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Anaesthetics > Pain > Flashcards

Pain Flashcards

1
Q

What are the benefits of treating pain?

A

Physical- improve sleep, better appetite
Psychological- reduce suffering, less depression and anxiety
For family- improve function as member of family, maintain employment
For society- reduced hospital stays so reduced cost, able to work

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2
Q

What are the different ways in which pain can be classified?

A

Duration- acute, chronic or acute on chronic
Cause- cancer or non-cancer
Mechanism- nociceptive or neuropathic

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3
Q

What is the difference between nociceptive and neuropathic pain?

A

Nociceptive- pain stimulus is directed into the pathway

Neuropathic- nerve damage

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4
Q

What are the characteristics of nociceptive pain?

A

Obvious tissue injury or illness
Also called physiological or inflammatory pain
Protective function
Described as sharp ± a dull aspect and well localized

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5
Q

What are the characteristics of neuropathic pain?

A

Nervous system damage or abnormality
Tissue injury may not be obvious
Does not have a protective function
Described as burning/shooting ± numbness/pins and needles. Not well localized

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6
Q

What are the four main steps in pain physiology?

A

Periphery
Spinal cord
Brain
Modulation

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7
Q

Describe the pain physiology processes in the periphery

A

Tissue injury
Release of chemicals- prostaglandins, substance P
Stimulation of nociceptors
Signal travels in Aδ or C nerve to spinal cord

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8
Q

Describe the pain physiology processes in the spinal cord

A

Dorsal horn is the first relay station
Aδ or C nerve synapses with second nerve
Second nerve travels up opposite side of spinal cord

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9
Q

Describe the pain physiology processes in the brain

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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10
Q

Describe the pain physiology processes in modulation

A

Descending pathway from brain to dorsal horn

Usually decreases pain signal

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11
Q

What are some examples of causes of neuropathic pain?

A

Nerve trauma
Diabetic pain
Fibromyalgia
Chronic tension headache

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12
Q

What pathological mechanisms can cause neuropathic pain?

A

Increased receptor numbers
Abnormal sensitisation of nerves (peripheral or central)
Chemical changes in the dorsal horn
Loss of normal inhibitory modulation

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13
Q

What are the drugs commonly used for pain?

A

Simples analgesics- paracetamol, NSAIDs (ibuprofen, diclofenac)
Opioids- codeine, dihydrocodeine, morphine oxycodone
Tramadol (mixed opiate and 5HT/NA reuptake inhibitor)
Nefopam (NMDA receptor antagonist, 5HT/NA reuptake inhibitor)
Antidepressants
Anticonvulsants
Ketamine
Local anaesthetics
Topical agents

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14
Q

What non-drug treatment can be used for pain originating from the periphery?

A

Rest
Ice
Compression
Elevation

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15
Q

What non-drug treatment can be used for pain originating from the spinal cord?

A

Acupuncture
Massage
TENS

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16
Q

What non-drug treatment can be used for pain originating from the brain?

A

Psychological

17
Q

What drug treatment can be used for pain originating from the periphery?

A

NSAIDs

Local anaesthetic

18
Q

What drug treatment can be used for pain originating from the spinal cord?

A

Local anaesthetic
Opioids
Ketamine

19
Q

What drug treatment can be used for pain originating from the brain?

A

Paracetamol
Opioids
Amitriptyline
Clonidine

20
Q

What are the advantages of paracetamol

A

Cheap
Safe
Can be given orally, rectally or IV
Good for mild pain in isolation or moderate to severe pain in conjunction with other drugs

21
Q

What are the disadvantages of paracetamol

A

Liver damage in overdose

22
Q

What are the advantages of NSAIDs

A

Cheap
Generally safe
Good for nociceptive pain

23
Q

What are the disadvantages of NSAIDs

A

GI bleeds
Nephrotoxic
Can cause bronchospasm in sensitive asthmatics

24
Q

What are the advantages of codeine

A

Cheap
Safe
Good for mild to moderate acute nociceptive pain

25
Q

What are the disadvantages of codeine

A

Constipation

Not good for chronic pain

26
Q

What are the advantages of tramadol

A

Less respiratory depression

Can be used with opioids and simple analgesics

27
Q

What are the disadvantages of tramadol

A

Nausea and vomiting

Withdrawal possible

28
Q

What are the advantages of morphine

A 
Cheap
Safe
Can  be given orally, IV, IM, SC
Effective if given regularly
Good for moderate to severe acute nociceptive pain or chronic cancer pain
29
Q

What are the disadvantages of morphine

A

Constipation
Respiratory depression
Misunderstandings about addiction
Controlled drug

30
Q

What are the advantages of amitriptyline

A

Cheap
Safe in low doses
Good for neuropathic pain

31
Q

What are the disadvantages of amitriptyline

A

Anti-cholinergic side effects (glaucoma, urinary retention)

32
Q

What are the advantages of anticonvulsants

A

Good for neuropathic pain

33
Q

How do treatments of neuropathic and nociceptive pain differ?

A

Nociceptive pain management based on WHO pain ladder
Neuropathic pain manegement based on alternative analgesics (amitriptyline, gabapentin, duloxetine) and/or psychological and non-drug treatments

34
Q

What are the steps in the RAT approach to pain?

A

Recognise
Assess
Treat

35
Q

What steps should be taking when recognising pain?

A

Does the patient have pain? (Ask, look (frowning, moving easily, sweating?))
Do other people know the patient has pain? (Other health workers, patient’s family)

36
Q

What steps should be taking when assessing pain?

A 
Verbal Rating Score
Numerical Rating Score
Visual Analogue Scale
Smiling faces
Abbey Pain Scale (for confused patients)
Functional Pain

Assess severity, type, characteristics and any other factors

37
Q

What levels of pain corresponds to which steps of the WHO pain ladder?

A

Mild to moderate pain- step 1
Moderate to severe pain- step 2
Severe pain- step 3

38
Q

What drugs are on each step of the WHO pain ladder?

A

Step 1- Non-opioids: aspirin, NSAIDs, paracetamol
Step 2- Mild opioids (codeine) with or without non-opioids
Step 3- Strong opioids (morphine)
Step 1 should be kept in conjunction with either step 2 or 3 but no need to keep step 2 when moved up to step 3

Anaesthetics (6 decks)

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