Lecture 4 Essential Pain Management

Question 1

What is Nociceptive pain

Answer 1

Pain from physical damage

Well localised

Question 2

What is Neuropathic pain

Answer 2

Pain caused by damage or disease affecting the somatosensory nervous system
Not well localised

Question 3

What is acute pain

Answer 3

Pain of recent onset and probably limited duration

Question 4

What is chronic pain

Answer 4

Pain lasting for more than 3 months and lasting after healing

Question 5

What is the first relay station of pain physiology

Answer 5

Dorsal horn

Question 6

What is the second relay station of the pain physiology

Answer 6

Thalamus

Question 7

What nerve fibre carries Noxious (Pain) Stimulus

Answer 7

Small (Peripheral Nerve Fibres)
Ad
C

Question 8

What nerve fibres carry distractive stimulus (rubbing

Answer 8

Large (Peripheral Nerve Fibres)
Aa
Ab

Question 9

What are the pathological mechanisms of neuropathic pain

Answer 9

Increased receptor numbers
Abnromal sensitisation of nerves
Chemical changes in the dorsal horn
Loss of normal inhibitory modulation

Question 10

What are the advantages of paracetamol

Answer 10

Cheap, oral, safe, mild pain

Question 11

What are the disadvantages of paracetamol

Answer 11

Liver damage in overdose

Question 12

What are the advantages of NSAIDs

Answer 12

Cheap, generally safe, good for nociceptive pain

Question 13

What are the disadvantages of NSAIDs

Answer 13

Gastro and renal side side effects

Question 14

What are the advantages of Codeine

Answer 14

Cheap, safe good for mild acute nociceptive pain

Best given with paracetamol

Question 15

What are the disadvantages of Codeine

Answer 15

Constipation

Not good for neuropathic pain

Question 16

What are the advantages of Tramadol

Answer 16

Less resp depression
Can be used with opioids
Less constipating

Question 17

What are the disadvantages of Tramadol

Answer 17

Nausea
Vomiting
Controlled drug

Question 18

What are the advantages of Morphine

Answer 18

Cheap
Generally safe
Oral, IV, IM, SC,PR
Nociceptive pain
Cancer pain

Question 19

What are the disadvantages of Morphine

Answer 19

Constipation
Resp distress
Addiction and avoidance
Not good for neuropathic pain

Question 20

What are the advantages of Amitriptyline

Answer 20

Cheap
Safe in low dose
Good for neuropathic pain
Depression, poor sleep

Question 21

What are the disadvantages of Amitriptyline

Answer 21

Anti-cholinergic side effects

Long term- cognitive decline and dementia

Question 22

What type of pain do anti-convulsants work for

Answer 22

Neuropathic

Question 23

Name methods of pain assessment

Answer 23

Verbal rating score
Numerical rating score
Visual analogue scale
Smiling faces
Abbey scale (confused patients)
Functional assessment

Question 24

What is step 1 in the WHO analgesic pain relief ladder

Answer 24

Mild to moderate pain
Non-opioids- Aspirin
NSAIDs or paracetamol

Question 25

What is step 2 of the WHO analgesic pain relief ladder

Answer 25

Mild opioids- codeine with or without non-opioids

Question 26

What is step 3 of the WHO analgesic pain relief ladder

Answer 26

Strong opioids- morphine

With or without non-opioids

Question 27

What is the RAT approach to pain management

Answer 27

Recognise
Assess- severity, type
Treat