Analgesia and pain management

Question 1

Define pain

Answer 1

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

Question 2

3 types of pain

Answer 2

Nociceptive
Inflammatory
Neuropathic

Question 3

What fibres are involved in upper pain transmission

Answer 3

A fibres and C fibres

Question 4

What happens to C fibre during inflammation

Answer 4

It becomes more sensitised

Question 5

What chemical mediators are released during inflammation

Answer 5

Potassium
Hydrogen
Bradykinin
Histamine
5-HT
NO

Question 6

What is activated in peripheral mechanism

Answer 6

Activation of arachidonic acid pathways producing leukotrienes and prstanoids
Activation of peripheral nociception

Question 7

What is neuropathic pain

Answer 7

Lesion somewhere in the nervous system producing neuropathic pain (eg diabetes)

Question 8

What 5 mechanisms may underly peripheral neuropathic pain

Answer 8

• Alterations in ion channel expression
• Ectopic and spontaneous discharge
• Ephatic conduction
• Collateral sprouting at primary afferents

Question 9

What is ephatic conduction

Answer 9

Conduction without a NT

Question 10

What is central hypersensitivity

Answer 10

Brain becomes extra sensitive to pain

Hyperallegeisia

Question 11

What happens to the inhibitory pathways in central sensitisation

Answer 11

They fail

GABA, opiod and monoaminergic

Question 12

What is acute pain

Answer 12

Nociceptive

Question 13

What neurones are involved in acute pain

Answer 13

Primary afferent neurones

Question 14

How long does acute pain last more

Answer 14

<12 weeks

Question 15

How is chronic pain characterised

Answer 15

• No apparent ongoing tissue damage
• Response to treatment less effective
• Significant psychological component

Question 16

What are the steps of the WHO pain ladder

Answer 16

step 1- non opiod
step 2- weak opiod
step 3- strong opiod

Question 17

Does paracetemol have any peripheral action?

Answer 17

No

Question 18

Is paracetemol opiate sparing? What does this mean

Answer 18

Yes

By carrying opiates can spare some of the side effects without compromising pain killing effects too much

Question 19

What is the NNT of paracetemol

Answer 19

4.6

Question 20

Major side effect of paracetemol

Answer 20

Liver damage in overdose

Question 21

What is diclofenac an example of

Answer 21

An NSAID

Question 22

How does diclofenac work

Answer 22

Inhibits prostaglandin via COX 1 and COX 2

Question 23

What are the side effects of diclofenac

Answer 23

GI, renal, CVS and bleeding effects

Question 24

What is the NNT of diclofenac

Answer 24

2.3

Question 25

What kind of drug is tramadol

Answer 25

Very weak opiod

Question 26

Via which pathways does tramadol act

Answer 26

Monoaminergic pathways

Question 27

What is the site of action of tramadol

Answer 27

CNS, LC, DR

Question 28

What are the side effects of tramadol

Answer 28

Nausea and vomiting
Dizziness
Sweating

Question 29

What is the NNT of tramadol

Answer 29

4.8

Question 30

Do opiods work peripherally or centrally

Answer 30

Centrally

Question 31

What are the 3 main receptor types are where are they found

Answer 31

mu, kappa, gamma

found mainly centrally but also peripherally (gut)

Question 32

Do opiods agonise or antagonise the receptor

Answer 32

Antagonise

Question 33

Side effect of morphine

Answer 33

Constipation
Nausea
Pruitiis
Drowsiness

Question 34

What receptor does morphine antagonise

Answer 34

mu opiod receptor

Question 35

Name 4 drug types whose primary action isn’t pain killing but are used as pain killers

Answer 35

Anti-neuropathic agents
Anti convulsants
Anti depressants
Topical creams

Question 36

What SNRI/ SSRI is commonly used for diabetic neuropathy

Answer 36

Duoloxetine

Question 37

Typical tricyclic to use? Higher or lower dose than antidepressant dose?

Answer 37

Amitriptyline

Lower