Pain

Question 1

Define Pain

Answer 1

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

Question 2

State the number of people who live with persistent pain

Answer 2

1 in 4

Question 3

State the number one disease for years lost to disability worldwide

Answer 3

Lower back pain

Question 4

State the physical benefits of treating pain

Answer 4

Improved sleep, better appetite, fewer medical complications

Question 5

State the psychological benefits of treating pain

Answer 5

Reduced suffering, less depression, anxiety

Question 6

Acute pain

Answer 6

Pain of recent onset and probable limited duration usually from inflammed and damaged tissues

Question 7

Chronic pain

Answer 7

Lasts longer than 3 months and lasts after normal healing which tends to be more neuropathic

Question 8

Cancer pain

Answer 8

Progressive, and may be a mixture of acute and chronic (mixture of nociceptive, neuropathic pain

Question 9

Nociceptive pain

Answer 9

Pain resulting from obvious tissue injury or illness. Often due to protective function. Can be described as sharp and dull and is always well localised.

Question 10

Neuropathic pain

Answer 10

Nervous system damage or abnormality. Described as burning, shooting and numbness, pins and needles. It it never well localised.

Question 11

State the chemicals released to cause pain

Answer 11

Prostaglandins, Substance P

Question 12

Describe pain in the periphery

Answer 12

Tissue injury

Release of chemicals e.g. Prostaglandins, Substance P

Stimulation of pain receptors (nociceptors)

Signal travels in Aδ or C nerve to spinal cord

Question 13

Describe pain in spinal chord

Answer 13

Dorsal horn is the first relay station

Aδ or C nerve synapses (connects) with second nerve

Second nerve travels up opposite side of spinal cord

Question 14

Describe pain in the brain

Answer 14

Thalamus is the second relay station

Connections to many parts of the brain
Cortex
Limbic system
Brainstem

Pain perception occurs in the cortex

Question 15

Describe pain modulation

Answer 15

Descending pathway from brain to dorsal horn

Usually decreases pain signal

Question 16

State some example of neuropathic pain

Answer 16

Nerve trauma, diabetic pain, fibromyalgia, chronic tension headache

Question 17

State the pathological mechanisms of neuropathic pain

Answer 17

Increased receptor numbers

Abnormal sensitisation of nerves

Chemical changes in the dorsal horn

Loss of normal inhibitory modulation

Question 18

State the treatment of periphery pain

Answer 18

Rest, ice, compression, elevation, NSAIDs, local anaesthetics

Question 19

State the treatments that act on pain signals in the spinal chord

Answer 19

Acupuncture, massage, TENS, local anaesthetics, opioids (inhibit the passage of the pain signal), ketamine (prevent requirement of dose increasing of opiates NMDA receptor antagonist)

Question 20

State the treatments of pain in the brain

Answer 20

Psychological 
Paracetamol
Opioids
Amitriptyline (alpha agonist) 
Clonidine

Question 21

State the advantages of paracetamol

Answer 21

Cheap, safe

Can be given orally, rectally or intravenously

Question 22

What is paracetamol good for

Answer 22

Mild pain and moderate to severe pain

Question 23

State the disadvantages of paracetamol

Answer 23

Liver damage in overdose

Question 24

NSAIDs advantages

Answer 24

Cheap and generally safe and good for nociceptive pain (best given regularly with paracetamol)

Question 25

State the disadvantages of NSAIDs

Answer 25

Gastrointestinal and renal side effects plus sensitive asthmatics

Question 26

State the advantages of codeine

Answer 26

Cheap, safe | Good for mild-moderate acute nociceptive pain

Question 27

State the disadvantages of codeine

Answer 27

Constipation | Not good for chronic pain

Question 28

State the advantages of morphine

Answer 28

Cheap, generally safe Can be given orally, IV, IM, SC Effective if given regularly

Question 29

What is morphine good for

Answer 29

Mod-severe acute nociceptive pain (e.g. post-op pain) | Chronic cancer pain

Question 30

State the disadvantages of morphine

Answer 30

Constipation Respiratory depression in high dose Misunderstandings about addiction Controlled drug

Question 31

What is tramadol

Answer 31

Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake

Question 32

State the advantages of tramadol

Answer 32

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

Question 33

State the disadvantages of tramadol

Answer 33

Nausea and vomiting

Question 34

How does amitriptyline work

Answer 34

Increases descending inhibitory pathway

Question 35

State the advantages of amitriptyline

Answer 35

Cheap, safe in low dose Good for neuropathic pain Also treats depression, poor sleep

Question 36

State the disadvantages of amitriptyline

Answer 36

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

Question 37

State the anticonvulsant drugs used in pain management

Answer 37

Carbamazepine (Tegretol) Sodium valproate (Epilim) Gabapentin (Neurontin)

Question 38

How do anticonvulsants work in pain relief

Answer 38

Membrane stabilisers and so reduce abnormal firing of nerves making them good for neuropathic pain

Question 39

Step 1 WHO health ladder (mild to moderate pain)

Answer 39

Non-opioids - aspirin, NSAIDS or paracetamol

Question 40

Step 2 WHO health ladder (moderate to severe pain)

Answer 40

Mild opioids (codiene) with or without non-opioids

Question 41

Step 3 WHO pain relief ladder

Answer 41

Severe pain, treat with strong opioids with or without non-opioids

Question 42

How should Neuropathic pain be treated

Answer 42

use other drugs early (amitriptylline, gabapentin and duloxetine)