Analgesia and Pain Management Flashcards
Describe the 4 types of pain [4]
Nociceptive
Inflammatory: describes the behaviour of pain signalling and transmission in the presence of an inflammatory process.
Neuropathic: describes a specific type of pain which results from damage to the signalling and transmission of neurones both within and outside of the CNS
Nociplastic: pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
How does pain stimulus alter between damaged and healthy tissue? [1]
(e.g. if burnt yourself & touch it)
In the presence of damaged tissue, pain is percieved greater than in healthy tissue due to
Explain the peripheral mechanism of inflammation during tissue injury [4]
Release of inflammatory mediators (K+ H+ bradykinin, histamine, 5HT, nitric oxide): make membranes more unstable
Activation of arachidonic acid pathway: production of leukotrienes and prostanoids
Activation of peripheral nociception (pain enhanced in inflammation)
Modulation of primary afferents to subsequent stimulus
Describe the pain pathways in neuropathic [4]
Pain is felt somewhere else, but pathology could be more proximal
Inflamamtion / mech. pressure causes the nerve to change behaviour: cell membrane becomes unstable and fires ectopic signals.:
* Alteration in ion channel expression
* Ectopic and spontaneous discharge
* Ephaptic conduction
* Collateral sprouting at primary afferents
* Sprouting of sympathetic neurones at DRG
Describe the pain pathways in nociplastic pain:
Central Pain Sensitastion [3]
Dysfunctional Inhibitory Pathways [34]
Central Pain Sensitisation
* Spinal reorganisation, WDR
* Wind up, glutamate and NMDA receptors
* Dysfunctional central pathway (pain loop)
Dysfunctional Inhibitory pathways: when pain is functional, these pathways modulate pain. When pain is abnormally percieved these pathways are decreased
* GABA
* Opioid
* Mono-aminergic
* Cannabinoid
Explain the basic difference between nociceptive and neuropathic pain [3]
Nociceptive pain:
* due to activation of nociceptors in tissues by a stimulus (e.g. trauma or burning for acute pain; cancer or rheumatism for chronic pain)
Neuropathic pain:
* due to damage of the nerve itself (e.g. amputation, shingles)
Both can be the underlying pathogenetic mechanism for acute or chronic pain
Both can appear together – e.g. back pain
What is duration for acute pain to be diagnosed as acute pain? [1]
< 12 weeks
Explain in more detail about chronic pain [4]
Often has a pyschological component
No apparent ongoing tissue damage
Central / peripheral sensitisation
> 12 weeks
What is the worst way to observe pain? [1]
Observations from staff [1]
State how we measure pain? [5]
VAS Visual analogue score
VRS Verbal rating scale
Observer scoring
BPI: brief pain invitory
Magill Pain Questionnaire
SF36
EQ5D
Take with a pinch of salt because all pain is individual
What are aims of treatment for pain management? [5]
- Identify the source of pain
- Limit further damage
- Optimise tissue homeostasis
- To reduce pain levels
- To restore function
State 5 biomedical options / add ons that help treat pain
Exercise
Physical therapy
Medication
Intervention
Surgery
How can exercise help treat chronic pain? [1]
Exercise can re-write pain pathways but need patients to believe in process
State 6 pyschosocial factors that need to be adressed in pain [6]
misconceptions
functioning
reassurance
fear avoidance
relations
anxiety and
depression
Why are benzodiazepines useful for pain medication? [1]
Anti anxiolytics
