Pain Flashcards
How can pain be classified?
acute vs chronic
Cancer vs non-cancer
Nociceptive vs neuropathic
What is Nociceptive pain?
Caused by obvious injury or illness. It is also called psychological or inflammatory pain. It serves a protective function and it is usually well localised, being described as sharp or dull
What is Neuropathic pain?
Caused by nervous system damage or abnormality. The tissue injury may not be obvious and does not have any protective function. Symptoms include burning, shooting, numbness, pins and needles. It is not well localised
What are the four steps of the physiology of pain?
Periphery
Spinal Cord
Brain
Modulation
What is involved in the issues at the periphery
Tissue injury, release of prostaglandins, stimulation of pain receptors. Signals travel to A or C nerve fibres into the spinal cord.
What is involved in the spinal cord in relation to pain?
First relay situation, A or C nerves synapse and the signal travels up the spinal cord
What is involved in the brain in relation to pain?
The thalamus is the secondary relay station. It connects to many parts of the brain forming bonds in the cortex, limbic system and brain stem. Pain perception occurs in the cortex. This feeds and amplifies a signal and can make pain worse in those with anxiety and depression
What is involved in he process of modulation in relation to pain?
Descending pathway from the brain to the dorsal horn. Acts to decrease the pain signal
What is the gate theory of pain?
Alternative stimulus can override pain. Stimulus of a and B fibres send signals to interneurons to switch of the pain stimulus of the aD and C fibres
What are simple analgesic drugs?
What are the benefits?
What are the side effects?
Paracetemol
NSAIDS- dicolfenac, ibuprofen
Cheap, safe and can be given in different forms?
bad for liver function, irreversible. reduce dose for those under 50kg
What are Opiods?
What are the benefits?
What are the side effects?
Codeine
Morphine
Oxycodine
Fentanyl
Cheap, safe, good for more advanced pain
constipation, bad for chronic pain, addiction
What other drug scan be used as painkillers?
Tramadol (mixed opiate) Nefopam(NMDA antagonist) Antidepressants Anticonvulsants Ketamine Local anaesthetic Topical agents
What drugs are good for neuropathic pain?
How does tramadol work?
What are its side effects?
Tricyclic antidepressants, Anticonvulsants
Inhibit of serotonin and noradrenaline uptake
Addictive, nausea and vomiting
What is the pain ladder?
What type of pain is it used for?
Mild- NSAIDS, paracetamol
Moderate-Paracetamol, NSAIDS, codeine
Severe- Paracetamol NSAIDS, morphine
nociceptive pain
How is pain in the periphery treated by drugs
RICE, NSAIDS, Local anaestheics
How is pain in the spinal cord treated by drugs?
Acupuncture, local, opoids, ketamine
How is pain in the brain treated?
Pyschological treatments, paracetamol, opiods, amitrityline, clonidine
What is the RAT method of treating pain?
Recognise
assess
treat
How do you recognise pain?
Ask, look, ask health workers, family members, verbal rating score, numerical rating score, ask what pain is stopping the patient from doing, abbey pain scale for confused patients
How do you assess pain?
How is pain assessed at rest and with movement . How does pain affect the patient? Can the patient work? Cacner or non cancer? Nociceptive or neiropathic?
How can we treat pain?
RICE,Nusring care, surgery, acupuncture, massage TENS, psychological reassurance, social work
