L20-21 Pain Management Flashcards
most challenging pain to treat
neuropathic pain
- relative resistance to opioids
cancer pain is usually acute/chronic?
chronic
- hard to manage at end of life
- progressively more symptomatic, req bg pain control
most widely used non-opioids
paracetamol
use of codeine in renal/hepatic impairment
try to steer away
which opiate least potential for abuse
tramadol
nociceptors
specialised neural receptors in the brain
small myelinated A-delta fibers carry signals for
mechanical and thermal stimuli
C fibers carry signals for
all 3 (mechanical, thermal, chemical) stimuli
nociceptive somatic pain
- site is tender
- pain is localised to injury site
- constant and sometimes throbbing or aching, stabbing or pressure
- skin, muscle, bone
where does nociceptive visceral pain originate from?
viscera, mediated by stretch receptors
nociceptice viscera pain
- poorly localised, referred to a distant cutaneous site which may be tender
- deep, dull, cramping, gnawing
- organ or viscera
neuropathic pain
- burning, squeezing, tingling, shooting, electric/shocking pain, sharp
- no area of tenderness or area of exquisite sensitivity to normal innoculus stimuli
- resistant to opioids
tapentadol
new, not meant for chronic cancer pain
why is aspirin generally avoided?
irreversible antiplatelet effects
NSAIDs precautions
- elderly: >65yo
- bleeding disorder
- asthma, bronchospasm
- gi diseases (ulcer, bleeding)
- cv disease
- renal or hepatic dysfunction
- receiving anticoagulants
