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Exam M - Anaesthetics (Megan and Rachel) > pain management > Flashcards

pain management Flashcards

1
Q

describe acute pain

A

recent onset

limited duration

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2
Q

describe chronic pain

A

lasts 3+ months

often lasts after normal healing with no identifiable cause

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3
Q

what are the two mechanisms of pain

A

nociceptive

neuropathic

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4
Q

describe nociceptive pain

A

also known as physiological/inflammatory
has obvious tissue injury
pain is well localised
has protective function

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5
Q

describe neuropathic pain

A

nervous system damage/abnormality
abnormal processing of pain signals
burning/shooting pain
numbness/tingling

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6
Q

what are some causes of neuropathic pain

A

increased receptor numbers
abnormal sensitisation of nerves
chemical changes in dorsal horn
loss of inhibitory modulation

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7
Q

what are simple analgesics

A

paracetamol

NSAIDs - ibuprofen, diclofenac

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8
Q

when can paracetamol be used

A

for mild pain

for moderate pain in combination with other drugs

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9
Q

what can a paracetamol overdose cause

A

liver damage

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10
Q

how do NSAIDs work

A

reduce prostaglandins and inflammatory process to prevent stimulating nociceptors in periphery

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11
Q

what can NSAIDs be used for

A

nociceptive pain

in combination with paracetamol

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12
Q

what are side effects of NSAIDS/when should they be avoided

A

stomach ulcers (give with PPIs)
hypertension
bronchospasm in asthmatics
avoid in kidney disease

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13
Q

what are ‘weak’ opioids

A

codeine
dihydrocodeine
tramadol

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14
Q

what are ‘strong’ opioids

A

morphine
oxycodone
fentanyl

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15
Q

what are common side effects of opioids

A 
constipation 
puritis 
nausea 
altered mental state 
respiratory depression
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16
Q

what is codeine good for

A

mild-moderate nociceptive pain

17
Q

how does tramadol work

A

mixed opiate and 5HT/NA reuptake

weak opioid effect + inhibits serotonin and noradrenaline reuptake

18
Q

what is morphine used for

A

moderate-severe nociceptive pain and cancer pain

can be given orally, IV, IM, SC, PR, intrathecally

19
Q

what are anti-convulsants used for

give examples

A

neuropathic pain
gabapentin
carbamazepine
sodium valproate

20
Q

side effects of gabapentin

A

very addictive - cocaine effect

only give if confirmed neuropathic pain

21
Q

what anti-depressants can be used for pain

A

amitriptyline

duloxetine

22
Q

what topical agents can be used for pain

A

capsaicin

23
Q

what is amitriptyline

A

tricyclic anti-depressant

24
Q

what is amitriptyline used for

A

neuropathic pain
depression
poor sleep

25
Q

what are side effects of amitriptyline

A

glaucoma

urinary retention

26
Q

what are non-pharmacological options for pain management

A 
acupuncture 
massage 
psychological 
rest, ice, elevation 
surgery 
physio 
explanation + planning
counselling  
input from social worker
27
Q

what is step 1 of the pain ladder

A

non-opioids
aspirin
NSAIDs
paracetamol

28
Q

what is step 2 of the pain ladder

A

mild opioids
codeine
dihydrocodeine
tramadol

29
Q

what is step 3 of the pain ladder

A

strong opioids
morphine
oxycodone
fentanyl

30
Q

what part of the pain ladder do you use for mild pain

A

just step 1

31
Q

what part of the pain ladder do you use for moderate pain

A

step 1 + step 2

32
Q

what part of the pain ladder do you use for severe pain

A

step 1+3

33
Q

when is the pain ladder less applicable

A

in neuropathic pain

34
Q

what is the RAT approach to pain

A

recognise
assess
treat

35
Q

what do you assess the pain for

A

pain score at rest vs with movement
nociceptive or neuropathic
other factors like other diseases

36
Q

What medication should be given in severe pain after trauma?

A

Morphine (+ paracetamol).

Ibuprofen - bottom of pain ladder (and NSAID)
Tramadol - middle of pain ladder

NSAIDS - should not be used after severe trauma to begin with because they increase the risk of bleeding.

Exam M - Anaesthetics (Megan and Rachel) (5 decks)

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