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Locomotor 2 > Analgesic and Pain Management > Flashcards

Analgesic and Pain Management Flashcards

1
Q

what is pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

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2
Q

name the 4 different types of pain

A
  • Nociceptive
  • Inflammatory
  • Neuropathic
  • Mixed
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3
Q

what are the two types of nocipeception

A

C fibres and delta fibres

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4
Q

What happens in tissue damage

A

Release of inflammatory mediators (K+ H+ bradykinin, histamine, 5HT, nitric oxide

Activation of arachidonic acid pathway – production of leukotrienes and prostanoids

Activation of peripheral nociception

Modulation of primary afferents to subsequent stimulus

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5
Q

What is neuropathic pain

A

Pain originates witin the nervous system proximal to the pain receptor

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6
Q

What happens in neuropathic mechanisms

A

Alteration in ion channel expression

Ectopic and spontaneous discharge

Ephaptic conduction

Collateral sprouting at primary afferents

Sprouting of sympathetic neurones at DRG

have a hyperexitied neurone which releases excess excitatory neurotransmitters

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7
Q

what leads to central hypersensitivity

A
  • Spinal reorganisation, WDR
  • Wind up, glutamate and NMDA receptors
  • Pain loop
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8
Q

name the inhibitory pathways

A

GABA

Opioid

Monoaminergic

Cannabinoid

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9
Q

what are the influences on pain experience

A
  • age
  • fear
  • gender - women do better with pain
  • culture
  • education and understanding
  • previous pain experience
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10
Q

how long does acute pain last for

A

less than 12 weeks

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11
Q

describe actue pain

A
  • Nociceptive
  • Primary afferent neurones
  • Detection of noxious / damaging stimulus
  • Information relayed to supraspinal structures
  • Pain response correlates to degree of tissue inflammation
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12
Q

How long does chronic pain last for

A

longer than 12 weeks

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13
Q

describe chronic pain

A

No apparent ongoing tissue damage

Ectopic focus of neural activity

Central / peripheral sensitisation

Response to treatment less effective

Prognosis unpredictable

Often has a significant psychological component

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14
Q

Name some co-morbdiity that is associated with chronic pain

A
  • difficulty sleeping
  • lack of energy
  • drowsiness
  • concentration difficulties
  • depression
  • anxiety
  • poor appetite
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15
Q

how can you measure the expression of pain

A

VAS Visual analogue score

VRS Verbal rating scale

Observer scoring

Likert scale

Magill Pain Questionnaire

SF36

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16
Q

What are the aims of treatment in pain

A
  • Identify the source of pain
  • Limit further damage
  • Maintain tissue homeostasis
  • To reduce pain levels
  • To restore function
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17
Q

What are options of treatment

A
  • exercise
  • physical therapy
  • medication
  • intervention
  • surgery
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18
Q

What are the psychosocial options of pain treatment

A
  • functioning
  • reassurance
  • fear avoidance
  • relations
  • anxiety and depression
  • misconception
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19
Q

What is the WHO pain relief ladder

A
  • non opioid
  • weak opioid
  • strokg opoid
20
Q

What are conventional analgesics

A
  • Paracetamol
  • NSAIDS / COX II
  • Weak opioids
  • Tramadol
  • Strong opioids
21
Q

describe paracetamol

A
  • has little anti-inflammatory action
  • moderate pain and pyrexia
  • no peripheral action
22
Q

How can paracetamol be administered

A

IV

Orally

23
Q

What are the side effects of paracetamol

A
  • liver damage in od
24
Q

What is the clinical effectiveness of paracetamol

A

NNT 4.6

25
Q

What is the mechanism of action of diclofenac

A
  • NSAID
  • Prostaglandin inhibition via COX I and COX II
  • Reduces inflammation peripherally
26
Q

how does diclofenac given

A

Parenteral, oral, topical and rectal

27
Q

What are the side effects of diclofenac

A

GI, renal, CVS and bleeding effects

28
Q

What is the clinical effectiveness of diclofenac

A

NNT 2.3 (50mg)

29
Q

How does tramadol work

A

Site of action
- CNS, LC, DR

Very weak opioid

Acts via monoaminergic pathways in brainstem

30
Q

what type of pain is tramadol given for

A

Used for moderate – severe pain

31
Q

what is the route of administration for tramadol

A

Oral, iv, im.

32
Q

what are the side effects for tramadol

A

Nausea & vomiting

Dizziness

Sweating

33
Q

What are the clinical effectiveness for tramadol

A

NNT 4.8

34
Q

name some opioids

A

Codeine

Morphine

Fentanyl - 1000x more potent can cause respiratory depression

Oxycodone

Buprenorphine

Diamorphine

Methadone

35
Q

what are opioid agonists

A

Mimic endogenous analgesic peptides: endorphins, dynorphins, enkephalins
- act on opioid receptors

36
Q

what are the three main opioid receptor and where are they fine

A
  • kappa, delta, mu
  • Found in CNS (brain stem, spinal cord and regions associated with pain perception)
  • they can also be found peripherally in the gut
37
Q

describe the mechanism of action of morphine

A
  • Analgesic action via mu receptors

Site of action

  • CNS (PAG, spinal cord)
  • Peripheral
38
Q

what are the routes of morphine

A

Intravenous, intramuscular, subcut, oral, epidural intrathecal, intra-articular

39
Q

what are the side effects of morphine

A

Constipation

Nausea

Pruritis

Drowsiness

40
Q

What type of pain is morphine used for

A

All pain states, moderate – severe

41
Q

What do opioids do

A

mimic endogenous endorphins

42
Q

give examples of antineurophatic agents

A 
Pregabalin
Gabapentin
Carbemazepine
Sodium Valproate
Phenytoin
43
Q

name medication

A
  • Tricyclics
  • SSRI’s
  • SNRI’s
  • Others
44
Q

what analesgics can be used for regional techniques

A

Topical application

Infiltration with local

Simple nerve blocks

Plexus blocks

Epidural infusions

45
Q

what physical methods can be used to prevent pain

A

TENS

Acupuncture

Ice

Heat packs

Exercise based therapy

Soft tissue release

46
Q

what are psychological management for pain

A
  • ACT
  • Mindfulness
  • Placebo effect
  • Reassurance

Locomotor 2 (30 decks)

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