Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anaesthetics > Pain > Flashcards

Pain Flashcards

1
Q

Define pain

A

An unpleasant sensory + emotional experience associated with actual or potential tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Benefits of treating pain

A

Physical

  • Improved sleep, better appetite
  • Fewer medical complications (e.g. MI, pneumonia)

Psychological

  • Reduced suffering
  • Less depression + anxiety

For Society

  • Lower health costs(e.g. shorter hospital stay
  • Able to contribute to community
  • Able to work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3 ways of classifying pain

A
  • Duration
  • Cause
  • Mechanism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

3 ways of classifying pain duration

A
  • Acute
  • Chronic
  • Acute on chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 ways of classifying the cause of pain

A
  • Cancer

- Non-cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 ways of classifying the mechanism of pain

A
  • Nociceptive

- Neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define acute and chronic pain

A

Acute
-Pain of recent onset + probable limited duration

Chronic

  • Pain lasting > 3 months
  • Pain lasting after normal healing
  • Often no identifiable cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe cancer and non-cancer pain

A

Cancer

  • Progressive
  • May be a mix of acute + chronic

Non-cancer

  • Many different causes
  • Acute or chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define nociceptive pain

A

-Obvious tissue injury or illness
-Protective function
-Description
Sharp +/- dull
Well localised
-Also called physiological or inflammatory pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define neuropathic pain

A

-Nervous system damage/abnormality
-No protective function
-Description
Burning, shooting +/- numbness, pins and needles
Not well localised
-Tissue injury may not be obvious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

4 steps in pain physiology

A
  • Periphery
  • Spinal cord
  • Brain
  • Modulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s involved in the periphery step of pain

A
  • Tissue injury
  • Release of chemicals (prostaglandins, substance P)
  • Stimulation of nociceptors
  • Signal travels in A-delta or C nerve fibres to spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What’s involved in the spinal cord step of pain

A
  • Dorsal horn in the 1st relay station
  • A-delta or C nerve fibre synapses with 2nd nerve
  • 2nd nerve travels up OPPOSITE side of spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What’s involved in the brain step of pain

A

-Thalamus is the secondary relay station
-Connections to many parts of brain
Cortex
Limbic system
Brainstem
-Pain perception occurs in cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What’s involved in the modulation step of pain

A
  • Descending pathway from brain to dorsal horn

- Usually decreases pain signal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the gate control theory

A
  • Non-painful input closes the “gates” to painful input
  • Which prevents pain sensation from traveling to the central nervous system
  • Therefore, stimulation by non-noxious input is able to suppress pain (hit head then rubbing the spot you hit)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

4 examples of neuropathic pain

A
  • Nerve trauma
  • Diabetic neuropathy
  • Fibromyalgia
  • Chronic tension headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

4 pathological mechanisms of neuropathic pain

A
  • Increased receptor numbers
  • Abnormal sensitisation of nerves (peripheral + central)
  • Chemical changes in dorsal horn
  • Loss of normal inhibitory modulation
19
Q

2 broad categories of analgesics

A
  • Simple analgesics

- Opioids

20
Q

3 simple analgesics

A
  • Paracetamol
  • Ibuprofen (NSAID)
  • Diclofenac (NSAID)
21
Q

5 opioids

A
  • Codeine
  • Dihydrocodeine
  • Morphine
  • Oxycodone
  • Fentanyl
22
Q

5 other analgesics

A
  • Tramadol (mixed opiate + 5HT/NA reuptake inhibitor)
  • Amitriptyline. Duloxetine (antidepressant)
  • Gabapentin (anticonvulsant)
  • Ketamine (NMDA receptor antagonist)
  • Capsaicin (topical agent)

+ Local anaesthetics

23
Q

3 treatments for pain affecting the periphery step

A
  • Non-drug treatment (rest, ice, compression, elevation)
  • NSAID
  • Local anaesthetics
24
Q

4 treatments for pain affecting the spinal cord step

A 
-Non-drug treatment 
Massage, TENS "acupuncture"
-Opioids 
-Ketamine 
-Local anaesthetics
25
Q

