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Medicine: Palliative Care > Pain > Flashcards

Pain Flashcards

1
Q

What is neuropathic pain?

A

Pain caused by a lesion or disease affecting somatosensory system and may lead to loss of function, increased pain sensitivity, and spontaneous pain.

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2
Q

What is breakthrough pain?

A

Transient exacerbation of pain, occurs spontaneously in relation to a specific trigger despite relatively stable background pain which is adequately controlled.

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3
Q

How long does breakthrough pain usually last?

A

Mean duration of 30 minutes.

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4
Q

How is pain assessed?

A
  1. Impact on quality of life
  2. Psychological wellbeing
  3. Sleep quality
  4. General function
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5
Q

What are the steps on the WHO pain relief ladder?

A
  1. Non-opioid +/- adjuvant
  2. Opioid for mild/moderate pain +/- non-opioid +/- adjuvant
  3. Opioid for moderate/severe pain (stop previous opioids) +/- non-opioid +/- adjuvant
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6
Q

What should be prescribed alongside strong opioids?

A

Regular laxatives and PRN anti-emetics

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7
Q

What are the options for adjuvant pain relief?

A

NSAIDs, amitriptyline, pregabalin, steroids, bisphosphonates, TENS, radiotherapy.

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8
Q

What is the first line strong opioid for those with normal renal function?

A

Morphine sulphate

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9
Q

What are the two options for prescribing morphine sulphate?

A
  1. Immediate release - Oramorph (10mg/5ml) or Sevredol tablets - lasts 4 hours
  2. Modified release capsules (Zomorph) or tablets (MST) - lasts 12 hours so give BD
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10
Q

What are the conversion factor for doses of oral morphine to these opioids?

  1. SC morphine
  2. Oral oxycodone
  3. SC diamorphine
  4. Oral codeine
A
  1. Divide by 2
  2. Divide by 2
  3. Divide by 3
  4. Times by 10
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11
Q

What is the conversion factor for oral oxycodone to SC oxycodone?

A

Divide by 2

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12
Q

What are the second and third line options if a patient is not tolerating morphine sulphate?

A

2nd line - Oxycodone

3rd line - syringe Alfentanil

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13
Q

What other pain relief should you prescribe as well as regular analgesia and why?

A

PRN opioid for breakthrough pain

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14
Q

How is the dose of breakthrough opioid pain relief calculated?

A

1/6th of the total 24 hour opioid dose

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15
Q

How many PRN opioid doses should make you consider changing the background pain relief doses?

A

> 3

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16
Q

What are the side effects of opioids?

A
  1. Nausea, vomiting (usually subsides after 5 days)
  2. Constipation (usually ongoing)
  3. Drowsiness, dry mouth
17
Q

What is this a presentation of?
Drowsiness, confusion, myoclonic jerks, hallucinations, respiratory depression, pinpoint pupils, recent pain relief change.

A

Opioid toxicity

18
Q

What is the first line opioid pain relief in severe renal impairment?

A

Alfentanil

19
Q

What are the first line opioid pain relief options in mild to moderate renal impairment?

A

Fentanyl and Oxycodone

Medicine: Palliative Care (5 decks)

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