Pain Flashcards
Pain in Sickle cell disease
Mild- Paracetamol/NSAID/Codiene
Severe: Morphine/Diamorphine
Avoid pethidine as seizures can occur
Dysmenorrhoea Pain
Oral contraceptives prevents the pain
Paracetamol/NSAID provide adequate pain relief
Chronic pain duration
> 12 weeks
Opioid use in chronic pain
Mild-moderate: Codeine
Moderate-Severe - Morphine or oxycodone
Should only be used short term
Tolerance and dependence can occur with long term use
Adjuvant analgesics in chronic pain
Antidepressants
anti epileptics
BDZ
Muscle relaxants
Sciatica/Back pain
1st line- NSAIDs (if not tolerated/CI - weak opioid with/without paracetamol)
Examples of neuropathic pain
Phantom limb
Peripheral neuropathies (e.g. diab)
Chronic excessive alcohol intake
HIV infection
Chemotherapy
Trauma
Postherpectic neuralgia (shingles)
Neuropathic pain options
Amitriptyline or Gabpentin or pregabalin or nortriptyline
can use combinations if not effective at max dose alone
Trigeminal neuralgia
Surgery is often required but during the acute stages can use carbamazepine
Cluster headaches treatment
SC sumatriptan injection or if unsuitable sumatriptan/zolmitriptan nasal spray
Prophylaxis of cluster headaches
Consider if frequent, last >3 weeks or cannot be treated effectively
Verapamil or lithium
Pred can be used short term mono therapy/ with verapamil during verapamil titration
Migraine prophylaxis
1st line : Propranolol (if unsuitable switch to another BB LIKE METOPROLOL, ATENOLOL OR NADOLOL). Bisopolol can be used if if already taking for cardiac reasons
Topirmate also can be but women need highly effective contraception
How long do you need to try migraine prophylaxis for
at least 3 months at max tolerated dose before assessing the effectiveness.
A good response is a 50% reduction in the severity and frequency of migraine attacks.
Why is diamorphine sometimes preferred than morphine
Diamorphine has a greater solubility that allows smaller volumes to be used
Why are patches not suitable for patients with acute pain
May need dose changes and rapid dose changes
Counselling on opioid patches
1) Avoid touching the adhesive side and wash hands after application
2) Do not cut patches
3) Remove old patch before applying new patch
4) Apply to dry non irritated non hairy skin
5) Avoid exposure to external heat
Morphine risks
QT prolongation
Signs of opioid toxicity
Pin point pupils
Nausea and vomiting
reduced consciousness
Constipation
respiratory depression
