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Anaesthetics, Geriatrics and Genetics > Pain > Flashcards

Pain Flashcards

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1
Q

What are the benefits of treating pain?

A 
Improved sleep, better appetite 
Fewer medical complications 
Reduced suffering 
Less depression, anxiety 
Improved functioning as a family member 
Able to keep working 
Lower health costs 
Able to contribute to community
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2
Q

What factors are used to classify pain?

A

Duration
Cause
Mechanism

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3
Q

How is acute pain defined?

A

Pain of recent onset and probable limited duration

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4
Q

How is chronic pain defined?

A

Pain lasting for more than 3 months
Pain lasting after normal healing
Often no identifiable cause

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5
Q

What is the difference between cancer and non-cancer pain?

A

Progressive

May be mixture of acute and chronic

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6
Q

How is nocicepetive pain described?

A

Sharp or dull

Well localised

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7
Q

How is neuropathic pain described?

A

Burning, shooting +/- numbness, pins and needles

Not well localised

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8
Q

What are the 4 steps in pain physiology?

A

Periphery
Spinal cord
Brain
Modulation

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9
Q

What is the pathway of pain in the periphery?

A

Tissue injury
Release of chemicals (prostaglandins etc)
Stimulation of pain receptors (nociceptors)
Signal travels in A(alpha) or C nerve to spinal cord

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10
Q

What is the pathway of pain in the spinal cord?

A

Dorsal horn is the first relay station
A(alpha) or C nerve synapses with second nerve
Second nerve travels up opposite side of spinal cord

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11
Q

What is the pathway of pain in the brain

A

Thalamus is the second really station
Connections to many parts of the brain (cortex, limbic system, brainstem)
Pain perception occurs in the cortex

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12
Q

What is the pathway of pain in modulation?

A

Descending pathway from brain to dorsal horn

Usually decreases pain signal

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13
Q

What are some examples of neuropathic pain?

A

Nerve trauma, diabetic pain (damage)

Fibromyalgia, chronic tension headache (dysfunction)

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14
Q

What is neuropathic pain?

A

Abnormal processing of pain signal

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15
Q

What are the pathological mechanisms of pain?

A

Increased receptor numbers
Abnormal sensitisation of nerves (peripheral, central)
Chemical changes in the dorsal horn
Loss of normal inhibitory modulation

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16
Q

What are some examples of simple analgesics?

A

Paracetamol (acetaminophen)

NSAIDs (diclofenac, ibuprofen)

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17
Q

What are some examples of opiods?

A 
Codeine
Dihydrocodeine 
Morphine 
Oxycodone 
Fentanyl
18
Q

What are some other examples of analgesics used?

A

Tramadol (mixed opiate and 5HT/NA reuptake inhibitor)
Antidepressants (amitriptyline, duloxetine)
Anticonvulsants (gabapentin)
Ketamine (NMDA receptor antagonist)
Local anaesthetic
Topical agents (capsaicin)

19
Q

What are the treatment options for peripheral pain?

A

Non-drug treatments (rest, ice, compression, elevation)
NSAIDs
Local anaesthetic

20
Q

What are the treatment options for spinal cord pain?

A

Non-drug treatments (acupuncture, massage, TENS)
Local anaesthetics
Opioids
Ketamine

21
Q

What are the treatment options for brain pain?

A 
Non-drug treatments (psychological) 
Paracetamol 
Opioids 
Amitriptyline 
Clonidine
22
Q

What are the advantages of paracetamol?

A

Cheap
Safe
Can be given orally, rectally or IV
Good for mild pain (by itself) or mod-severe pain (with other drugs)

23
Q

What are the disadvantages of paracetamol?

A

Liver damage in overdose

24
Q

What are the advantages of NSAIDs?

A

Cheap
Generally safe
Good for nociceptive pain

25
Q

What are the disadvantages of NSAIDs?

A

Gastrointestinal and renal side effects plus sensitive asthmatics

26
Q

What are the advantages of codeine?

A

Cheap
Safe
Good for mild-mod acute nociceptive pain

27
Q

What are the disadvantages of codeine?

A

Constipation

Not good for chronic pain

28
Q

What are the advantages of tramadol?

A

Less respiratory depression
Can be used with opioids and simple analgesics
Not a controlled drug

29
Q

What are the disadvantages of tramadol?

A

Nausea and vomiting

30
Q

What are the advantages of morphine?

A 
Cheap 
Generally safe 
Can be given orally, IV, IM, SC 
Effective if given regularly 
Good for mod-severe acute nociceptive pain and chronic cancer pain
31
Q

What are the disadvantages of morphine?

A

Constipation
Respiratory depression in high dosage
Misunderstandings about addiction
Controlled drug

32
Q

What are the advantages of amitriptyline?

A

Cheap
Safe in low doses
Good for neuropathic pain
Also treats depression, poor sleep

33
Q

What are the disadvantages of amitriptyline?

A

Anti-cholinergic side effects (glaucoma, urinary retention)

34
Q

What are some examples of anticonvulsant drugs?

A

Carbamazapine (Tegretol)
Sodium valproate (Epilim)
Gabapentin (Neurotonin)

35
Q

What are the delivery routes for medication?

A 
Oral 
Rectal 
Sublingual 
Subcutaneous 
Transdermal 
Intramuscular 
Intravenous
36
Q

What are the delivery routes for local anaesthetics?

A 
Epidural (+/- opiates) 
Intrathecal (+/- opiates) 
Wound catheters 
Nerve plexus catheters 
Local infiltration of wounds
37
Q

How is pain assessed?

A 
Verbal rating score 
Numerical rating score 
Visual analogue score 
Smiling faces 
Abbey pain scale (for confused patients)
38
Q

What are the physical non-drug treatments?

A 
Rest 
Ice 
Compression 
Elevation 
Surgery 
Acupuncture 
Massage 
Physiotherapy
39
Q

What are the psychological non-drug treatments?

A

Explanation
Reassurance
Counselling

40
Q

What is the RAT approach to pain management?

A

Recognise
Assess (severity, type, other factors)
Treat (drug/non-drug)

41
Q

What is the treatment for nociceptive pain?

A

Mild (paracetamol +/- NSAIDs)
Moderate (paracetamol +/- NSAIDs + codeine/alternative)
Severe (paracetamol +/- NSAIDs + morphine)

Anaesthetics, Geriatrics and Genetics (14 decks)

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