Pain

Question 1

how many people live with persistent pain?

Answer 1

1 in 4

Question 2

what is the number 1 cause of years lost of disability?

Answer 2

low back pain

Question 3

what are the benefits for the patients physically for treating pain?

Answer 3

improved sleep, better appetite

fewer medical complications

Question 4

what are the benefits for the patients psychologically for treating pain?

Answer 4

reduced suffering

less depression and anxiety

Question 5

what are the benefits for the patients family for treating pain?

Answer 5

improved functioning as a family member

able to keep working

Question 6

what are the benefits for society for treating pain?

Answer 6

lower health costs

able to contribute to the community

Question 7

how can pain be classified in three ways?

Answer 7

duration - acute, chronic

cause - cancer, non cancer

mechanism - nociceptive, neuropathic

Question 8

when is pain classed as chronic?

Answer 8

more than 3 months

lasting after normal healing

Question 9

what is cancer pain?

Answer 9

progressive and can be a mixture of acute and chronic pain

Question 10

describe nociceptive pain?

Answer 10

obvious tissue injury
protective function
well localised

Question 11

describe neuropathic pain

Answer 11

nervous system damage
tissue injury may not be obvious
doesn’t have protective function
not well localised

Question 12

what nerve fibres carry pain?

Answer 12

A delta

C

Question 13

what chemicals are released after tissue injury?

Answer 13

prostaglandins

substance P

Question 14

where is the first relay statin for nociception?

Answer 14

dorsal horn

- and travels to opposite side of the spinal column

Question 15

where is the second relay station ?

Answer 15

thalamus

Question 16

what connections does the thalamus make in the brain?

Answer 16

cortex
limbic system
brainstem

Question 17

where does pain preception occur in the brain

Answer 17

cortex

- somatosensory cortex

Question 18

give some examples of conditions which cause neuropathic pain?

Answer 18

nerve trauma
diabetic pain
fibromyalgia
chronic tension headache

Question 19

what are the two type of abnormal sensitisation of nerves ?

Answer 19

peripheral

central

Question 20

what are two simple analgesics?

Answer 20

paracetamol

NSAIDs

Question 21

name a anticonvulsant?

Answer 21

gabapentin

Question 22

name an antidepressant?

Answer 22

amitriptyline

Question 23

what type of drug is ketamine?

Answer 23

NMDA receptor antagonist

Question 24

what medication can be used on the spinal cord for pain relief?

Answer 24

opioids

ketamine

Question 25

name some opioids

Answer 25

codeine morphine dihydrocodeine

Question 26

what medication can be used on the brain for pain relief?

Answer 26

paracetamol opioids amitriptyline clonidine

Question 27

what is a disadvantage of paracetamol in large quantities ?

Answer 27

liver damage

Question 28

name three NSAIDs?

Answer 28

aspirin ibuprofen diclofenac

Question 29

what are some disadvantages of NSAIDs?

Answer 29

Gastrointestinal and renal side effects plus sensitive asthmatics

Question 30

what is a disadvantage of codeine?

Answer 30

constipation

Question 31

what is a disadvantage of tramadol ?

Answer 31

nausea and vomiting

Question 32

what are disadvantages of morphine ?

Answer 32

constipation respiratory depression in high dose controlled drug

Question 33

what is a disadvantage of amitriptyline ?

Answer 33

Anti-cholinergic side effects (e.g. glaucoma, urinary retention)

Question 34

what type of pain are anti-convulsants good to treat?

Answer 34

neuropathic pain

Question 35

state some delivery routes for medication?

Answer 35

``` oral rectal sublingual subcutaneous transdermal intramuscular intravenous ```

Question 36

what is the RAT approach to pain management ?

Answer 36

recognise assess treat

Question 37

what assessments of the pain need to be done before treatment?

Answer 37

severity pain type physical, social and psychological factors