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Clinical symposium > clinical aspects of pain > Flashcards

clinical aspects of pain Flashcards

1
Q

define pain

A

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

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2
Q

can you experience pain when you are unconscious

A

No

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3
Q

how is pain classified

A

duration- acute/chronic

pathophysiology- nociceptive and neuropathic

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4
Q

what is the most common cause of acute pain

A

trauma and injury.

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5
Q

what defines chronic pain (timing)

A

• Pain extends 3-6 months beyond onset

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6
Q

why do we get pain

A

assists wound repair in- acute pain.

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7
Q

when does pain resolve

A

upon healing in acute

doesn’t in chronic

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8
Q

what physiologic system regulates the nocioceptive pain mechanisms

A

opioidergic system

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9
Q

what causes noiceptive pain

A

tissue damage and painful stimuli at noiceptors.

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10
Q

what are the main benefits of acute pain

A

part of trauma response, protective to avoid further damage, learning experience.

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11
Q

what are the main adverse effects of acute pain

A

humanitarian issues, cardiovascular stress, respiratory compromise, hyper coagulation.

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12
Q

what factors effect a persons perception of pain

A 
anxiety
depressed
gender- socliasation and gonadotropins
circadian variation
climatic conditions
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13
Q

how is pain assessed

A

Ideally self reported by patient.
Visual analogue- pain scale
Assess pain at rest and during movement.

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14
Q

what pain management (medication) is used for pain

A

Non-opiods- parecetamol, aspirin, NSAID.s COX-2 inhibitors
Opiods for mild to moderate pain- codeine, dihyroceodeine, tramadol.
Opiods for moderate to severe pain- morphine, fentanyl, hydromorphone, buprenorphine, methadone.

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15
Q

What is the mechanism of action of NSAID’s

A

COX inhibitors (act peripherally), decrease prostaglandin synthesis

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16
Q

What is the mechanism of action for opiods

A

Act at 2 sites in spinal cord
Presynaptically pain signal transmission is reduced
Postsynaptically membrane is hyperpolarised, decreasing the probability of action potential generation

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17
Q

what are the main side effects of non-opiods

A

due to change in amount of prostaglandins
o Cardiovascular side effects
o Renal side effects
o GI side effects.

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18
Q

what is the main side effects of paracetamol

A

liver toxicity.

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19
Q

what is the mode of action of paracetamol

A

inhibit central prostaglandin synthesis

20
Q

what examples of non-opiods

A

parecetamol, aspirin, NSAID.s COX-2 inhibitors

21
Q

what examples of opiods (mild to moderate pain)

A

codeine, dihyroceodeine, tramadol.

22
Q

what examples of opiods (moderate to severe)

A

morphine, fentanyl, hydromorphone, buprenorphine, methadone.

23
Q

what are the side effects of opioid analgesics

A

nauseas, vomiting, constipation, vertigo, sosmnolence, dry skin and pruritus.

24
Q

where are opiod receptors present

A

found in bowel, pupillary light reflex, control of respiration, chemoreceptor

25
Q

what is the earliest prediction of respiratory depression which is a side effect of respiratory depression

A

sedation

26
Q

why must opiod levels be measured accurately in analgesia

A

different people will have different plasma levels of opiods in their blood.

27
Q

what 2 drugs must never be used in renal failure

A

morphine or codeine

28
Q

what 2 drugs can be used in renal failure

A

fentanyl and oxycodone

29
Q

what are the main benefits of a epidural

A 
High quality pain relief
Improved pulmonary function
Reduced chest infection and sepsis
Reduced cardiac morbidity.
Anticipated block from epidural- can be specifically targeted for a specific space.
30
Q

what drug is commonly used in cancer treatment

A

morphine

31
Q

where do spinal opiods work

A

Act on the dorsal horn

32
Q

which reaches the brainstem lipophillic or lipophobic morphine

A

lipophobic

33
Q

define neuropathic pain

A

pain due to damage in pain stimulating system e.g stroke or Type II diabetes.

34
Q

what are the main characteristics of chronic pain

A

Intense pain
Recurrent pain
Associated with severe co-morbidity and poor quality of life.

35
Q

define allyodonia

A

pain to a non painful stimulus/

36
Q

what are the main features of neuropathic pain

A

Pain different from normal everyday pain
Pain in absence of ongoing tissue damage
Pain in area of sensory loss!
Paroxysmal or spontaneous pain!
Allodynia
Hyperalgesia
Dysaesthesia

37
Q

define hyperalgesia

A

increased pain in response to painful stimuli

38
Q

define dysaesthesia

A

unpleasant abnormal sensations “ants crawling on the skin”

39
Q

what drugs are used to treat neuropathic pain

A

NSAIDs –poor
Antidepressants- inhibits neuronal reuptake of noradrenaline and serotonin.
Anticonvulsants- dampens down the neuronal pathways.
Opiods
Membrane stabilising drugs
Topical drugs
Other.

40
Q

what symptoms are antidepressants used for

A

neuropathic, complex regional pain and tension headache.

41
Q

what is the mode of action of antidepressants

A

inhibition of neuronal reuptake or noradrenaline and serotonin.

42
Q

what are the side effects of antidepressants

A

constipation, dry mouth, somnolence, heart rate, insomnia.

43
Q

what are the symptoms for which anticonvusants are used

A

neuropathic pain

44
Q

what is the mode of action of antidepressants

A

o gabapentin- binds presynaptic voltage dependent calcium channels (excreted renally, not metabolised)
o Pregabalin- interacts with special N type calcium channels.
o Carbamazepine- blocks Na and Ca channels. (rashes and liver damage)

45
Q

what are the side effects of anticonvulsants

A

sedation, dizziness, ataxia, peripheral odema, nausea, weight gain

46
Q

what machine is used for spinal cord stimulation

A

TENS machine

Clinical symposium (20 decks)

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