Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTY2101 EOS > B2 L31 Medical aspects of pain management > Flashcards

B2 L31 Medical aspects of pain management Flashcards

1
Q

What are the 4 steps in the standard medical perspective for symptom management?

A
  1. Diagnose cause (understand pathophysiology of problem)
  2. Develop management plan
  3. Review progress
  4. Re-evaluate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 2 features of acute pain?

A
  1. Indicates damage being inflicted NOW
  2. Demands action to prevent further damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute main is one of the most ___ mechanisms. Why?

A

defensive mechanisms

  • feel pain when injury/damage is occurring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 3 features of chronic pain?

A
  1. Immediate damage not necessarily being done (“useless” pain- unlike acute pain)
  2. Persists in spite of appropriate action to prevent further damage
  3. Leads to behaviour that is very counter-productive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Explain the pathway from the start (damage to tissue) to the end (managing pain). 8 steps

A
  1. Damage to tissues
  2. Inflammation
  3. Nociceptors stimulated
  4. Input to anterior horn
  5. Cross midline (decussate)
  6. Goes up through contralateral spinothalamic tract
  7. Decussate (back to original side)
  8. Goes down through ipsilateral side to manage pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 4 features of anterior horn synapse?

A
  1. Pain agonists
  2. Pain antagonists
  3. Noxious stimulus
  4. Quality of message to brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 2 modifications to central pathways with chronic pain?

A

Persistent afferent impulses, esp slow fibres:

  1. New pathways laid down
  2. NMDA sensitisation,
    • damage to inhibitory neuronal paths
    • leads to “wind-up”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is wind up? How does this have an effect on medication?

A

Pain accelerates for no particular reason

Medication stops working, need to use more for same effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the modification of pain perception?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 2 forms of pain?

A
  1. Incident pain
    • Pain with an event – eg bathing
    • PREDICTABLE
  2. Breakthrough pain
    • Pain occurring when controlled analgesia already in place.
    • Related to sudden event – eg bleed into a tumour
    • UNPREDICTABLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is incident pain? How does that affect treatment?

A
  • Pain with an event – eg bathing
  • PREDICTABLE
  • Can give dose of medication before event
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is breakthrough pain? How does that affect treatment?

A
  • Pain occurring when controlled analgesia already in place.
  • Related to sudden/unexpected event – eg bleed into a tumour
  • UNPREDICTABLE
  • Have a generic plan ready (to manage pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 2 types of assessment for pain?

A
  1. Nociceptive
  2. Non-nociceptive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 2 types of nociceptive pain?

A
  1. Somatic
  2. Visceral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is somatic nociceptive pain?

A

skin, muscle, connective tissue are damaged (nociceptors are in tissue)

  • pain is worse with movement
  • pain is localised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 2 types of visceral nociceptive pain?

A
  1. Solid organs
  2. Hollow organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is visceral nociceptive pain of hollow organs/

A

obstruction of organ

  • always has muscle
  • tries to push through obstruction pain comes and goes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 2 types of non-nociceptive pain?

A
  1. Neuropathetic
  2. Non-neuropathetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is neuropathetic non-nociceptive pain?

A

nerve is damaged and still perceiving pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is non-neuropathetic nociceptive pain?

A

panic, anxiety, anticipation/fear of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is total pain?

A
  • Totality of suffering comprises physical, psychological and spiritual distress.
  • One element can’t be seen in isolation.
  • Each element affects the others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 3 features nociceptive pain?

A
  1. Arising from stimulation of nociceptive pain receptors by “inflammatory soup”
  2. Found in connective tissue - skin, muscles, organ capsules, peritoneum
  3. Pain is locallised, worse with movement (internal movement)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 4 features of neuropathic pain?

A
  1. Arises from damage to, compression of or invasion of nerves at any level of the CNS
  2. Burning, tingling, hypersensitivity
  3. Possibly dermatomal
  4. Not changed with movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 2 purpose of using validated tools for pain?

A
  1. Consistent reporting of pain
  2. Early warning of escalation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the aim for pain?

A

control acute pain to minimise risk of progression to chronic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 4 tasks of a consultation?

A
  1. Presenting compliant(s)
  2. Defining the problem(s)- (Diagnosis)
  3. Understanding impact of problem on person
  4. Negotiate a management plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the 3 tasks of the reasoning process?

