Pain Consultant Flashcards
explain the RAT approach to pain management
1) recognise: Does the patient have pain?
- Do others recognise
2) assess: Severity, type and other factors
3) Treat: Non drug and drug treatments
what is pain?
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
- Chronic pain -3 months or more
outline the physiological derangements of acute pain on the following parts of the body:
1) Brain
2) Lung
3) Heart
1) Brain: sleep and mental function impaired
2) Lungs: decreased lung function
3) Heart : increased stress
4) DVT, muscle wasting
5) Gut motility affected, hormonal imbalances, salt and water retention
Below is a list of effects that Chronic Pain can have on a patient. explain how each one is influenced by chronic pain.
1) Physical Functioning
2) Social Functioning
3) Moods
4) Societal Consequences
1) Physical Functioning: mobility, Sleep disturbances, fatigue, Loss of appetite
2) Social Functioning: diminished social relationships, decreased sexual function/intimacy, decreased recreational and social activities
3) Moods: depression, anxiety, anger, irritability
4) Societal Consequences: Health care utilisation, disability, loss of work days or employment, substance abuse
explain the issues with the management of chronic pain
1) Lack of knowledge or interest
2) Failure to assess pain relief accurately
3) Failure of communication
4) Fear of addiction to analgesics
5) Fear of unwanted side effects
6) Fear of masking physical signs
7) Legal aspects of drug administration
what 3 questions can be used to classify pain?
1) How long has the patient had pain?
- Acute, Chronic, Acute on chronic
2) What is the cause?
- Cancer, Non cancer
3) What is the mechanism?
- nociceptive, neuropathic, mixed
Nociception is the sensory nervous system’s response to certain harmful or potentially harmful stimuli. explain the process involved in nociception.
1) Pain or noxious stimuli are converted into electrical signals following activation of receptors sensitive to temperature, chemicals, mechanical…
2) This occurs in the unmyelinated C-fibre, thinly myelinated Aδ-fibre, and myelinated Aβ fibre of the peripheral nociceptors
3) Electrical signals (action potentials) are transmitted to the dorsal horn of the spinal cord, and then relayed to the thalmus.
Depending on the neuron type, each group of neurons respond with slow, intermediate, or rapid velocity to different stimuli and pain thresholds. explain the speed at which and the stimuli that affects each of the following fibres:
1) Aβ fibres
2) Aδ fibres
3) C fibres
Depending on the neuron type3, each group of neurons respond with slow, intermediate, or rapid velocity to different stimuli and pain thresholds:
Aβ fibres: are considered rapidly conducting and respond to mechanical stimuli with a low threshold.
Aδ fibres: respond to heat, cold, and high intensity mechanical stimuli and conduct with intermediate velocity.
C fibres: conduct slowly and can respond to heat, mechanical or chemical stimuli.
state the analgesic drugs they work by targeting the following:
1) Descending inhibitory pathways
2) Peripheral changes in channels Na, K,
3) Increased NT release from afferent fibres via Ca channels
4) Increased NMDA activity centrally
5) Opioids
6) TRPV1 receptor activity
1) Descending inhibitory pathways: TCAs (Amitriptyline etc) SNRIs (Duloxetine)
2) Peripheral changes in channels Na,K, : Carbamazepine, Sodium valproate etc, Lidocaine patches
3) Increased NT release from afferent fibres via Ca channels: Gabapentin, Pregabalin
4) Increased NMDA activity centrally: Ketamine (Methadone, Dextropropoxyphene)
5) Opioids: Morphine, Fentanyl ,Buprenorphine Oxycodone
6) TRPV1 receptor activity: Capsaicin cream and patches
explain the link between neuropathic pain and depression
1) Dysregulation of serontonin and norepinephrine play major roles in depression
2) Because of the same dysregulation of serotonin and norepinephrine in the spinal cord, the brain may perceive an amplified pain signal
3) If depressed patients have an imbalance of both serotonin and norepinephrine, it may explain why they experience both emotional and physical symptoms
outline the physical Non-drug treatments that can be used in the management of pain
1) Physiotherapy
2) TENS
3) Acupuncture
4) Rest, Ice, Compression, elevation
5) Interventions – simple/advanced
outline the psychological treatments used in pain management
1) Explanation
2) Reassurance
3) Counselling
outline the drug treatments that can be used in the management of pain
1) Simple analgesics
2) Opiates: weak, moderate and strong
3) Other analgesics
- Local anaesthetics
- Ketamine
- Tramadol
- Tricyclics
- Anticonvulsants
- Clonidine
- Capsaicin
summarise the general principles used in pain management.
- selection of therapy, route, combinations, doses
1) Least invasive route of administration and titrate to response.
2) Timing of medication administration is important.
3) Only one drug at a time using a low dose
4) Consider combination synergistic therapy
5) Consider the use of non-pharmacological strategies
6) Treatment should be monitored regularly
what is the first line treatment for pain and state the dose?
1) Paracetamol – first line, do not exceed 4g/24hrs
2) caution in severe liver disease
3) available in different combinations- co-codamol, tramadol, ibuprofen
