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Specialites Summary > Pain > Flashcards

Pain Flashcards

1
Q

What is pain?

A

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

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2
Q

Benefits of treating pain

A 
To the patient 
- improved sleep 
- better appetite 
- fewer medical complications
- reduced suffering
- less depression + anxiety 
To the family
- improved function as a family member e.g. parent 
- able to keep working
For society
- Lower health costs (e.g. shorter hosp stay) 
- able to contribute to the community
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3
Q

Classification of pain

A

Duration
Cause
Mechanism

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4
Q

Types of duration of pain

A

Acute
Chronic
Acute on chronic

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5
Q

Types of causes of pain

A

Cancer

Non-cancer

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6
Q

Types of mechanism of pain

A

Nociceptive

Neuropathic

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7
Q

What is acute pain?

A

Pain of recent onset and probable limited duration

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8
Q

What is chronic pain?

A

Pain lasting for more than 3 months
Pain lasting after normal healing
Often no identifiable cause

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9
Q

Features of cancer pain

A

Progressive

May be a mixture of acute and chronic

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10
Q

Features of non cancer pain

A

May be different causes

Acute or chronic

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11
Q

Features of nociceptive pain

A

Obvious tissue injury or illness
Protective function
Sharp +/- dull
Well localised

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12
Q

What is nociceptive pain also known as?

A

Physiological or inflammatory pain

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13
Q

What function does nociceptive pain have?

A

Protective function

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14
Q

Description of the pain in nociceptive pain

A

Sharp + / - dull

Well localised

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15
Q

Features of neuropathic pain

A 
Nervous system damage or abnormality 
Tissue injury may not be obvious 
Does not have a protective function 
Burning, shooting + / - numbness, pins and needles
Not well localised
Abnormal processing of pain signal
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16
Q

Does neuropathic pain have a protective function?

A

No

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17
Q

Description of the pain in neuropathic pain

A

Burning, shooting +/- numbness, pins and needles

Not very well localised

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18
Q

4 steps of the pain physiology

A

Periphery
Spinal cord
Brain
Modulation

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19
Q

What happens in the physiology of pain of the periphery stage?

A
  1. tissue injury
  2. release of chemicals eg. prostaglandins, substance P
  3. Stimulation of pain receptors (nociceptors)
  4. Signal travels in A lamda or C nerves to spinal cord
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20
Q

What happens in the physiology of pain in the spinal cord stage?

A
  1. Dorsal horn is the first relay station
  2. A lamba or C nerves synapses (connects) with second nerve
  3. Second nerve travels up opposite side of spinal cord (spinothalamic tract)
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21
Q

What is the first relay station of the physiology of pain?

A

Dorsal horn

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22
Q

What happens in the physiology of pain in the brain stage?

A 
Thalamus is the second relay station 
Connections to many parts of the brain 
- cortex
- limbic system 
- brainstem 
Pain perception occurs in the cortex
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23
Q

Where is the second relay station?

A

Thalamus

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24
Q

Where does pain perception occur?

A

In the cortex

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25
Q

What happens in the physiology of pain in the modulation stage?

A

Descending pathway from brain to the dorsal horn

Usually decreases the brain signal

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26
Q

What does the “gate theory” of pain involve?

A

Noxious (pain) stimulus as well as a distractive stimulus (e.g. rubbing, massaging, application of heat etc)
- the distractive stimulus has larger peripheral nerve fibres than the noxious stimulus (which are small)

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27
Q

Examples of neuropathic pain

A 
Damage 
- nerve trauma
- diabetic pain 
Dysfunction 
- fibromyalgia 
- chronic tension headache
28
Q

Pathological mechanisms of pain

A 
Increased receptor numbers
Abnormal sensation of nerves 
- peripheral 
- central 
Chemical changes in the dorsal horn 
Loss of normal inhibitory modulation
29
Q

Drug classifications

A

Simple analgesics
Opioids
Other analgesics

30
Q

Examples of simple analgesics

A

Paracetamol (acetaminophen)
NSAIDs
- diclophenac
- ibuprofen

31
Q

Examples of Other analgesics used

A 
Tramadol 
Antidepressants
Anticonvulsants
Ketamine 
Local anaesthetics 
Topical agents e.g. Capsaicin
32
Q

Treatment of peripheral pain

A 
Non drug
- rest 
- ice
- compression 
- elevation 
NSAIDs
Local anaesthetics
33
Q

Treatment of spinal cord pain

A 
Non drug
- acupuncture
- massage
- TENS
local anaesthetics
opioids
ketamine
34
Q

Treatment of brain pain

A 
Non drug
- psychological treatment
Paracetamol 
Opioids
Amitriptyline
Clonidine
35
Q

Disadvantages of paracetamol

A

Liver damage on overdose

36
Q

How can paracetamol be given?

