Brainscape's Knowledge GenomeTM

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


See full index

Palliative Medicine > Pain > Flashcards

Pain Flashcards

Controlling pain in palliative patient

1
Q

What is meant by ‘total pain’?

A

Pain has 4 dimensions to it.

  1. Physical: pain, symptoms, fatigue, side effects
  2. Social: loss of social position, job prestige, role in family, feeling abandoned and isolated
  3. Spiritual: why am I suffering like this, what’s the point in life, can I be forgiven for actions in life?
  4. Psychological: anger at delays and treatment which doesn’t work, fear of pain, fear of death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If a patient is in acute pain, what signs will they show?

A

More of a physical response

Sympathetic response (fight or flight)
Pupillary dilation
Sweating
Tachypnoea
Tachycardia
Shunting of blood from peripheries to viscera
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If a patient is in chronic pain, what signs will they show?

A

More of a psychological response

Sleep disturbance
Anorexia
Decreased libido
Anhedonia
Lethargy
Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of pain in cancer?

A
  1. Cancer itself: soft tissue, visceral and bone damage, compression or damage to nerves
  2. The treatment: chemotherapy or radiotherapy
  3. Debility caused by cancer results in constipation, muscle tension, spasm, wasting, ulcers
  4. Concurrent disorders: arthritis etc.
  5. Psychological pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What’s the difference between functional and pathological pain?

A

Pathological: there is actual damage occurring which is causing the pain

Functional: there is no damage occurring that’s causing the pain

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

Name and define the two types of pathological pain?

Describe mechanism of action of both types.

A

Nociceptive: distortion or damage to tissue
Stimulation of sensory nerve endings in tissues

Neuropathic: damage or compression of nerves
Stimulation of nervi nervorum (small nerves that innervate the sheath of larger nerve)

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

What things might make you think a patient’s pain is neuropathic?

A

Dermatomal distribution

Type of pain: burning, stinging, deep ache, stabbing

Accompanying sensory loss or paraesthesia
Allodynia: light touch exacerbates pain

Sympathetic component: sweating, cutaneous vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is allodynia?

A

Pain is exacerbated by light touch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are nervi nervorum?

A

Nerves of nerves

Small nerve filaments that innervate the sheath of larger nerve

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

Define pain.

A

Unpleasant sensory and emotional experience associated with actual or potential tissue damage.

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

Where are nociceptors found?

A 
Skin
Viscera
Muscles
Joints
Meninges
Peri-osteum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe how nociceptive pain is transmitted to the brain?

Draw it!

A

Nociceptors are stimulated by the damage to the tissue (be it thermal, mechanical, chemical, inflammatory)

Nociceptors are the free nerve endings of primary afferent nerve fibres (A delta and C fibres)

Which transmit electrical signal to the dorsal horn of spinal cord

Which then goes up the spinothalamic and spinoreticular tract to brain for processing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which inflammatory mediators cause pain?

A 
Bradykinin
Serotonin
Prostaglandins
Cytokines
H+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the nerves which transmit sensation to the spinal cord?

What type of sensation do they transmit?

A

Primary afferent fibres
3 types

A beta - non-noxious, light touch

A delta - sharp, acute, localised pain

C fibres - chemical, mechanical, thermal pain
Feels like a slow burning pain

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

What are the differences between the primary afferent nerve fibres?

Size
Myelination
Speed of conduction
Receptor activation thresholds
Type of sensation
A

A beta

  • large diameter
  • highly myelinated
  • fast conduction
  • low threshold
  • light touch, non-noxious

A delta

  • small diameter
  • thinly myelinated
  • slower speed
  • variable thresholds
  • rapid, sharp, localised pain

C

  • smallest diameter
  • unmyelinated
  • slowest conduction
  • high threshold
  • slow, diffuse, dull pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which primary afferent nerve fibre…

  1. is unmyelinated
  2. has the lowest
  3. has lowest threshold
  4. has the slowest conduction velocity
  5. is thinly myelinated
  6. transmits sharp pain
  7. transmits diffuse pain
  8. transmits light touch
  9. largely innervates viscera
A
  1. C fibres
  2. A beta
  3. A beta
  4. C fibres
  5. A delta
  6. A delta
  7. C fibres
  8. A beta
  9. C fibres
17
Q

Which neurotransmitters do primary afferent nerve fibres use?

Are they excitatory or inhibitory?

A

Glutamate
Substance P

Excitatory

18
Q

In which part of the spinal cord do the primary afferent nerve fibres attach?

A

The dorsal horn

19
Q

Name some inhibitory neurotransmitters?

A

GABA (gamma-aminobutyric acid)

Glycine

20
Q

Name the spinal pathways which carry nociceptive pain signals to the brain?

Where do they each go to in the brain?
What information about the pain do they transmit?

A

SPINOTHALAMIC

  • goes to nuclei in thalamus
  • then to somatosensory cortex
  • also to peri-aqueductal grey matter
  • transmits signals important for pain localisation

SPINORETICULAR

  • to nuclei in the thalamus
  • then into the cortex
  • involved in emotional aspects of pain
21
Q

Where is the peri-aqueductal gray matter?

What does it do?

A

It is in the midbrain

It has a role in the inhibition of pain

Known as descending inhibition

22
Q

What mechanisms are there which inhibit pain transmission to the brain?

Explain them.

A

Descending inhibition: involving the peraqueductal gray area. Noradrenaline and serotonin pathways inhibit pain transmission

Gate control theory: activation of A beta fibres inhibits signals transmitted by C fibres via inhibitory interneurons in the dorsal horn. (this is why rubbing a painful area helps pain)

23
Q

Define referred pain?

How can you explain it?

A

When pain is experienced at a site distant from the source of the pain

Different afferent nerve fibres converge onto the same dorsal horn neurones in the spinal cord.

24
Q

What is primary sensitisation?

A

Inflammatory mediators (cytokines, prostaglandins, H+, serotonin etc.) are able to lower the threshold at which nociceptors are activated.

So less stimulation is needed to cause activation and thus cause pain.

25
Q

How is pain managed pharmacologically?

A

Follow the WHO analgesic ladder

STEP 1:
non-opioid
+/- adjuvants

STEP 2:
weak opioid
+/- non-opioid
+/- adjuvants

STEP 3:
strong opioid
+/- non-opioid
+/- adjuvants

26
Q

List some non-opioids?

Describe their mechanism of action?

What is the most important side effect to think about? And what should you do about it?

A

PARACETAMOL

  • inhibits COX
  • which prevents conversion of arachidonic acid to prostaglandins

NSAIDs (aspirin, ibuprofen, naproxen, diclofenac)

  • good for inflammation
  • inhibits COX

NSAIDs can cause GI bleeding, so prescribe a PPI or a H2 receptor antagonist

27
Q

List some adjuvant analgesics used as part of the WHO analgesic ladder?

For each, list some indications for adding these drugs?

What’s the mechanism of action of each?

A

Corticosteroids:

  • Nerve compression, raised ICP
  • Reduce oedema

Anti-depressants (amitriptyline)

  • neuropathic pain
  • enhances descending inhibitory pathways

Sodium valproate:

  • Neuropathic pain
  • Enhances GABA inhibitory action

Gabapentin:

  • neuropathic pain
  • selective Ca channel blocker

Bisphosphonates:
Bone pain

Ketamine:

  • Refractory pain, neuropathic pain
  • NMDA receptor blockers
28
Q

How should pain medication be prescribed in a palliative patient?

I.e what regimen?

A

It should be prescribed as regular medication, not as required.

Also should prescribe ‘as required’ analgesia for breakthrough pain

And should advise that a patient takes ‘as required’ analgesia before doing something that’s potentially pain provoking

29
Q

What are some weak opioids?

A

Codeine phosphate
Dihydrocodeine
Tramadol

30
Q

What are some strong opioids?

A

Morphine
Diamorphine
Fentanyl (patches)
Methodone (rarely)

31
Q

How is morphine commonly given in palliative medicine?

A

Orally (first line)

Subcutaneously via syringe driver

IM or IV (in this case diamorphine is used)

Palliative Medicine (4 decks)

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