pain management Flashcards
define pain
pain is a protective helpful mechanism to prevent further damage
what is chronic pain
no longer helpful- still there beyond the normal healing process. pain that persists or reoccurs for 3 months.
what is primary chronic pain
don’t know what is causing the pain but this is the most prominent concern = harder to treat
what is secondary chronic pain
there is another element causing the pain eg RA
what is social prescribing and how can it help patients
another way of dealing with patients- not just with medicines eg signposting to a social group, reduce social isolation, look at the individual holistically
what is the pain ladder
non opioids eg paracetamol NSAIDs eg ibuprofen Adjuvant eg gabapentin or amitriptyline weak opioids eg tramadol or codeine strong opioids eg morhpine then oxycodone as second line
what is the analgesic of choice in pregnant women
paracetamol
what are the risks and cautions surrounding paracetamol use
hepatotoxicity, or risk of overdose in a malnourished individual, (dose reduction in patients under 50kg)
what is the issue with effervescent formulations
may exceed salt intake for the day if taking two QDS for long term management, avoid in CVD patients
issues with NSAID use
increased risk of bleeding if prescribed alongside warfarin, aspirin or SSRIs
how does NSAIDs work
reversibly inhibit COX enzymes. COX 1 inhibition results in side effects, COX 2 inhibition- is the pain relieving and anti inflammatory element. usually non selective so inhibit both
how do NSAIDs cause gastric irritation
inhibit COX 1 which is responsible for maintaining gastric mucosa
how do NSAIDs cause an increased risk of bleeding
they block COX 1 and therefore block the production of thromboxane which is involved in clotting process
how do COX 2 inhibitors increase the risk of cardiac problems
cause damage to endothelium
what is the mechanism of renal damage due to NSAIDs
COX 1 blocks the prostaglandin that is responsible for vasodilation on the afferent arteriole of the glomerulus. in order for the kidney to filter medication you need a conc gradient. if NSAIDs inhibits prostaglandins then you won’t get vasodilation = reduces the conc gradient = reduces the filtration of drugs so they build up and you get kidney damage as a result
what type of conditions can adjuvant analgesics be suitable in
neuropathic pain
what are the concerns surrounding opioid use
side effects, withdrawal, addiction, no longer effectively treating pain
cons of codeine coming as a fixed dose with paracetamol
acute pain- you would want to avoid the fix dose because you don’t have flexibility of dosing. dose of codeine is usually 8mg which is a low dose which had been shown to not have much benefit so you are exposing the patient to be side effect profile of codeine without the benefit
pros of combined dosing of paracetamol and codeine
chronic- long term management so reduces pill burden and increases adherence
what side effects of opioids can patients become tolerant to
nausea and vomiting. patients will not develop tolerance to constipation.
what is pain
an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
define acute pain
recent onset, limited duration and usually related to pathological process, disease or injury
phantom limb pain
feeling pain in an amputated area
define nociception
the neural process of encoding noxious stimuli to send signal to brain to avoid pain= protective function. no emotional component
