathic pain need to be treated differently

Answer 9

• Abnormal processing of pain signal
• Damage to the nervous system
• Conventional analgesics don’t work

Question 10

Examples of neuropathic pain

Answer 10

• Nerve trauma
• Neuropathic pain
• Fibromyalgia
• Chronic tension headache

Question 11

2 main types of analgesics

Answer 11

• Simple analgesics → NSAIDS, paracetamol
• Opioids → codeine, morphine, oxycodone, fentanyl

Question 12

Management of pain localised to peripheries

Answer 12

• Non-drug -→ Rest, ice, compression, elevation
  
  • NSAIDS and local anaesthetics

Question 13

Management of spinal cord localised pain

Answer 13

• Non-drug → acupuncture, massage, TENS
• Local anaesthetic
• Opioid
• Ketamine

Question 14

Management of pain localised to the brain

Answer 14

• Psychological therapies
  
  • Drug → paracetamol, opioids, amitryptiline and clonidine

Question 15

How can pain be assessed

Answer 15

• Verbal rating score
• Numerical rating score
• Visual analogue scale
• Smiling faces
• Abbey pain scale → confused patients

Question 16

WHO pain ladder

Answer 16

• Mild/ moderate → non-opioids (NSAIDS, paracetamol)
• Moderate to severe → mild opioids with/ without non-opioids
• Severe → strong opioids (morphine)

Question 17

RAT approach to pain

Answer 17

• Recognise, assess, treat
• Recognise → does the persona have pain
• Assess
  
  • Severity, type, other factors
  • At rest
  • With movement
  • Functional effect
  • Neuropathic features
  • Physical, psychological, social factors
• Treat
  
  • RICE
  • Nursing care
  • Surgery, acupuncture, massage, TENS

Question 18

Drugs for neuropathic pain

Answer 18

• Amitriptylline
• Gabapentin
• Duloxetine