Pain Management Flashcards
What is the ‘Nociception’ process?
The transmission of electrical nerve impulses to the brain and spinal cord creating conscious awareness of pain and alterations of pain signals
What are the stages of nociception?
Transduction: stimulus (e.g temp) is converted into electrical signals in the nerve cells.
Transmission: information from the signal is relayed along two peripheral nerve fibre - A-delta and C.
Perception: conscious awareness of pain. The person is aware of pain and responds emotionally and is motivated to take action
Modulation: the body modulates pain by mechanisms decreasing or increasing pain impulses.
What is Neuropathic pain
Pain arising as a result of nerve lesions, damage or dysfunction of the nervous system, it has no protective functions.
Example: post amputation
Characteristics of nociceptive pain?
Subtypes
Duration
Causes
Management
Subtypes:
Somatic - sharp, stabbing localised pain.
Visceral - dull, heavy, aching may occur over a wide area
Duration: less than 3months
Causes: stimulation of nociceptors in response to inflammation or damage.
Management: multimedia analgesia
Opioid therapy
Characteristics of neuropathic pain?
Subtypes
Duration
Causes
Management
Subtypes: usually experienced with sensory loss. Can be associated with increased sympathetic response (rise in tempt)
Described as burning, stinging, pricking
Durayion: more than 3 months
Causes: associated with injury or disease of peripheral or central nervous system.
Mamagement: Poor response to opioid consider adjuvant (antidepressant or anticonvulsant therapy)
What questions would you ask in a pain assessment?
Where is the pain
How strong is it
Is it there all the time or does it come and go
What does it feel like
What makes it worse
What makes it better
What is meant by the
Ascending pathway and descending pathway of pain
Acending: Responsible for transmitting the pain signal to the brain
Decending: controlling and inhibiting the Ascending pathway
Name 3 types of pain
Acute
Chronic
Breakthrough
According to the WHO pain ladder there are 3 steps to pain management. In each step what pain management is recommended?
Step 1: mild pain - non-opioid analgesic (NSAID, paracetamol)
Step 2: moderate pain - week options (codeine, dihydrocodeine), with or without non-opioids
Step 3: severe pain- potent opioids (morphine, fentanyl, buprenorphine), with or without non-opioids
What is the physiology for opioid function?
Opioid bind to opioid receptors located throughout the body. They cause depending inhibitory impulses which lead to a decrease in nociception transmission.
Which theory explains how the brain modulates it’s own pain after perception?
Modulation Gate Theory
Endorphins and the bodies own opioids are released between the 1st and 2nd order nerves to block additional pain signals being transmitted.
What four elements should be included in an assessment of Total Pain?
Physical, Psychological, Social and Spiritual
Applying the Theory of Total Pain, what is a limitation of analgesic medication.
Medication only addresses the physical symptoms of pain, ignoring the psychological, social and spiritual aspects of Total Pain.
Frank is reporting a pain score of 5/10 after tripping at home.
Using the WHO pain ladder, what analgesia would you recommend he be given?
Moderate Pain:
Non-Opioids (NSAIDs, paracetamol)
Weak Opioids (codeine, tramadol)
+/- adjuvants (heat/cold packs, TENS, Acupuncture, CBT)
Tina reports a pain score of 2/10, using the WHO pain ladder, what analgesia would you reccomend?
Mild Pain:
Non-Opioids (NSAIDs, Paracetamol)
+/- Adjuvants (heat/cold packs, TENS)
Following a fall with a #NOF (neck of femur), Betty has a pain score of 9/10. Using the WHO pain ladder, what analgesia would be appropriate?
Non-Opioids (NSAIDs, paracetamol)
Potent Opioids (Morphine, Fentanyl, Ketamine)
+/- adjuvants (heat/cold packs, TENS, Acupuncture, CBT)
What considerations should be made before giving opiod medications?
The are MU Opioid receptors all over the body, including:
Bowel - increased fluid absorption leads to constipation.
Respiratory - respiratory chemoreceptor centre also has opiod receptors which can lead to respiratory depression when blocked.
CNS - Can lead to euphoria, drowsiness and confusion.
Tolerance, Dependance, Addiction.
In terms of drug use, misuse and abuse, what is meant by the term Tolerance?
Tolerance to opioid medication builds with each use, meaning that regular use makes it less effective for that individual.
In terms of drug use, misuse and abuse, what is meant by the term Dependence?
This refers to the phsyical and psychological reliance on long-term medications to perform daily tasks. Without the medication the patient can decline rapidly and suffer withdrawl symptoms.
In terms of drug use, misuse and abuse, what is meant by the term Addiction?
Addiction is a multi-factorial condition that goes beyond management of symptoms.
If given as prescribed, opioid medications should have very low rates of addiction.
Pharmacodynamics NSAIDS:
What are the three types of NSAIDs and how do they differ?
COX 1 inhibitors, COX 2 inhibitors and non-selective COX inhibitors.
COX 1 regulates many cellular processes including platelet aggregation, kidney afferent arteriole vasodilation and gastric mucousa acid protection.
COX 2 is part of the inflammatory process, inhibiting this reduces inflammation.
Non-selective - Bit of both.
Give an example of each of the three types of NSAID medication.
COX 1 -
COX 2 -
Non-selective -
COX 1 - Aspirin, Ketoralac
COX 2 - Naproxen, Diclofenac
Non-selective - Ibuprofen
What are some considerations that must be made before giving NSAIDs?
Renal Failure
Hepatic Failure
GI Bleeds.
Dyspepsia (indigestion)
Pharmacodynamics Paracetamol
How does paracetamol work and what are it’s therapeutic effects?
No-one quite understands how it works, though it thought to have some effect on prostaglandins.
Therapeutic effects include analgesia and antipyretic actions.
What is meant by the term co-analgesics?
Co-analgesics are a group of medications that were developed for a reason other than analgesia, but have analgesic effects.
Give 2 examples of a common co-analgesic medication.
Antidepressants - Amitriptiline, duloxetine.
Anti-convulsants - Pregablin, gabapentin.
NMDA Antagonists - ketamine, methadone.
Corticosteroids - Prednisolone, dexamethasone.
Jamie refuses to take any pain medications because his body is a temple and “you don’t know what big-pharma put in them pills.”
Identify 3 alternatives to pharmaceutical pain management for Jamie.
Hot/Cold packs
Massage
Physio
TENS
Acupuncture
CBT
Acceptance therapy
What is meant by hyper-algesia?
Hyper-algesia describes a patient who has become very sensitive to pain.
This could possibly have been caused by opioid use.