A
  1. Developing a problem list
  2. Defining pathological process(es)
  3. Coming to a working diagnosis / diagnoses
28
Q

In clinical medicine, what are 3 features that reasoning and hypothesis generation uses?

A
  1. Knowledge
    • Basic sciences and pathology
  2. Probability
    • What are the most prevalent conditions in people like this patient that have the relevant symptoms and signs?
  3. Key questions
    • identifies major symptoms and signs that distinguish one condition from another (rule in or out a disease)
29
Q

What are the 3 features in key questions for reasoning and hypothesis generation?

A
  1. How to RULE IN or RULE OUT a disease
  2. What are the KEY FEATURES that MUST be present to have that disease?
  3. What are the KEY FEATURES that are NEVER present with that disease?
30
Q

For example, what are the key questions for determining whether it is a migrane, neck-related headache or a space occupying lesion?

A
  1. Does the head ache throb? (Quality of pain)
  2. Where is the headache (Location of pain)
  3. When is it worst (Time of pain)
31
Q

What is triangulation? What are 2 features?

A

Seeks to confirm the presumed diagnosis by other evidence:

  1. More features from the history that confirm or reject the initial hypothesis
  2. Physical examination or investigations may support hypothesis or suggest competing hypotheses. (it is important not to rely on imaging for diagnosis, should be used to confirm)
32
Q

What is the mapping grid for complex medical problems?

A
33
Q

What are the 3 features in the mapping grid for complex medical problems?

A
  1. Physiology and chemistry
  2. Circumstances and environment
  3. Personality strengths and weaknesses
34
Q

What is the physiology and chemistry part in the mapping grid for complex medical problems? Give examples.

A

Diseases going on?

  • Depression or anxiety (chemical change)
  • Need medication to control pain

Eg.

  • Musculoskeletal pathology
  • Allodynia- neuropathic pain
    • Lyrica – eliminated this pain
  • Anxiety/depression/panic (can do chemical treatment)
    • A role for SSRIs
    • Avoid benzodiazepines
35
Q

What is the circumstances and environment part in the mapping grid for complex medical problems? Give examples

A
  • Living space
  • Financial struggles

Eg.

  • Moved from country town 4-5 yrs ago
  • Lives alone, no family support
  • Attends church in Brisbane, therefore usually miles from friends and support
36
Q

What is the personality strengths and weaknesses part in the mapping grid for complex medical problems?

A

Internal- that can’t change

  • Family history
  • Personality

Eg. Strengths

  • Likeable
  • Is teachable (even with low average intelligence- just repeat instructions)

Weaknesses

  • Habitual Dependency
  • Anxiety (catastrophises)
  • Low average intelligence
37
Q

What are some examples of management in regards to circumstances?

A
  • nurse navigator training him and supporting good choices.
  • Recognition that a GP is there for him
38
Q

What are some examples of management in regards to personality?

A
  • Training him in self reliance
  • Rewarding good choices (praise)
  • Weekly consultations to sort out problems ( ED won’t do it for him)
39
Q

What are some examples of management in regards to physiology/chemistry?

A
  • Physiotherapy and exercises
  • Pregabalin for neuropathic pain
40
Q

What are 4 considerations when choosing medication?

A
  1. Nature of the pain
  2. Timing of pain – Chronic? – Incident? – Breakthrough?
  3. Predictable side effects
  4. Unpredictable side effects
41
Q

What are 4 non-pharmacological modalities for treatment?

A
  1. splinting
  2. positioning
  3. physio
  4. counselling
42
Q

What are the 2 types of pharmacological treatments?

A
  1. Analgesics
  2. Adjuvants
43
Q

What are analgesics? Give 3 examples.

A

Directly affect pain perception

  1. Paracetamol
  2. Aspirin
  3. Opioids
44
Q

What are adjuvants?

A

modify other processes, pain relief is secondary

45
Q

What are 4 specialist modalities?

A
  1. Radiotherapy –eg single bony metastases
  2. Chemotherapy
  3. Nerve blocks
  4. Neurosurgical techniques.
46
Q

What are the 3 steps to the W.H.O Analgesic Ladder?

A

Step 1- Non-Opioid+/- adjuvant

Step 2- “mild/moderate” opioid +/- non-opioid +/- adjuvant

Step 3- Opioid for moderate to severe pain +/- non opioid +/- adjuvant

47
Q

What are the 5 limitations of the ladder approach?

