Pain Management

Question 1

What is allodynia

Answer 1

Pain experienced in response to a stimulus not normally painful

Question 2

What is hyperalgesia

Answer 2

Heightened pain response from something that is painful

Question 3

What is hyperpathia

Answer 3

Sensation of painful numbness

Question 4

What is neuropathic pain

Answer 4

Pain arising as a direct consequence of a lesion or somatosensory system

Question 5

Symptoms of neuropathic pain

Answer 5

Spontaneous, paroxysmal, burning, shooting, sharp, numb, allodynia, hyperalgesia, hyperpathia

Question 6

Pain tool used to assess chronic pain

Answer 6

McGill pain questionnaire

Question 7

Pain tool used to assess pain in delirium, cognitive impairment or dementia

Answer 7

Bolton pain assessment tool

Question 8

What is at the bottom of the analgesic pyramid

Answer 8

Simple analgesics such as NSAIDs and paracetemol

Question 9

What is in the middle of the analgesic pyramid

Answer 9

Weak opioids such as codeine, tramadol

Question 10

What is at the top of the analgesic pyramid

Answer 10

Strong opioids such as morphine

Question 11

What does paracetemol do

Answer 11

Analgesic and antipyretic, unknown mechanism of action

Question 12

Dose of paracetemol given to adults

Answer 12

1g / 6 hours - but if <50kg then max 60mg/kg/day

Question 13

Contraindications of paracetemol

Answer 13

Allergy, hepatic failure

Question 14

Dose of paracetemol given to children

Answer 14

20mg/kg loading dose
10-15mg/kg up to max 90mg/kg/day

Question 15

Examples of NSAIDs

Answer 15

Ibuprofen, diclofenac, naproxen - COX-2s

Question 16

What do NSAIDs do

Answer 16

Anti-inflammatory, antipyretic and analgesic

Question 17

Side effects of NSAIDs

Answer 17

Platelet dysfunction, mucosal damage, renal impairment and bronchospasm

Question 18

Contraindications of NSAIDs

Answer 18

Allergy, asthma, GI upset, coagulopathy, renal impairment, CVS disease

Question 19

Examples of weak opioids

Answer 19

Codeine, dihydrocodeine, tramadol

Question 20

Examples of strong opioids

Answer 20

Morphine, oxycodone, fentanyl

Question 21

Side effects of opioids

Answer 21

Nausea, vomiting, bradycardia, pruritis, constipation, sedation, hallucinations, respiratory distress, tolerance, dependence, addiction

Question 22

Which opioid is fentanyl especially good for

Answer 22

Renal impairment

Question 23

What does tramadol do to epileptic patients

Answer 23

Lowers the seizure threshold

Question 24

Which weak opioid is used first line and why

Answer 24

Dihydrocodeine as codeine can be metabolised differently in a small group of patients

Question 25

Risk factors for chronic pain

Answer 25

females, age >45, socio-economic status, lifestyle risk factors, employment, psychological distress, history of trauma or chronic pain, family history

Question 26

Non spinal causes of back pain

Answer 26

Aortic aneurysm, renal causes, pancreatisis, psoas abscess

Question 27

Spinal causes of back pain

Answer 27

Slipped intervertebral disc, fracture, osteoarthritis, infection, malignancy, cauda equina