A

Orally
Rectally
IV

37
Q

Examples of NSAIDs

A

Aspirin
ibruprofen
Diclofenac

38
Q

Disadvantages of NSAIDs

A

GI and renal side effects plus sensitive asthmatics

39
Q

Disadvantages of codeine

A

Constipation

Not good for chronic pain

40
Q

Disadvantages tramadol

A

Nausea

Vomiting

41
Q

How can morphine be given?

A

oral
IV
IM
SC

42
Q

Disadvantages of morphine

A

Constipation
Respiratory depression in high dose
Misunderstandings about addiction
Controlled drug

43
Q

What is paracetamol good for?

A 
Mild pain (by itself)
Mod - severe pain (with other drugs)
44
Q

What are NSAIDs good for?

A

Nociceptive pain

- best given regularly with paracetamol (synergism)

45
Q

What is codeine good for?

A

Mild - moderate acute nociceptive pain

- best given regularly with paracetamol

46
Q

What is morphine good for?

A

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

47
Q

Oral dose of morphine vs other routes

A

Oral dose is 2-3x IV / IM / SC dose

48
Q

What is amitriptyline?

A

A tricyclic antidepressant (TCA)

49
Q

What is amitriptyline good for?

A

Neuropathic pain
Depression
Poor sleep

50
Q

Disadvantages of amitriptyline

A

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

51
Q

Examples of anti convulsant drugs

A

Carbamazepine
Sodium valproate
Gabapentin

52
Q

What do anticonvulsant drugs do?

A

Membrane stabilisers

Reduce abnormal firing of nerves

53
Q

What are anticonvulsant drugs good for?

A

Neuropathic pain

54
Q

Possible delivery routes

A 
Oral 
Rectal 
Sublingual 
Subcutaneous 
Transdermal 
Intramuscular 
Intravenous - boluses
55
Q

Delivery routes for local anaesthetics

A 
Epidural (+/- opiates)
Intrathecal (+/- opiates) 
Wound catheters
Nerve Plexus Catheters
Local infiltration of wounds
56
Q

Pain assessment is done by……

A 
Verbal rating score
Numerical rating score
Visual Analogue Scale
Smiling faces
Abbey pain scale (for confused patients)
57
Q

What type of pain is not responsive to the WHO pain ladder drugs?

A

Neuropathic pain

58
Q

WHO analgesic (pain relief) ladder

A

Step 1 - mild to moderate pain
- non opioids - aspirin, NSAIDs, paracetamol
Step 2 - moderate to severe pain
- mild opioids (e.g. codeine) with or without non-opioids
Step 3 - severe pain
- strong opioids (e.g. morphine) with or without non opioids

59
Q

Where to prescribe from the WHO ladder in mild pain

A

Start at the bottom

60
Q

Where to prescribe from the WHO ladder in moderate pain

A

Bottom of the ladder plus the middle rung

61
Q

Where to prescribe from the WHO ladder in severe pain

A

Bottom of the pain ladder plus the top of the pain ladder

Miss out the middle

62
Q

As the pain resolves, where do you prescribe from on the pain ladder?

A

Move down the ladder

63
Q

As pain subsides, do you stop NSAIDs or paracetamol first and why?

A

NSAIDs

as more adverse effects with NSAIDs

64
Q

RAT approach to pain management

A

Recognise
- does the patient have pain? - ask, look, other people
Assess
- severity
- pain score (at rest, with movement)
- how is the pain affecting the patient ( can patient cough / move / work?)
- type
- physical factors - other illnesses
- anger , anxiety, depression
- lack of social supports
Treatment

65
Q

What does RICE stand for?

A

Rest
Ice
Compression
Elevation of injuries

66
Q

What is done after RAT?

A

Reassure the patient

  • is it working?
  • are other treatments needed?

Specialites Summary (15 decks)

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