Pain Flashcards
Measure pain?
Pain scale 1-10
• faces for children
Non-opioid analgesia
- Paracetamol
- NSAIDs/COX-2 inhibitors
- Topical treatments
- Capsaicin
- Lidocaine
Opioids analgesia for mild/mod pain
- weak opioids - limited potency at mu receptor
- Codeine
- dihydrocodeine
- tramadol
Opioid analgesia mod/severe pain
- strong opioids
- high potency at mu receptor
- Morphine
- diamorphine
- oxycodone
- fentanyl
Strong opioid eg
- morhpine
- diamorphine
- oxycodone
- fentanyl
Weak opioid eg
- codeine
- tramadol
- dihydrocodeine
considerations surrounding opioid analgesia
- metabolism
- SE
- renal function
- dependence/addiction
opioid SE
- Constipation
- N&V
- drowsiness
- drowsiness
- sedation
- respiratory depression
Adjuvant therapy
- anti-epileptic drugs
- antidepressants
- dexamethasone for bone pain in palliative care
- non-pharmaceutical strategies
non pharmaceutical strategies for pain relief
- physiotherapy
- exercise
- psychological therapy
- acupuncture
chronic pain classification?
- musculoskeletal
- neuropathic
- non-specific persistent pain
- chronic headache syndrome
Musculoskeletal pain eg
- mechanical pain
- osteoarthritis
- lower back pain
- rheumatoid arthritis
Lower back pain/ sciatica
- low back pain that is not associated with serious or potentially serious causes
- sciatica - leg pain secondary to lumbosacral nerve root pathology
- worldwide lower back pain causes more disability than any other condition
Sciatic is?
leg pain 2º to lumbosacral nerve root pathology
Lower back pain/sciatica treatment
- continue normal activities
- group exercise programs
- manual therapies
- psychological therapy
- oral NSAID
- if NSAID CI weak opioid +/- paracetamol for ACUTE pain only
- surgical treatments
Surgical treatments for lower back pain/sciatica
- radiofrequency denervation
* spinal cord stimulation
Sciatica specfic treament
- epidural injections (local anaesthetic + corticosteroid),
* spinal decompression surgery
Ostheoarthritis
- most common form
- breakdown of cartilage in the joints, commonly hips, knees, hands, lower back and neck
- symptoms
symptoms of osteoarthritis
- joint pain during and after activity
- initial limited range of of motion
- clicking or cracking in joints
- swelling around joints
- muscle weakness around joint
- instability of the joint
osteoarthritis treatment
- exercise and manual therapy
- weight loss if overweight/obese
- paracetamol +/- topical NSAID
- topical capsaicin
- if the above are ineffective, consider oral NSAID/COX2 inhibitor
- intra-articular corticosteroid
Rheumatoid Arthritis what?
- autoimmune disease
- inflammation of synovium
- leads to erosion and deformation of the affected joints
- can affect other tissues
Rheumatoid arthritis symptoms
- symmetrical pain and swelling of small joint in hands and feet lasting >6weeks
- spread to larger joints
- joints may be warm and tender
- stiffness on waking/after inactivity
- fatigue, fever and loss of appetite
Treat to target monotherapy
- methotrexate
- leflunomide
- sulfasalazine
treat to target in mild or palindromic disease
hydroxychloroquine as alternative to MTX/leflunomide