4 treatments for pain affecting the brain step

A 
-Non-drug 
Psychological 
-Paracetamol 
-Opioids
-Amitriptyline
26
Q

Pros + cons of paracetamol

A

Pros

  • Cheap + safe
  • Can be give orally, rectally or IV
  • Good for Mild pain (by itself) + mod-severe pain (with other drugs)

Cons
-Liver damage in overdose

27
Q

3 types of NSAIDs

A
  • Aspirin
  • Ibuprofen
  • Diclofenac
28
Q

Pros + cons of NSAIDs

A

Pros

  • Cheap, generally safe
  • Good for nociceptive pain (best given regularly with paracetamol [synergism] )

Cons
-GI + renal SE + sensitive asthmatics

29
Q

Pro + cons of codeine

A

Pros

  • Cheap, safe
  • Good for mild-severe acute nociceptive pain (best given regularly with paracetamol)

Cons

  • Constipation
  • Not good for chronic pain
30
Q

Pros + cons of Tramadol

A
  • Less resp. depression
  • Can be used with opioids + simple analgesics
  • Not a controlled drug

Cons
-Nausea + vomiting

31
Q

Pros + cons of morphine

A 
Pros 
-Cheap, generally safe 
-Can be given orally, IV, IM, SC 
-Effective if given regularly 
-Good for:
Mod-severe acute nociceptive pain (e.g. post-op)
-Chronic cancer pain

Cons

  • Constipation
  • Resp. depression in high dose
  • Controlled dose
  • Misunderstanding about addiction
32
Q

Pros + cons of amitriptyline

A

Pros

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

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

33
Q

3 examples of anticonvulsant drugs used to treat pain and their advantage

A
  • Carbamazepine
  • Sodium valproate
  • Gabapentin
34
Q

5 delivery routes of local analgesia

A
  • Epidural (+/- opiates)
  • Intrathecal (+/- opiates)
  • Wound catheters
  • Nerve plexus catheters
  • Local infiltration of wounds
35
Q

5 methods of pain assessment

A
  • Verbal rating score
  • Numerical rating score
  • Visual analogue scale
  • Smiling faces
  • Abbey pain scale (for confused patients)
36
Q

Non-drug treatment of pain

A

Physical

  • RICE
  • Surgery
  • Massage, physiotherapy, “acupuncture”

Psychological

  • Explanation
  • Reassurance
  • Counselling
37
Q

How to treat acute and neuropathic pain

A
  • Acute, Use WHO analgesic ladder

- Neuropathic, use alternative analgesics and/or non-drug treatments

38
Q

Describe the WHO analgesic ladder

A 
Step 1 (mild-moderate pain)
-Non-opioids (NSAIDs + Paracetamol)
Step 2 (moderate to severe pain)
-Mild opiates (e.g. codeine with/without non-opioids
Step 3 (severe pain)
-Strong opioids (e.g. morphine) with/without non-opioids
39
Q

What to do when pain resolves

A
  • Move from top to middle of WHO ladder
  • Continue bottom rung drugs at all times
  • Lastly stop NSAIDs, then paracetamol, as more adverse effects with NSAIDs
40
Q

Describe the RAT approach to pain management

A

-Recognise
-Assess
Severity
Type
Other factors (other illnesses, anger, anxiety, depression, lack of support)
-Treat (drug/non-drug)

41
Q

How to asses severity of pain

A

-Pain score (at rest + moving)
-How is it affecting the patient
Can they move, cough, work?

42
Q

How to assess pain type

A

-Acute/chronic (time)
-Cancer/non-cancer
-Nociceptive/neuropathic
Burning, shooting, numbness, pin + needles, phantom limb all = neuropathic

43
Q

How to treat mild, moderate and severe pain

A
  • Mild = Paracetamol (+/- NSAIDs)
  • Moderate = Codeine/alternative + Paracetamol (+/- NSAIDs)
  • Severe = Morphine + Paracetamol (+/- NSAIDs)

Anaesthetics (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions