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Specialties > Pain > Flashcards

Pain Flashcards

1
Q

What is pain

A

Patients perspective

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2
Q

Physical benefits of treating pain

A

Improved sleep
Better appetite
Fewer medical complications

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3
Q

Psychological benefits of treating pain

A

Decreased suffering

Less depression, anxiety

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4
Q

Family benefits of treating pain

A

Improved functioning as a family member

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5
Q

Duration classification of pain

A

Acute
Chronic
Acute on Chronic

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6
Q

Cause classification of pain

A

Cancer

Non-cancer

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7
Q

Mechanism classification of pain

A

Nociceptive

Neuropathic

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8
Q

Describe acute pain

A

Pain of recent onset and probable limited duration

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9
Q

Describe chronic pain

A

Pain lasting >3 months

Pain lasting after normal healing

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10
Q

What is nociceptive pain

A

Obvious tissue injury or illness
Damage to nociceptive afferents
Also called:
Physiological or Inflammatory pain

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11
Q

Description of nociceptive pain

A

Sharp+/- dull
Well localised
Visceral pain slightly less localised

Protective function

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12
Q

What is neuropathic pain

A

Nervous system damage of abnormality

Tissue injury may not be obvious

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13
Q

Description of neuropathic pain

A

Burning, shooting +/- numbness, tingling, pins and needles
Not well localised

Does not have a protective function

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14
Q

4 steps of pain

A

Periphery (spinothalamic tract)
Spina Cord
Brain
Modulation

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15
Q

Which chemicals are release at the site of tissue damage

A

Prostaglandins

Substance P

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16
Q

What are nociceptors

A

Pain receptors

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17
Q

Through which fibres does pain travel

A

Alpha
Delta
or C

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18
Q

What is the first relay station in pain sensation

A

Dorsal horn

alpha, delta or c nerves synapse with 2nd neruon

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19
Q

Where is the 2nd relay station in pain sensation

A

Thalamus

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20
Q

Where does pain perception occur

A

Cortex

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21
Q

Examples of neuropathic pain

A

Nerve trauma, Diabetic pain

Fibromyalgia, Chronic TTH

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22
Q

Pathological mechanisms in neuropathic pain

A

Increased number of receptors
Abnormal sensation of nerves
Chemical changes in dorsal horn
Loss of normal inhibitory modulation

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23
Q

Name some simple analgesics

A

Paracetamol

NSAIDs

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24
Q

Pros of paracetamol

A

V. useful
V. cheap
Better when used in combination

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25
Q

Examples of NSAIDs

A

Ibuprofen

Diclofenac

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26
Q

Examples of opioids

A 
Codeine 
Morphine 
Fentanyl 
Oxycodone 
Dyhydrocodeine
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27
Q

Which anti-depressants can be used to treat pain

A

SNRI: Duloxetine
TCA: Amitryptiine

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28
Q

Other analgesic types

A 
Tramadol 
Antidepressants
Anti-convulsants (e.g gabapentin)
Ketamine (NDMA receptor)
Local anaesthetics 
Topical agents (Capsaicin)
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29
Q

Non-drug treatments of pain at the periphery

A

Rest
Ice
Compression
Elevation

30
Q

Drug treatments of pain at the periphery

A

NSAIDs

Local anaesthetics

31
Q

Non-drug treatments of pain at the spinal cord

A

Acupuncture
Massage
TENS

32
Q

Drug treatments of pain at the spinal cord

A

Local anaesthetic
Opioids
Ketamine

33
Q

Non-drug treatments of pain at the brain

A

Psychological

34
Q

Drug treatments of pain at the brain

A

Paracetamol
Opioids
Amitryptiline
Clonidine

35
Q

Pros Paracetamol

A

Cheap
Safe
Can be given orally, IV or rectally

36
Q

Cons of paracetamol

A

Liver damage in overdose

37
Q

Pros of NSAIDS

A

Cheap
Generally, safe
Best for nociceptive pain
Best given regularly with paracetamol (Synergism)

