Pain Managament

Question 1

What is the negative impact unrelieved pain has on an individual?

Answer 1

1) . Acute pain –> chronic pain.
2) . Depression.
3) . Immobility.
4) . Isolation.

Question 2

What are the pharmacological approaches to pain management?

Answer 2

1) . Non-opioid, opioid analgesics, adjuvents.
2) . 3-step strategy.
3) . Dosing at regular intervals.

Question 3

What is the 3 step strategy also known as?

Answer 3

Analgesic ladder.

Question 4

Name the steps of the analgesic ladder?

Answer 4

Step 1 =

• non-opioid –> mild pain.

Step 2 =

• weak opioid –> moderate pain.

Step 3 =

• strong opioid –> severe pain.

Question 5

What is the results of the analgesic ladder?

Answer 5

Results in pain management.

Question 6

What happens if analgesia is not achieved?

Answer 6

Progression up the ladder.

Question 7

What is an example of a non-opiod, weak opioid and strong opioid?

Answer 7

1). Non-opioid =

• aspirin.
• paracetamol.

2). Weak opioid =

• codeine.
• dihydrocodiene.

3). Strong opioid =

• morphine.
• fentanyl.
• oxycodone.

Question 8

What does NSAIDs mean?

Answer 8

Non-Steroidal Anti-Inflammatory Drugs.

Question 9

What is an NSAIDs?

Answer 9

• Inhibits the production of prostaglandins.

Question 10

How are prostaglandins related to pain?

Answer 10

Have a role in pain and inflammation.

• inflammatory = release of prostaglandins.
• NSAIDs block prostaglandins 00> reducing inflammation.

Question 11

Is COX 1 or COX 2 bad?

Answer 11

COX 2 =

• increases inflammation/pain.
• COX 1 = inhibits inflammation/pain.

Question 12

What produces the release of prostaglandins?

Answer 12

Cyclooxgenase enzymes (COX).

Question 13

What are the ‘good’ functions of prostaglandins?

Answer 13

Homeostatic functions including regulating =

• renal function.
• platelet function.
• vascular endothelial function.
• integrity of gastric mucosa.

Question 14

What are the ‘bad’ functions of prostaglandins?

Answer 14

• Inflammation.

- Pain.

Question 15

What are prostaglandins necessary for?

Answer 15

• Inhibiting gastric secretion.

- Producing a protective mucus layer to line the stomach.

Question 16

What are some of the common side effects of NSAIDs?

Answer 16

• Nausea.
• Vomiting.
• Diarrhoea.
• Indigestion.
• Abdominal pain.

Question 17

What are some contradictions of NSAIDs?

Answer 17

• People with gastric irritation.
• People with a history of upper gastrointestinal tract bleeding associated with NSAIDs.
• People with decreased kidney/liver function.

Question 18

Explain ibuprofen on pain?

Answer 18

1) . Non-selective inhibitor of COX 1 and 2 and inhibits prostaglandin synthesis.
- Usually used for pain associated with inflammation.
- Rapidly absorbed and distribution.
- Excretion is rapid.

Question 19

Explain codeine on pain?

Answer 19

• 1/10 the potency of morphine.

- Metabolised into morphine in the liver and binds to opioid receptors in the spinal cord.

Question 20

Explain morphine on pain?

Answer 20

• Oral morphine = first-line opioid in palliative care.

- Morphine binds to opioid receptors which are widespread in the brain and spinal cord.

Question 21

What receptors do morphine bind to?

Answer 21

mu receptors.

Question 22

What is an mu receptor?

Answer 22

• Exist on presynaptic nerve in the periaqueductal grey region –> primary control centre for descending pain (dorsal horn of the spinal cord).