Essential pain management

Question 1

what are the 6 key notes of pain management

Answer 1

• Pain is a personal experience influence by biological, psychological and social factors
• Pain and nociception are different phenomena
• Individuals learn the concept of pain through life experiences
• A person’s report of pain should be respected
• Pain serves an adaptive role but may have adverse effects on function and psychological well being
• Verbal description is only one of several behaviours to express pain.

Question 2

benefits for treating pain - physical

Answer 2

Improved sleep, better appetite
Fewer medical complications
(e.g. heart attack, pneumonia)

Question 3

benefits for treating pain - psychological

Answer 3

Reduced suffering

Less depression, anxiety

Question 4

benefits for treating pain - for the family

Answer 4

Improved functioning as a family member
(e.g. as a father or mother)
Able to keep working

Question 5

benefits for treating pain - for society

Answer 5

Lower health costs
(e.g. shorter hospital stay)
Able to contribute to the community

Question 6

2 mechanisms of pain classification are?

Answer 6

Nociceptive

Neuropathic

Question 7

what is acute pain defined as ?

Answer 7

Pain of recent onset and probable limited duration

Question 8

what is chronic pain defined as? (3)

Answer 8

• Pain lasting for more than 3 months
• Pain lasting after normal healing
• Often no identifiable cause

Question 9

cancer pain can be a mixture of?

Answer 9

of acute and chronic

Question 10

non-cancer pain can be?

Answer 10

Many different causes

Acute or chronic

Question 11

what is nociceptive pain?

- what would a patient description be?

Answer 11

Obvious tissue injury or illness
Also called physiological or inflammatory pain
Protective function
Description
Sharp ± dull
Well localised

Question 12

what is Neuropathic Pain?

patient description?

Answer 12

Nervous system damage or abnormality
Tissue injury may not be obvious
Does not have a protective function
Description
Burning, shooting ± numbness, pins and needles
Not well localised

Question 13

what are the 4 basic steps os pain physiology?

Answer 13

Periphery
Spinal cord
Brain
Modulation

Question 14

in the periphery - what chemicals are released? (2)

Answer 14

Prostaglandins, Substance P

Question 15

what receptors are stimulated in the periphery?

- how is signal sent?

Answer 15

nociceptors

• Aδ or C nerve to spinal cord

Question 16

where is the first relay station?
what synapses connect with the second nerve?
- where does it travel?

Answer 16

Dorsal horn

• Aδ or C nerve
• opposite side of SC

Question 17

Where is the second relay station?

Answer 17

thalamus

Question 18

what can feed into the thalamus?

Answer 18

cortex - enhances pain experience

Question 19

what occurs in the cortex?

Answer 19

Pain perception

Question 20

modulation of the pain pathway is?

what does it decrease?

Answer 20

Descending pathway from brain to dorsal horn

- Usually decreases pain signal

Question 21

what is neuropathic pain?

Answer 21

Abnormal processing of pain signal
Nervous system damage or dysfunction
Needs to be treated differently

Question 22

examples where you may see neuropathic pain?

Answer 22

Nerve trauma, diabetic pain (damage)

Fibromyalgia, chronic tension headache (dysfunction)

Question 23

where are there chemical changes?

Answer 23

the dorsal horn

Question 24

Simple analgesics used for pain?

Answer 24

• Paracetamol (acetaminophen)
• Non-Steroidal Anti-inflammatory drugs
  Diclofenac, Ibuprofen

Question 25

Opioids examples used for pain - give examples of weak and strong

Answer 25

- Codeine, Dihydrocodeine, Tramadol | - Morphine, Oxycodone, Fentanyl

Question 26

other analgesics you may use?

Answer 26

Tramadol - Antidepressants (e.g. amitriptyline, duloxetine) - Anticonvulsants (e.g. gabapentin) - Ketamine (NMDA Receptor antagonist) - Local anaesthetics - Topical agents (e.g. Capsaicin)

Question 27

Treatments -in the Periphery (3)

Answer 27

Non-drug treatments Rest, ice, elevation Non-steroidal Anti-inflammatory drugs Local anaesthetics

Question 28

Treatments - Spinal Cord (4)

Answer 28

``` - Non-drug treatments Acupuncture, massage , TENS - Local anaesthetics - Opioids - Ketamine ```

Question 29

Treatments - Brain (5)

Answer 29

- Non-drug treatments Psychological ``` Drug treatments Paracetamol Opioids Amitriptyline Clonidine ```

Question 30

paracetamol advantages? | disadvantage?

Answer 30

``` Cheap, safe Can be given orally, rectally or intravenously Good for: Mild pain (by itself) Mod-severe pain (with other drugs) ``` Liver damage in overdose

Question 31

Non-Steroidal Anti-Inflammatory Drugs examples (3)

Answer 31

Aspirin, ibuprofen, diclofenac

Question 32

Non-Steroidal Anti-Inflammatory Drugs - advantages (3)

Answer 32

Cheap, generally safe Good for nociceptive pain Best given regularly with paracetamol (Synergism

Question 33

Non-Steroidal Anti-Inflammatory Drugs - dis advantages (3)

Answer 33

Gastrointestinal and renal side effects plus bronchospasm in some patients with asthma

Question 34

disadvantages for codeine?

Answer 34

Constipation | Not good for neuropathic pain

Question 35

tramadol effect?

Answer 35

Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake (modulation)

Question 36

main disadvantage of tramadol?

Answer 36

Nausea and vomiting, controlled drug

Question 37

morphine is not advised for?

Answer 37

neuropathic pain

Question 38

oral dose of morphine needs to be increased when? why is this?

Answer 38

increased if changing from IV/ IM or S/C routes as third pass metabolism reduces the amount of morphine available.

Question 39

Amitriptyline is a? | what does it do?

Answer 39

``` Tricyclic antidepressant (TCA) Increases descending inhibitory signals ```

Question 40

what does Amitriptyline also treat?

Answer 40

depression and poor sleep

Question 41

disadvantages of Amitriptyline ?

Answer 41

- Anti-cholinergic side effects (e.g. glaucoma, urinary retention) - Long term use might be linked with cognitive decline and dementia

Question 42

Anticonvulsant Drugs examples?

Answer 42

Carbamazepine Sodium valproate Gabapentin

Question 43

Anticonvulsant Drugs are also called?

Answer 43

membrane stabilisers | Reduce abnormal firing of nerves

Question 44

Pain Assessment (6)

Answer 44

- Verbal Rating Score - Numerical Rating Score - Visual Analogue Scale - Smiling faces - Abbey Pain Scale (for confused patients) - Functional assessments

Question 45

give physical non - drug treatments

Answer 45

Rest, ice, elevation Surgery Acupuncture, massage, physiotherapy

Question 46

Psychological Non-Drug Treatments?

Answer 46

Explanation Reassurance Counselling

Question 47

RAT approach to treatment

Answer 47

Recognize Assess Severity? Type? Other factors? Treat Non-drug treatments Drug treatments

Question 48

the pain score should be done at? (2)

Answer 48

rest | with movement

Question 49

neuropathic features? (3)

Answer 49

- Burning or shooting pain - Phantom limb pain - Other features (pins and needles, numbness)