Lecture 4 Essential Pain Management Flashcards
What is Nociceptive pain
Pain from physical damage
Well localised
What is Neuropathic pain
Pain caused by damage or disease affecting the somatosensory nervous system
Not well localised
What is acute pain
Pain of recent onset and probably limited duration
What is chronic pain
Pain lasting for more than 3 months and lasting after healing
What is the first relay station of pain physiology
Dorsal horn
What is the second relay station of the pain physiology
Thalamus
What nerve fibre carries Noxious (Pain) Stimulus
Small (Peripheral Nerve Fibres)
Ad
C
What nerve fibres carry distractive stimulus (rubbing
Large (Peripheral Nerve Fibres)
Aa
Ab
What are the pathological mechanisms of neuropathic pain
Increased receptor numbers
Abnromal sensitisation of nerves
Chemical changes in the dorsal horn
Loss of normal inhibitory modulation
What are the advantages of paracetamol
Cheap, oral, safe, mild pain
What are the disadvantages of paracetamol
Liver damage in overdose
What are the advantages of NSAIDs
Cheap, generally safe, good for nociceptive pain
What are the disadvantages of NSAIDs
Gastro and renal side side effects
What are the advantages of Codeine
Cheap, safe good for mild acute nociceptive pain
Best given with paracetamol
What are the disadvantages of Codeine
Constipation
Not good for neuropathic pain
What are the advantages of Tramadol
Less resp depression
Can be used with opioids
Less constipating
What are the disadvantages of Tramadol
Nausea
Vomiting
Controlled drug
What are the advantages of Morphine
Cheap Generally safe Oral, IV, IM, SC,PR Nociceptive pain Cancer pain
What are the disadvantages of Morphine
Constipation
Resp distress
Addiction and avoidance
Not good for neuropathic pain
What are the advantages of Amitriptyline
Cheap
Safe in low dose
Good for neuropathic pain
Depression, poor sleep
What are the disadvantages of Amitriptyline
Anti-cholinergic side effects
Long term- cognitive decline and dementia
What type of pain do anti-convulsants work for
Neuropathic
Name methods of pain assessment
Verbal rating score Numerical rating score Visual analogue scale Smiling faces Abbey scale (confused patients) Functional assessment
What is step 1 in the WHO analgesic pain relief ladder
Mild to moderate pain
Non-opioids- Aspirin
NSAIDs or paracetamol
What is step 2 of the WHO analgesic pain relief ladder
Mild opioids- codeine with or without non-opioids
What is step 3 of the WHO analgesic pain relief ladder
Strong opioids- morphine
With or without non-opioids
What is the RAT approach to pain management
Recognise
Assess- severity, type
Treat
