Pain Flashcards
What is pain?
Abnormal stimulus that the patient says hurts
What are the main types of pain?
Nociceptive
- somatic
- visceral
Neuropathic
What is nociceptive pain?
Normal nervous system, identifiable lesion causing tissue damage
What is somatic pain?
Pain originates from skin/muscle/bone
What is visceral pain?
Pain originates from hollow viscus/solid organ
What is neuropathic pain?
Pain from a malfunctioning nervous system
How is neuropathic pain described?
Stabbing
Shooting
Burning
What can be used for neuropathic pain?
Amitriptyline 10-25 mg nocte
Gabapentin 300mg TDS
Pregabalin 75mg BD
What are side effects of neuropathic pain reliedf?
Sedation
Dizziness
Confusion
Renal impairment
What is the WHO ladder?
Step 1
- non-opioid +/- adjuvant
Step 2
- weak opioid +/- adjuvant
Step 3
- strong opioid +/- adjuvant
What are non-opioids?
Paracetamol
NSAIDs
What are weak opioids?
Codeine
Co-codamol
Dihydrocodeine
Tramadol
What are strong opioids?
Morphine
Oxycodone
Fentanyl
What are adjuvants?
Anti-depressants - amitriptyline
Anti-convulsants - gabapentin, pregabalin
Steroids
Bisphosphonates
What are the WHO principles of pain relief?
By the mouth - give oral whenever possible By the clock - give regularly By the ladder Individual dose titration Use adjuvants as necessary
What should you always prescribe with an NSAID/COX2 inhibitor?
PPI
Which NSAID/COX2 inhibitor do you prescribe if there is no GI/CVS risk?
Naproxen
Which NSAID/COX2 inhibitor do you prescrive if there is GI risk?
Celecoxib
Which NSAID/COX2 inhibitor do you prescribe if there is CVS risk?
Naproxen
What are the types of morphine available?
Immediate release = oramorph
Slow release = zomorph
How is morphine dose calculated?
TDD = total daily requirement
SR = TDD/2
IR = TDD/6
What are the side effects of morphine?
Constipation
Nausea
Sedation
Dry mouth
What is a syringe driver
Subcutaneous morphine given over 24hrs
Still need PRNs
What is the conversion between PO and SC morphine?
PO:SC
2:1
So half the dose when going oral to SC
How long do fentanyl patches take to work?
24 hours
How long are fentanyl patches left on for?
3 days
What are signs of opioid toxicity?
Pinpoint pupil
Drowsiness
Sedation
Hallucinations
What is key to check in someone with new opioid toxicity?
Renal function