A
  1. only relates to pain intensity
  2. does not identify causes and types of pain
  3. Step 2 often omitted
  4. adjuvants have increasing usefulness, but portrayed as second line treatments
  5. no consideration of alternate routes of administration
48
Q

What are 2 simple analgesics?

A
  1. Paracetamol
  2. Aspirin
49
Q

What is the most important thing when prescribing opioids?

A

lowest dose and shortest duration

50
Q

Opioids: “I’ll make my patient addicted.” True or false.

A

False

Dependence NOT addiction in chronic pain

51
Q

Opioids: “The patient won’t have anything left for later on if I start them now.” True or false

A

False

Delayed control of pain allows pain preferred pathways to be laid down

52
Q

Opioids: “Opioids cause respiratory depression”. True or false.

A

False

Only in overdose- not if titrated (slowly increase)

53
Q

What are the 4 ways to administer opioids?

A
  1. Oral
    • immediate release.
    • Slow release
  2. Parenteral - s/c - syringe driver
  3. Transdermal
  4. Intrathecal, epidural
54
Q

What are the 3 forms of morphine available in Australia?

A

Oral short -acting • Oral Long acting - slow release with peak levels after 12 hours, and 12-24 hrs duration (MS Contin, Kapanol) • Injectable - morphine sulphate, morphine tartrate

55
Q

What are 3 characteristics of short-acting morphine?

A
  1. 20 minute onset action
  2. 4 hour duration
  3. Forms: liquid, multiple concentrations, or tablets.
56
Q

What are the 2 types of morphine?

A
  1. Short acting
  2. Long acting
57
Q

What are 4 characteristics of long-acting morphine?

A
  1. slow release
  2. peak levels after 12 hours \12 (MS Contin) or 24 hrs duration Kapanol or MS Mono)
  3. 48 hours to reach steady state
58
Q

What are 4 alternatives to opioids? Why are these used?

A
  1. Fentanyl – patches, less sedation, constipation, very strong
  2. Hydromorphone- less constipation, hepatic metabolism
  3. Oxycontin- less sedation, confusion
  4. Buprenorphine – patches, weaker –ideal for older people
59
Q

What are 5 processes to follow for the initiation of morphine?

A
  1. Explanations to minimise opioid-phobia
  2. Start liquid morphine with q4h dose (eg 5mg) plus prn breakthrough
  3. Consider Short-term anti-emetic, and start laxative
  4. Review at 48 hrs, calculate average dose per 24 hrs.
  5. Start long acting opioid same dose per 24 hours
60
Q

What is opioid rotation?

A
  • Can be useful if dose escalates
  • Some opioids target NMDA (eg Methadone), but are hard to use
61
Q

What are 5 alternatives to opioids? Why are they used?

A
  1. Fentanyl - less sedation, constipation
  2. Hydromorphone- less constipation, hepatic metabolism
  3. Oxycontin- less sedation, confusion
  4. Pethidine - short acting, toxic metabolites
  5. Methadone – useful when windup – targets NMDA
62
Q

What are 3 reasons why adjuvants are used for nociceptive pain?

A
  1. Targeting the inflammatory soup
    • NSAIDS
    • Steroids
  2. Skeletal muscle spasm
    • Benzodiazepines
    • baclofen
  3. Smooth muscle spasm
    • Hyoscine butylbromide
63
Q

What are 4 processes to follow with neuropathetic pain?

A
  1. Assess severity.
  2. If very severe, start morphine as before
    • Start an adjuvant simultaneously.
  3. If not severe, start adjuvant slow response times – days to weeks
  4. Regular review and titration upwards of BOTH opioids and adjuvants.
64
Q

What are 3 adjuvants for neuropathetic pain?

A
  1. Antidepressants
    • best evidence for amitryptaline
  2. Anti-epileptics
    • pregabalin, gabapentin, valproate, carbamezepine
  3. Anti- Arrhythmics (Xylocaine derivatives)
    • mexilitine, flecainide – rarely used
65
Q

The _____ is the key element of determining pain management

A

diagnosis

66
Q

Examination and investigations support the ___ but frequently do not make it.

A

diagnosis

67
Q

Pain is complex and ____ treatment requires all elements to be managed

A

comprehensive

PHTY2101 EOS (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions