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PAIN Flashcards

1
Q

Describe ‘Somatic’ Pain

A
  • Well localised and sharp in nature

- Constant and increases with movement

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2
Q

Describe ‘Neuropathic’ Pain

A

Burning or electrical in nature

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3
Q

Describe ‘Breakthrough’ Pain

A

A transient increase in pain in patient who has stable persistent pain treated with opioids

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4
Q

What is ‘Allodynia’?

A

Pain by a stimulus that does not normally provoke pain

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5
Q

What is Parasthesia?

A

Tingling sensation

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6
Q

Neuropathic pain is a WHAT disorder?

A

Disorder of the Neurones

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7
Q

Over what time course does acute pain occur?

A

Less than 3 to 6 months

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8
Q

Over what time course does chronic pain occur?

A

More than 3-6 months or persisting beyond course of acute disease or after tissue healing

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9
Q

What is ‘referred pain’?

A

Pain from organ in body felt in different part of body - e.g swollen liver may cause pain in right shoulder due to inflammation pressing on nerves

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10
Q

Fibromyalgia is what?

A

Chemical/hormone imbalance leading to widespread pain

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11
Q

List two groups of drugs commonly used in pain relief in fibromyalgia

A

Antidepressants (Low dose TCAs, SSRIs, SNRIs) and Anticonvulsants (Carbamazepine, valproate, pregabalin)

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12
Q

What is first line treatment of BTP?

A

Oramorph - Low cost and trusted therapeutic profile

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13
Q

Only consider Fentanyl products when…

A

Intolerance of Morphine, patient can’t swallow or rapid onset and short duration of BTP

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14
Q

List four types of rating scare…

A
  • Verbal rating scale
  • Numerical rating scale
  • Visual analogue scale
  • Visual recognition scale
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15
Q

Name the questionnaire that allows patient to show position of pain, rate pain and rate type of pain…

A

McGill pain questionnaire

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16
Q

What are the 5 points for correct use of analgesics?

GENERAL THREE?

A

1) Oral
2) Regular intervals
3) Rx according to intensity as evaluated by scale of intensity of pain
4) Dosing adapted to individual - everyone diff
5) Constant concern for detail - provide patient with programme

Right drug, dose, time

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17
Q

State the 3 steps of the WHO analgesic ladder

A

1) Para +/- NSAID/ ADJUVANT
2) Step 1 + weak opioid
3) Step 1 + strong opioid

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18
Q

Why is it often good to prescribe paracetamol and codeine separately?

A

Allows stepping down to take place easily if needed

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19
Q

List the 3 main side effects from opioids…

A
  • Constipation
  • Nausea and vomiting
  • Respiratory depression
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20
Q

What is the safest COX-2 inhibitor in terms of CV risk?

A

Naproxen

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21
Q

What should be prescribed with Naproxen to minimise GI risks?

A

Omeprazole

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22
Q

List THREE things commonly associated with chronic pain that can cause further pain

A
  • Anxiety and depression
  • Loss of sleep
  • Muscle tension
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23
Q

What does CPSP stand for?

A

Central ‘post-stroke’ pain

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24
Q

What is CPSP?

A

Neurological disorder develops when CNS damaged. Brain registers all stimuli as pain.

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25
What is first line treatment for Neuropathic pain (except trigeminal neuralgia)?
TCAs (amitriptyline) or Gabapentioids (gabapentin, pregabalin)
26
Is Amitriptyline licensed for neuropathic pain?
NO
27
Duloxetine comes under what class of drug? and is used in the treatment of what type of pain?
SNRI - Neuropathic pain
28
What should be used in the treatment of localised neuropathic pain if the patient cannot tolerate oral treatments?
Capsaicin cream
29
What is first line pain treatment in Trigeminal Neuralgia? and what class of drug does this belong to?
Carbamazepine (anti-epileptic)
30
What adjuvant therapy can be used in treatment of bone pain?
Bisphosphonates (Pamidronate, clodronate, etidronate)
31
What topical treatments can be used in Post-herpetic neuralgia?
Lidocaine, capsaicin creams
32
What must be considered first of all before initiating opioids?
Is the patient Opioid naive or Not opioid naive?
33
Immediate release opioids should be given in __ hourly doses
4 hourly doses
34
Modified release opioids should be given in __ hourly doses
12 hourly doses
35
An opioid naive patient should be started on Morphine __-__mg daily
20-30mg daily
36
A patient switching from a weak opioid to a strong opioid should be on a starting dose of __ to __mg daily
40-60mg daily
37
BTP doses are rescue doses of immediate release morphine and should be given as _/_th to _/_th of the regular 24 hour dose and repeated as needed
1/10th to 1/6th of the 24 hour dose
38
If the patient is using their BTP dose of morphing more than ___ a day then the regular dose of morphine should be reviewed
Twice
39
Incremental increases of doses should not exceed __ to __ of the TDD in 24 hours
1/3rd to 1/2
40
100mg of Codeine PO is equal to __mg of Morphine PO
10mg
41
10mg of PO Morphine is equiv to __mg of IM,IV,SC Morphine
5mg
42
Why may a syringe driver be used? 5 reasons
- Persistant nausea and vom - Unable to swallow oral - Poor GI abs - Weakness or unconscious - Unstable symptoms e.g pain/nausa
43
Syringe drivers are... | IV, IM, PO, SC
SC
44
List 4 sites for syringe driver infusion...
1) Upper arm 2) Ant/Post chest wall 3) Abdomen 4) Thigh
45
Tramadol should be used in ____ for acute rescue therapy if needed
Those with neuropathic pain
46
Morphine use should be avoided in ___ pain unless advised by a specialist
Neuropathic pain
47
What is the maximum dose of paracetamol?
1g QDS
48
What is the maximum dose of ibuprofen daily?
2.4g daily
49
When starting Fentanyl an alternative analgesic therapy should be continued for at least the first ___ hours until therapeutic levels are achieved
12
50
Respiratory depression can be reversed by...
Naloxone
51
Anti emetics should be co-prescribed routinely with opioids for the first ___ days
4 or 5 days then review need thereafter
52
If a patient is on a regular opioid then they should be prescribed a laxative. Suggest one.
Co-danthramer (softener and stimulant) Lactulose and Senna (softener and stimulant) Docusate sodium and Senna (softener and stimulant) Dosage should be titrated to give a comfortable stool
53
What are TENS machines?
- Portable battery powered devices that generate small current to electrodes applied to skin - Electrodes placed at painful site or close to course of peripheral nerve innervating the painful area - Current passed until parathesia (tingling) felt at site of pain - Results in pain relief
54
Describe 'incident pain'
- Predictable - Could be movement based e.g sit up, remove dressing, coughing etc - Give when anticipate pain will happen - Give a potent opioid to manage
55
What monitoring requirements are needed for those being treated for pain?
- Levels of pain - Sleeping patterns - Side effects - constipation, sedation, dry mouth etc... - Ability to carry out daily activities - Mood
56
What is Post Herpetic Neuralgia? | What can be used to treat it?
Post-herpetic neuralgia is a persistent nerve pain that occurs at the site of a previous attack of shingles. - Topical lidocaine or capsaicin
57
Visceral pain can be described as what?
- Caused by damage to hollow organs and smooth muscle | - Usually referred
58
What is the recommended treatment for fibromyalgia?
- Non pharmacological: - Hot pool therapy - More or less exercise - CBT - Massage/relaxation - Pharmacological: - Analgesics - Anti-depressants (TCA) - Tramadol? Baclofen muscle spasms?
59
What is trigeminal neuralgia? What can be used to treat it? What else can be done?
- Abrupt, busrt severe pain provoked by touching trigger areas on one side of face - Carbemazapine can be used to treat it - Surgery to decompress 5th cranial nerve (if successful then slowly withdraw anti-epileptics)
60
The analgesic effect of NSAIDs should be seen within ____ whereas the anti-inflammatory effects of NSAIDs may not be seen until around ____ weeks
Analgesics: 1 week | Anti-inflammatory: 3 weeks
61
What are two effects of codeine that aren't related to analgesia?
- Cough suppressant | - Causes constipation
62
When starting fentanyl, an alternative analgesic therapy should be continued fro at least the first __ hours until therapeutic levels are achieved
12
63
Why is diamorphine good for parenteral administration?
- It is extremely water soluble so a high dose can be given in a small volume

DONE CLINICAL (10 decks)

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