Pain

Question 1

1) What is allodynia?
2) What receptors detect damage or potential damage to tissues?
3) What is referred pain
4) Name 1 mechanism that can result in referred pain
5) What causes neuropathic pain?

Answer 1

1) When pain is experienced with sensory inputs that do not normally cause pain
2) Nociceptors
3) Pain that’s experienced in a location away from the site of tissue damage
4) Nerves may share the innervation of multiple parts of the body, pain in one area amplifies the sensitivity in the spinal cord to signals coming from other areas, activation of the SNS in response to pain results in pain in other areas
5) Abnormal functioning or damage of the sensory nerves

Question 2

What medications are indicated in each of the 3 steps of the WHO pain ladder?

Answer 2

Step 1: Paracetamol and NSAIDs
Step 2: Weak opioids i.e. codeine and tramadol
Step 3: Strong opioids i.e. morphine, oxycodone, fentanyl and buprenorphine

Question 3

Name 2 other drugs (and what kind of drugs they are) that may be used alongside the WHO ladder

Answer 3

• Amitriptyline – a tricyclic antidepressant
• Duloxetine – an SNRI antidepressant
• Gabapentin – an anticonvulsant
• Pregabalin – an anticonvulsant
• Capsaicin cream (topical) – from chilli peppers

Question 4

What are the 2 aspects of opioid treatment in palliative care?

Answer 4

• Background doses
• Rescue doses

Question 5

The rescue dose is usually what fraction of the background 24-hour dose?

Answer 5

1/6th

Question 6

For patients with primary chronic pain, what is the only drugs that should NOT be avoided to manage the pain (according to NICE guidelines)?

Answer 6

Antidepressants i.e. amitriptyline, duloxetine, SSRIs

Question 7

What are the 4 first line medication for neuropathic pain?

Answer 7

• Amitriptyline
• Duloxetine
• Gabapentin
• Pregabalin