38
Q

What type of relationship do paracetamol and NSAIDs have

A

Synergistic

39
Q

Cons of NSAIDs

A

GI side effects
Renal SE
Plus sensitive asthmatics

40
Q

Pros of codeine

A

Cheap
Safe
Good for mild-moderate acute nociceptive pain

41
Q

Cons of codeine

A

Constipation
Nausea
Not good for chronic pain

42
Q

Pros of Tramadol

A

Weak opioid effect plus inhibitor of serotonin and noradrenaline reuptake (modulation)
Advantage
Less respiratory depression
Can be used with opioids and simple analgesics
Not a controlled drug

43
Q

Cons of tramadol

A

Nausea

Vomiting

44
Q

Pros of morphine

A

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

45
Q

What is morphine good for

A

Mod-severe acute nociceptive pain

Chronic cancer pain

46
Q

Cons of morphine

A 
Constipation 
Respiratory distress in high dose
Misunderstandings about addiction:
As long as you stop taking it when pain resolves this shouldn’t be an issue 
Controlled drug
47
Q

Pros of Amitryptiline

A

Cheap

Safe in low dose

48
Q

What is amitryptiline good for treating

A

Neuropathic pain

Also treats depression and poor sleep

49
Q

Cons of amitryptiline

A

Anti-cholinergic SE

50
Q

Pros of anti-convulsants

A

Good for neuropathic pain

51
Q

Examples of anti-convulsants used to treat pain

A

Carbamezepine
Sodium Valproate
Gabapentin

52
Q

What is the preferred route of delivery

A

Oral

53
Q

Other routes of delivery for pain medication

A 
Rectal 
Sublingual 
Subcutaneous 
Transdermal 
Intramuscular 
Intravenous (boluses, possible patient controlled systems)
54
Q

Delivery routes for local anaesthetics

A 
Epidural 
Intrathecal 
Wound catheters
Nerve plexus catheters
Local infiltration of wound
55
Q

How do we assess severity of pain

A

Ask the patient
Verbal rating score (none, mild, severe ect)
Numerical rating score (0-10)
Visual analogue scale (theoretical 10cm line)
Smiling faces (children)
Abbey Pain Scale (for confused patient)

56
Q

Which ladder should be used for acute pain

A

WHO pain ladder

57
Q

Should the WHO pain be used for neuropathic pain?

A

No

Not responsive

58
Q

Step 1 WHO pain ladder

A

Mild to Moderate Pain: Non-opioids – aspirin, NSAIDs or paracetamol

59
Q

Step 2 WHO pain ladder

A

Moderate to severe pain :
Opioids:
Codeine with or without non-opioids

60
Q

Step 3 WHO pain ladder

A

Severe pain:
Strong opioids
Morphine with or without non- opioids

61
Q

What should you give according to WHO pain ladder for mild pain

A

Start at the bottom of the ladder

Step 1

62
Q

What should you give according to the WHO pain ladder for Moderate pain

A

Step 1 and Step 2

63
Q

What should be given according to the WHO pain adder for Severe pain

A

Step 1 and Step 3

Miss out middle (step 2)

64
Q

Is it okay to start at the to of the WHO pain ladder

A

Yes

For severe/unbearable pain

65
Q

As pain resolves how should you move down the WHO pain ladder

A 
Move down the ladder
Do not kip 
Continue step 1 drugs at all times 
Lastly stop NSAIDs 
Then paracetamol as adverse SE with NSAIDs
66
Q

What does RAT approach stand for

A

Recognise
Assess
Treat

67
Q

RAT assessing pain

A

Severity?:
Pain score
At rest and on movement

Types?
Acute or chronic
Cancer or non-cancer
Nociceptive or neuropathic

Other factors?
Physical factors
Psychological factors (anger, anxiety, depression)

68
Q

RICE non-drug treatments

A

Rest
Ice
Compression
Elevation

69
Q

Recognising pain RAT approach

A

Ask do you have pain
Look (at facial expressions, sweating ect..)
Do other people know the patient has pain

70
Q

What should you do after RAT

A

Reassess the patient
Is Rx working?
Is other RX required?

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