Pain and Pain Management Flashcards
What are some of the core features of palliative care?
Affirms life with emphasis on quality of life
Prevention and relief of suffering
Dying is a normal part of life
Support for patients- physical, psychological and spiritual
Support for families and carers
What are the four factors that influence total pain?
Physical
Social
Spiritual
Phychological
What physical factors can cause pain?
Pain due to disease process
Symptoms such as nausea and vomiting
Physical decline and fatigue
What psychological factors can influence pain?
Grief Depression Anxiety Frustration Anger
What social factors might influence pain?
Relationships with family or cares
Changing roles in family
Work life
Financial problems
What spiritual factors might influence pain?
Existential issues Conflicting thoughts Religious issues Questions about the meaning of life Difficulty rationalising the disease process
How does palliative care continue after the patient’s death?
Support for family members and carers
How can pain be described?
An unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage
What are the two types of pain fibres?
C Fibres
Delta fibres
What kind of pain do C fibres transmit
Dull, poorly localised, ill defined pain
They’re unmyelinated
C= Crap pain fibres
What kind of pain do delta fibres transmit?
Myelinated fibres which transmit fast, sharp, well localised pain.
D= Direct pain location
What are some features seen in patients with acute pain?
Acute pain causes a flight or flight response. It is therefore associated with sweating, tachypnoea, tachycardia, cold extremities and pupil dilation
What are some features seen with chronic pain?
Chronic pain serves no useful purpose. It causes sleep disturbance, depression, personality change, decreased libido, lethargy, anorexia
What is important to ask about in a pain history?
SOCRATES
Drug History- ask about what has been tried in the past, why it didn’t work, side effects in order to evaluate previous treatments
Psychological history- assess mental state
What would you want to know about previously tried analgesic agents?
Drug Dose Route of administration Side effects Duration of treatment Why was it stopped Compliance
What are the steps in the WHO pain letter?
Step 1- Non-Opioid- Paracetamol/NSAID (with or without adjuvant agents e.g. Gabapentin)
Step 2- Weak Opioid +/- Paracetamol/ NSAID (with or without adjuvant agents)
Step 3- Strong Opioids +/- Non-opioid analgesic agents (with or without adjuvant agents)
Step up and down as appropriate
What opioid agents might be used at Step 2 of the WHO pain ladder?
Step 2 is Weak Opioids +/- Step 1
Weak opioids include codeine and dihydrocodeine and tramadol
What opioid agents might be used in Step 3 of the WHO pain ladder?
Step 3 is Strong Opioids +/- Step 1
Strong opioids include morphine, fentanyl, oxycodone, diamorphine, hydromorphine
What are some adjuvant agents used in the treatment of pain?
Antidepressants- indicated for neuropathic pain Anticonvulsants- e.g. Gabapentin Smooth muscle relaxants Steroids- reduce swelling around tumours Bisphosphonates- reduce osteoclast activity to reduce bone pain Radiotherapy Chemotherapy Surgery
What are the types of pain seen in cancer?
Somatic Visceral Neuropathic Background Breakthrough Incident pain
What is somatic pain?
Somatic pain is well localized pain
Aching and often constant pain
May be dull or sharp
Often worse with movement
What are some examples of somatic pain?
Often MSK issues
Bone mets, arthritis, muscle sprain, fracture
How is somatic pain often treated?
NSAIDs, Opioids
For bone mets- High dose dexamethasone, radiotherapy, surgery, bisphosphonates (inhibit osteoclasts so prevent further breakdown)
What is visceral pain?
Visceral pain is poorly localised pain, it comes from the viscera
Features include aching, cramping, dull, continuous pain
Can also experience referred pain
