Mx Pain Older people and malignant disorders Flashcards
What are the dimensions of pain?
- Sensory discriminative (location, intensity, quality, duration)
- Affective-motivational (unpleasant, desire to avoid)
- Cognitive evaluative (feelings of distress and despair)
What is the lateral pain transmission system?
-Spinothalamic tracts
Location, intensity and quality of pain
What is the medial pain transmission system?
-Medulla
-Medial thalamus
-Hypothalamic nuclei
-Limbic
-Insula cortex
Emotion, arousal, attentions (i.e. unpleasant, affective dimensions)
What is adaptive v maladaptive pain?
Adaptive: contributes to survival by protecting organism from injury / promoting healing
Maladaptive: i.e. chronic pain = pain as a disease
What is chronic pain?
- Generally pain >3 months
- Persists longer than expected period of healing of tissue damage
- May be unprovoked
- Severity not correlated with degree of tissue damage
- may be considered disease in own right
Emotional problems associated with chronic pain?
Depression, anxiety, secondary gain
What is nociceptive pain?
- Most common mechanism e.g. injury, surgery
- Somatic and visceral
- Responsive to analgesia
What is neuropathic pain?
- Poster herpetic neuralgia, painful peripheral neuropathies, central post stroke pain
- Less responsive to conventional analgesia
- may respond to adjuvant strategies
What is functional pain?
- Fibro, IBS, interstitial cystitis, tension HAs
- Unclear aetiology
- Difficult to treat
What is psychological pain?
- Chronic pain frequently a/w depression, anxiety, anger
- Purely psychogenic pain rare
What are examples of pain intensity scales?
- Visual analogue scale
- Numerical rating scale
- Wong Baker Faces Scale
- Verbal rating scale
- Brief pain inventory (short form)
What are issues associated with opioid use?
- Physical tolerance
- Physical dependence
- Opioid dependence
What is physical tolerance?
- physiologic adaptation to the drug
- manifestation: increased disease required to produced same pharmacologic efffects
What is physical dependence?
- Physiologic adaptation to continuous presence of a substance
- Manifested by withdrawal syndrome if dose significantly lowers or stops
What is opioid dependence?
- Preoccupation with desire to obtain and take the drug
- persistent drug seeking behaviour
- Impairment of function and harm
What is pseudo addiction?
- Pain is poorly controlled
- Patient makes attempts to obtain analgesia that resembles drug seeking behaviour
- staff misinterpret as addictive behaviours thereby compromising pain management and undermining trust
What is breakthrough pain?
Exacerbation of chronic pain otherwise stable on continuous analgesia; manage with PRN analgesia
What is incident pain?
Pain occurring with or exacerbated by physical activity e.g. wound dressing. Manage with analgesia prior to the incident.
What are adjutant analgesics?
Drugs with primary indication other that pain that have analgesic properties in some painful conditions
e. g. -antidepressants
- anticonvulsants
- corticosteroids
- local anaesthetics
- NMDA antagonists
- calcitonin
- bisphosphonates
Which conditions are TCAs useful in?
TCA e.g. amitriptyline
- neuropathic pain
- fibromyalgia
- low back pain
- headaches
- IBS
SNRI usefulness in pain Mx?
- Neuropathic pain esp diabetic peripheral neuropathy
- fibro
What is the action of gabapentin and pregabalin?
a2y subunit of Ca++ channels: brain and dorsal horn.
What is the evidence for gabapentin and pregabalin in pain conditions?
Good: neuropathic pain, fibro
Some: low back pain with radiculopathy
No: non specific low back pain
What are non pharmacologic approaches to pain Mx?
- heat or cold
- PT
- Massage
- accupuncture
- relaxation and stress Mx
- TENS
- CBT
Services offered by PTs for management pain?
- therapeutic exercise
- TENS
- CT mobilisation techniques
- relaxation techniques
- gait aids/ techniques
- accupuncture
What are indications for a syringe driver?
- Inability to swallow
- Persistent nausea and vomiting
- Dysphagia
- Persistent fits
- Profound weakness
- Poor absorption
What are examples of non-drug treatments for cancer pain?
- TENS
- {T
- Accupuncture
- Relaxation therapy
What are common adjuvant analgesics for cancer pain?
- NSAIDs
- Corticosteroids
- Antidepressants / convulsants / antiarrhythmics
- Bisphosphonates
What are the indications for NSAIDs as adjuvants in cancer analgesia?
- Bone pain
- Soft tissue infiltration
- Hepatomegaly
What are the indications for corticosteroids as adjuvants in cancer analgesia?
- raised ICP
- Soft tissue infiltration
- Nerve compression
- Hepatomegaly
What are the indications for antidepressants / anti convulsants / antiarrhythmics as adjuvants in cancer analgesia?
- Nerve compression or infiltration
- Paraneoplastic neuropathies
