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Anaesthetics Pain management Flashcards

1
Q

What characteristics do we use to categorise pain?

A

Duration
Cause
Mechanism

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2
Q

When does acute pain become chronic?

A

IF it lasts for >3 months, after normal healing and/or has no identifiable cause

Pain can also be acute-on-chronic

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3
Q

What are the mechanisms of pain?

A

Nociceptive:

  • Obvious injury
  • Sharp or dull
  • well localised

Neuropathic:

  • Nerve damage or NS dysfunction
  • Burning, shooting, numbess or Pins/needles
  • Not well localised
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4
Q

What types of analgesics do we have?

A

Simple analgesics (PCM &NSAIDS)
Opiods
Others

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5
Q

What are the pros and cons of paracetamol /NSAIDs

A
  • Cheap and safe.
  • PCM can be given orally, rectally or IV
  • PCM can lead to liver damage if overdose is given
  • NSAIDs are synergistic with PCM but come with GI, renal and asthmatic side effects
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6
Q

Give an example of mild and strong opioids?

A

Mild - Codeine or Dihydrocodeine

Strong - Morphine/ hydrocodone

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7
Q

Opioids can be compined with PCM and are mostly cheap and safe. What are their cons?

A

Constipation
Respiratory depression (mostly stronger ones)
Not good for chronic pain

Strong opioids are controlled so can be practically more difficult to deliver

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8
Q

What’s included in the “Other analgesics” category?

A
  • Tramadol
  • TriCyclic Antidepressant e.g. Amitriptyline
  • Anti-convulsants e.g. Gabapentin or NaValproate
  • Ketamine
  • LA
  • Topical agents e.g. Capsaicin cream
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9
Q

How do TCAs help with pain?

A

Increase modulatory effect of desc inhibitory pathways.
This makes them good for neuropathic pain
They also help with sleep problems and depression

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10
Q

How do Anti-convulsants help with pain?

A

Reduce abnormal firing of nerves which is good for neuropathic pain

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11
Q

How do we treat pain non-pharmacologically?

A

RICE
Acupuncture & massage
TENS

Explanantion, reassurance and counselling can make a huge amount of difference, patients knowing the pain is expected, normal and where applicable temporary can handle it much better

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12
Q

How do we treat nociceptive pain?

A

Follow the WHO analgesic ladder:
Mild - Simple analgesics
Moderate - Mild opioids + Simple analgesics
Severe - Strong opioids + simple analgesics

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13
Q

How do we wean people off analgesics?

A

Go back down the WHO analgesic ladder in steps.

Stop PCM last (as it has the least side effects)

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14
Q

How do we treat neuropathic pain?

A

Start non-pharmacologically

Then try alternative analgesics such as Amitriptyline, Gabapentin and duloxetine

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15
Q

What is the RAT approach to pain relief?

A

Recognize
Assess (severity, cause, type and other factors)
Treat

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16
Q

How do we assess the severity of pain?

A

1) verbal rating (mild –> severe)
2) Numerical scale (1 –> 10)
3) Visual analogue scale
4) Faces
5) Abbey pain scale

17
Q

How does a visual analogue scale work?

A

Draw a line and ask patients to mark along the line where their pain sits

18
Q

What is an abbey pain scale for?

A

Confused patients

19
Q

what is noci-receptive pain also known as?

A
  • Physiological

- Inflammatory

20
Q

examples of neuropathic pain?

A

nerve trauma, diabetic pain (damage)

Fibromyalgia, chronic tension headache (dysfunction)

21
Q

4 steps in pain

A

– Periphery
– Spinal cord
– Brain
– Modulation

22
Q

peripheral pain

A
  • Tissue injury
  • Release of chemicals e.g. Prostaglandins, Substance P
  • Stimulation of pain receptors (nociceptors)
  • Signal travels in Aδ or C nerve to spinal cord
23
Q

Spinal cord pain

A
  • Dorsal horn is the first relay station
  • Aδ or C nerve synapses (connects) with second nerve
  • Second nerve travels up opposite side of spinal cord
24
Q

Brain pain

A 
•Thalamus is the second relay station
•Connections to many parts of the brain
o	Cortex
o	Limbic system
o	Brainstem
•Pain perception occurs in the cortex
25
Q

Modulation

A
  • Descending pathway from brain to dorsal horn

* Usually decreases pain signal

26
Q

examples of anti-convulsants

A

– Carbamazepine (Tegretol)
– Sodium valproate (Epilim)
– Gabapentin (Neurontin)

27
Q

What are the effects of tramadol?

A

weak opiod + inhibitor of serotonin and noradrenaline re-uptake

28
Q

Pros and cons of tramadol

A

Pros:

  • less respiratory distress
  • can be used with opioids and simple analgesics

cons:
- can cause Nausea and vomiting

29
Q

Pros and cons of morphine

A
  • good from chronic cancer pain
  • good for mod-severe nocireceptor pain

cons

  • constipation
  • respiratory depression in high dose
  • misunderstanding about addiction
30
Q

How to manage peripheral pain?

A
  • RICE
  • NSAIDs
  • Local Anaestetics
31
Q

How to manage brain pain?

A
  • Psychological therapy
  • Paracetamol
  • Opiods
  • Amitryptiline
  • Clonidine
32
Q

Which drugs are good for nocireceptive pain?

A
  • PCM
  • NSAIDs
  • Morphine
33
Q

Which drugs are good for neuropathic pain?

A

TCAs e.g. amytriptaline

Anticonvulsants

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