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Anaesthetics > Essential pain management > Flashcards

Essential pain management Flashcards

1
Q

what are the 6 key notes of pain management

A
  • 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.
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2
Q

benefits for treating pain - physical

A

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

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3
Q

benefits for treating pain - psychological

A

Reduced suffering

Less depression, anxiety

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4
Q

benefits for treating pain - for the family

A

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

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5
Q

benefits for treating pain - for society

A

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

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6
Q

2 mechanisms of pain classification are?

A

Nociceptive

Neuropathic

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7
Q

what is acute pain defined as ?

A

Pain of recent onset and probable limited duration

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8
Q

what is chronic pain defined as? (3)

A
  • Pain lasting for more than 3 months
  • Pain lasting after normal healing
  • Often no identifiable cause
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9
Q

cancer pain can be a mixture of?

A

of acute and chronic

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10
Q

non-cancer pain can be?

A

Many different causes

Acute or chronic

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11
Q

what is nociceptive pain?

- what would a patient description be?

A 
Obvious tissue injury or illness
Also called physiological or inflammatory pain
Protective function
Description
Sharp ± dull
Well localised
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12
Q

what is Neuropathic Pain?

patient description?

A 
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
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13
Q

what are the 4 basic steps os pain physiology?

A

Periphery
Spinal cord
Brain
Modulation

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14
Q

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

A

Prostaglandins, Substance P

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15
Q

what receptors are stimulated in the periphery?

- how is signal sent?

A

nociceptors

  • Aδ or C nerve to spinal cord
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16
Q

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

A

Dorsal horn

  • Aδ or C nerve
  • opposite side of SC
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17
Q

Where is the second relay station?

A

thalamus

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18
Q

what can feed into the thalamus?

A

cortex - enhances pain experience

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19
Q

what occurs in the cortex?

A

Pain perception

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20
Q

modulation of the pain pathway is?

what does it decrease?

A

Descending pathway from brain to dorsal horn

- Usually decreases pain signal

21
Q

what is neuropathic pain?

A

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

22
Q

examples where you may see neuropathic pain?

A

Nerve trauma, diabetic pain (damage)

Fibromyalgia, chronic tension headache (dysfunction)

23
Q

where are there chemical changes?

A

the dorsal horn

24
Q

Simple analgesics used for pain?

A
  • Paracetamol (acetaminophen)
  • Non-Steroidal Anti-inflammatory drugs
    Diclofenac, Ibuprofen
25
Q

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

A
  • Codeine, Dihydrocodeine, Tramadol

- Morphine, Oxycodone, Fentanyl

26
Q

other analgesics you may use?

A

Tramadol

  • Antidepressants (e.g. amitriptyline, duloxetine)
  • Anticonvulsants (e.g. gabapentin)
  • Ketamine (NMDA Receptor antagonist)
  • Local anaesthetics
  • Topical agents (e.g. Capsaicin)
27
Q

Treatments -in the Periphery (3)

A

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

28
Q

Treatments - Spinal Cord (4)

A 
- Non-drug treatments
Acupuncture, massage
, TENS
- Local anaesthetics
- Opioids
- Ketamine
29
Q

Treatments - Brain (5)

A
  • Non-drug treatments
    Psychological
Drug treatments
Paracetamol
Opioids
Amitriptyline
Clonidine
30
Q

paracetamol advantages?

disadvantage?

A 
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

31
Q

Non-Steroidal Anti-Inflammatory Drugs examples (3)

A

Aspirin, ibuprofen, diclofenac

32
Q

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

A

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

33
Q

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

A

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

34
Q

disadvantages for codeine?

A

Constipation

Not good for neuropathic pain

35
Q

tramadol effect?

A

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

36
Q

main disadvantage of tramadol?

A

Nausea and vomiting, controlled drug

37
Q

morphine is not advised for?

A

neuropathic pain

38
Q

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

A

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

39
Q

Amitriptyline is a?

what does it do?

A 
Tricyclic antidepressant (TCA)
Increases descending inhibitory signals
40
Q

what does Amitriptyline also treat?

A

depression and poor sleep

41
Q

disadvantages of Amitriptyline ?

A
  • Anti-cholinergic side effects (e.g. glaucoma, urinary retention)
  • Long term use might be linked with cognitive decline and dementia
42
Q

Anticonvulsant Drugs examples?

A

Carbamazepine
Sodium valproate
Gabapentin

43
Q

Anticonvulsant Drugs are also called?

A

membrane stabilisers

Reduce abnormal firing of nerves

44
Q

Pain Assessment (6)

A
  • Verbal Rating Score
  • Numerical Rating Score
  • Visual Analogue Scale
  • Smiling faces
  • Abbey Pain Scale (for confused patients)
  • Functional assessments
45
Q

give physical non - drug treatments

A

Rest, ice, elevation
Surgery
Acupuncture, massage, physiotherapy

46
Q

Psychological Non-Drug Treatments?

A

Explanation
Reassurance
Counselling

47
Q

RAT approach to treatment

A

Recognize

Assess
Severity?
Type?
Other factors?

Treat
Non-drug treatments
Drug treatments

48
Q

the pain score should be done at? (2)

A

rest

with movement

49
Q

neuropathic features? (3)

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

Anaesthetics (5 decks)

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