chronic pain Flashcards
3 physiologically different types of pain
- neuropathic (nerve)
- nociceptive (tissue)
- nociplastic (e.g. fibromyalgia)
nociceptive, neuropathic, nociplastic
which one generally responds to treatment with conventional analgesics?
nociceptive
the other two respond poorly to conventional analgesics and can be difficult to treat
define chronic pain
lasts for more than 12 weeks (beyond expected time of wound healing)
chronic primary pain
pain that lasts longer than 12 weeks and has no clear underlying condition, or the pain and its impact appears to be out of proportion to any observable injury or disease
examples of primary pain (2)
fibromyalgia
primary headache and orofacial pain
what is secondary pain
caused by underlying condition e.g. endometriosis, OA, RA, UC
6 categories of pain for secondary pain
- cancer related
- neuropathic
- secondary MSK
- secondary visceral (to do with internal organs)
- post surgical or post traumatic
- secondary headache or orofacial pain
all pt with chronic pain should be offered the following non pharmacological management
- supervised group exercise programme
- encourages to remain physically active for longer term general health benefits
- offered self management advice
TENS, either high or low freq can be considered for
relief of chronic pain
what is the WHO ladder
how often should opioid treatment be reviewed
at least annually but more freq if needed
pain specialist advice or review should be sought for pt taking doses of …… daily morphine equivalent
> 90mg morphine daily equivalent
what are some adjuvant analgesics
ADs, AEDs, BZDPNs and other muscle relaxants, bone modulating drugs, CCs, topical capcaisin, lidocaine, rubefacients
refer if any signs of giant cell arteritis
new onset unilateral headache or scalp tenderness
frequent, severe headaches
jaw claudication (pain/discomfort when chewing)
general malaise
esp if over 50
visual disturbance
Temporal arteritis (giant cell arteritis) is where the arteries, particularly those at the side of the head (the temples), become inflamed. It’s serious and needs urgent treatment.
