Pain

Question 1

What is pain?

Answer 1

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

Question 2

What are the physical benefits of treating pain?

Answer 2

Improved sleep, better appetite, fewer medical complications

Question 3

What are the psychological benefits of treating pain?

Answer 3

Reduced suffering

Less depression, anxiety

Question 4

What benefits can the family experience when pain is treated?

Answer 4

Improved functioning as a family member

Able to keep working

Question 5

What benefits can society experience when pain is treated?

Answer 5

Lower health costs

Able to contribute to the community

Question 6

How can the duration of pain be classified?

Answer 6

Acute
Chronic
Acute on Chronic

Question 7

What is the cause of pain?

Answer 7

Cancer or non-cancer

Question 8

How can the mechanism of pain be classified?

Answer 8

Nociceptive

Neuropathic

Question 9

What is nociceptive pain?

Answer 9

Obvious tissue injury or illness
Physiological pain or inflammatory pain
Protective dunction
Well localised
Sharp/dull

Question 10

What is neuropathic pain?

Answer 10

Nervous system damage or abnormality
Tissue injury may not be obvious
Does not have a protection function
Burning/shooting/numb/pins and needlese
Not well localised

Question 11

How is pain perceived at the peripheries?

Answer 11

Tissue injury where release of chemicals stimulates nociceptors and signal travels along A Delta or C nerve fibres to spinal cord

Question 12

What part does the spinal cord play in the pain pathway?

Answer 12

Dorsal horn is first relay station

ADelta or C nerve synapses with second nerve and then travels up contralateral side of spinal cord

Question 13

What role does the brain play in the pain pathway?

Answer 13

Thalamus acts as second relay station and connects to cortex, limbic system, brainstem
Pain perception occurs in cortex

Question 14

What pathways modulate pain?

Answer 14

Descending pathways

Question 15

What are simple analgesics?

Answer 15

NSAIDs or Paracetamol

Question 16

Give examples of opioids

Answer 16

Coedine, dihydrocoedine (Mild)

Morphine, oxycodone, fentanyl (strong)

Question 17

What is tramadol?

Answer 17

Mixed opiate andd 5HT/Na reuptake inhibitor

Question 18

What is Nefopam?

Answer 18

NMDA R antagonist, 5HT/Na reutake inhibitor

Question 19

Name some antidepressants?

Answer 19

Amitriptyline, duloexetine

Question 20

Name some anticonvulsants?

Answer 20

Gabapentin

Question 21

Name a NMDA receptor antagonist?

Answer 21

Ketamine

Question 22

Name a topical agent?

Answer 22

Capsaicin

Question 23

How does one treat a peripheral injury?

Answer 23

RICE
NSAID
local anaesthetics

Question 24

How does one treat a spinal cord injury?

Answer 24

Acupuncture, massage,TENS
Local anaesthetics
Opioids
Ketamine

Question 25

How does one treat a brain injury?

Answer 25

Paracetamol Opioids Amitryptyline Clonidine

Question 26

What are the benefits of paracetamol?

Answer 26

Cheap, safe | Oral, rectal or IV administered

Question 27

What are the disadvantages of paracetamol?

Answer 27

Liver damage in overdose

Question 28

What are the advantages of NSAIDs?

Answer 28

Cheap and safe | Good for nociceptive pain

Question 29

What are disadvantages of NSAIDs?

Answer 29

GI and renal side effects

Question 30

What are the advantages and disadvantages on codeine?

Answer 30

Advantages Cheap, safe Good for mild-moderate acute nociceptive pain Best given regularly with paracetamol Disadvantages Constipation Not good for chronic pain

Question 31

What are the advantages and disadvantages of tramadol?

Answer 31

Advantages Less respiratory depression Can be used with opioids and simple analgesics Not a controlled drug Disadvantages Nausea and vomiting

Question 32

What are the advantages of morphine?

Answer 32

``` 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 pain) Chronic cancer pain ```

Question 33

What are the disadvantages of morphine?

Answer 33

Constipation Respiratory depression in high dose Misunderstandings about addiction Controlled drug

Question 34

What is the oral dose of morphine?

Answer 34

2-3 times IV / IM / SC dose

Question 35

What are advantages of amitryptiline?

Answer 35

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

Question 36

What are the disadvantages of amitryptiline?

Answer 36

Anti-cholinergic side effects (glaucoma and urinary retention)