pain management

Question 1

define pain

Answer 1

pain is a protective helpful mechanism to prevent further damage

Question 2

what is chronic pain

Answer 2

no longer helpful- still there beyond the normal healing process. pain that persists or reoccurs for 3 months.

Question 3

what is primary chronic pain

Answer 3

don’t know what is causing the pain but this is the most prominent concern = harder to treat

Question 4

what is secondary chronic pain

Answer 4

there is another element causing the pain eg RA

Question 5

what is social prescribing and how can it help patients

Answer 5

another way of dealing with patients- not just with medicines eg signposting to a social group, reduce social isolation, look at the individual holistically

Question 6

what is the pain ladder

Answer 6

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

Question 7

what is the analgesic of choice in pregnant women

Answer 7

paracetamol

Question 8

what are the risks and cautions surrounding paracetamol use

Answer 8

hepatotoxicity, or risk of overdose in a malnourished individual, (dose reduction in patients under 50kg)

Question 9

what is the issue with effervescent formulations

Answer 9

may exceed salt intake for the day if taking two QDS for long term management, avoid in CVD patients

Question 10

issues with NSAID use

Answer 10

increased risk of bleeding if prescribed alongside warfarin, aspirin or SSRIs

Question 11

how does NSAIDs work

Answer 11

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

Question 12

how do NSAIDs cause gastric irritation

Answer 12

inhibit COX 1 which is responsible for maintaining gastric mucosa

Question 13

how do NSAIDs cause an increased risk of bleeding

Answer 13

they block COX 1 and therefore block the production of thromboxane which is involved in clotting process

Question 14

how do COX 2 inhibitors increase the risk of cardiac problems

Answer 14

cause damage to endothelium

Question 15

what is the mechanism of renal damage due to NSAIDs

Answer 15

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

Question 16

what type of conditions can adjuvant analgesics be suitable in

Answer 16

neuropathic pain

Question 17

what are the concerns surrounding opioid use

Answer 17

side effects, withdrawal, addiction, no longer effectively treating pain

Question 18

cons of codeine coming as a fixed dose with paracetamol

Answer 18

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

Question 19

pros of combined dosing of paracetamol and codeine

Answer 19

chronic- long term management so reduces pill burden and increases adherence

Question 20

what side effects of opioids can patients become tolerant to

Answer 20

nausea and vomiting. patients will not develop tolerance to constipation.

Question 21

what is pain

Answer 21

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Question 22

define acute pain

Answer 22

recent onset, limited duration and usually related to pathological process, disease or injury

Question 23

phantom limb pain

Answer 23

feeling pain in an amputated area

Question 24

define nociception

Answer 24

the neural process of encoding noxious stimuli to send signal to brain to avoid pain= protective function. no emotional component