Pain Flashcards
Definition of primary pain
No obvious cause or pain is out of proportion to any obvious injury/disease
Definition of secondary pain
Caused by an underlying condition
How often should pain relief for chronic pain be reviewed?
At least annually
Definition of chronic pain
pain >12 weeks
Why are fixed dose combination products containing low-dose opioids not used in chronic pain?
Increase side effect burden without offering additional pain relief
Describe the licensing for opioid use in pain
To be used short-medium term for when other therapies have been insufficient in chronic non-malignant pain
What is the paracetamol dosing in a 6-7 year old child?
240- 250mg every 4-6 hours. Max 4 doses in 24 hours
What is the paracetamol dosing in a neonate 28-32 weeks corrected gestational age?
20mg/kg for 1 dose. Then 10-15mg/kg every 8-12 hours. Max 30mg/kg in 24 hours
What is the paracetamol dosing in a neonate 32+ weeks corrected gestational age?
20mg/kg for 1 dose. Then 10-15mg/kg every 6-8 hours. Max 60mg/kg in 24 hours
What is the paracetamol dosing in a child aged 1-2 months?
30-60mg every 8 hours. Max 60mg/kg in 24 hours
What is the paracetamol dosing in a child aged 3-5 months?
60mg every 4-6 hours. Maximum 4 times daily
What dose of opioids (morphine equivalent) requires a specialist pain referral?
> 90mg OD
Which NSAID has the weakest anti-inflammatory properties?
Ibuprofen
Which NSAIDs are associated with a particularly increased thrombotic risk?
High dose ibuprofen and diclofenac, selective COX-2 inhibitors
Which NSAID is licensed for pain associated with acute gout?
Etorcoxib
Which NSAID has the highest risk of GI side effects?
Piroxicam
What is Celecoxib licensed for?
Licensed for rheumatoid arthritis, ankylosing spondylitis and osteoarthritis
Which of the NSAIDs is superior to that of Naproxen but has a high SE profile including GI disturbances, dizziness and headaches?
Indomethacin
Which class of NSAIDs have a higher risk of GI side effects?
Non-selective COX-2 inhibitors
Which NSAID is associated with diarrhoea and haemolytic anaemia?
Mefenamic acid
Which NSAID is associated with a lower thrombotic risk than others?
Naproxen
From what point of pregnancy is it advised NSAIDs aren’t used?
Should be avoided from 20 weeks
Which trimester are NSAIDs completely contra-indicated in?
3rd trimester (week 28)
What is a fundoscopy?
Investigation that looks at the optic nerve and retina (back of eye)
What does the SNOOP mnemonic stand for?
S- systemic signs and disorders
N- neurological symptoms
O- onset new or changed or onset >50 years old
O- Onset in thunderclap presentation
P- Pappiloedema, pulsative tinnitus, positional provocation, precipitated by exercise
What are the symptoms of an aura associated with migraine?
Visual symptoms, sensory symptoms e.g., pins and needles + numbness, dysphasia
Chronic migraine definition
Occurs on >15 days of the month, with 8 of those days demonstrating migraine characteristics + lasts >3 months.
Episodic migraine definition
episodes occur <15 days a month
Why are migraines more common in females?
Can correlate with drop in ostrogen before period
Complication of migraine
Medication overuse headache
Symptoms of migraine
Unilateral, pulsating headache, severe enough to interupt daily activities
How long should a headache diary be kept for?
Minimum 8 weeks
When should a 5-HT1- receptor agonist be taken in migraines associated with aura?
At start of headache, not aura.
When is nasal zolmitriptan and s/c sumatriptan indicated?
severe migraines or those who present with early vomiting
How many days is migraine treatment restricted to a week?
2 days
Second-line for migraines
Paracetamol
Treatment for acute migraine if monotherapy fails
Naproxen + sumatriptan
Fourth line treatment option for migraines
Rimegepant
Which anti-emetics can be used for pain associated with migraine in addition to their use in nausea?
Metoclopramide and prochlorperazine
Which antiemetics are used in migraine?
Metoclopramide, prochlorperazine, and domperidone
1st line for prophylaxis of migraine
Propranolol
2nd line for prophylaxis of migraine
Topirimate
3rd line for prophylaxis of migraine
Amitriptyline
4th line for prophylaxis of migraine
Candesartan
What antiepileptic can be used in migraine prophylaxis?
Sodium valproate in >55 years old
Which type of headache may present as a worsening of headache in the morning?
Idiopathic intracranial hypertension
Which 5HT-1 agonist is preferred in prophylaxis of pre-mesntrual migraine syndromes?
Frovatriptan- Given 2 days before menstruation and stopped 3 days after starting menstruation
Which headache is most likely to present with autonomic symptoms such as blood shot eye, runny nose, watery eye?
Cluster headache
1st line therapy for cluster headaches?
S/C sumatriptan
2nd line therapy for cluster headaches?
nasal Sumatriptan/ Zolmitriptan
What additional treatment can be used other than 5-HT1 agonists in the treatment of cluster headaches?
100% O2
Which steroid can be used in prophylaxis of cluster headaches?
Prednisolone
1st line for cluster headache prophylaxis
Verapamil or lithium
Which headache disorder may present as pulsatile tinnitus?
Idiopathic intracranial hypertension
Which headache disorder may present as photosensitivity?
Subarrachnoid haemhorrage
