Pain Management Flashcards by Alex Crawford

What is pain?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

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What are three pain assessments?

Physical, Functional & Psychosocial

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What are the three types of neuron?

1st - sensation of pain
2nd - modulation & propagation of pain
3rd - translation and perception of pain

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What are the three types of neuron fibres? What do they do?

A- delta = acute pain - middle
A- Beta = sensation/ other types of stimulation - fastest
C fibre = Chronic pain - Slowest

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How is pain perceived by the body?

Activation of nociceptors, found at the nerve terminals of 1st order neurons, these are pain mediator receptors. These are stimulated by prostaglandins, substance p & nociceptins. This propagates the impulse in the first-order neuron, to the second-order and finally to third-order neurons.

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What is the most common pain associated with acute pain?

Anxiety

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What is the most common pain associated with chronic pain?

Depression

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What are 3 characteristics of acute pain?

Myelinated - faster conduction as can jump between nodes of Ranvier
Large Diameter
Fast conduction - A-Delta

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What are 3 characteristics of chronic pain?

Unmyelinated
Slower conduction - C fiber
Small diameter

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What can acute and chronic pain each be accompanied with?

Acute - Stress & Anxiety
Chronic - Depression

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What is adjuvant medication?

Not true analgesics
Pt with chronic or acute pain - on analgesics - but will be experiencing other pain like stress/ anxiety/ depression so added therapies are required additionally. These for example could be anti-depressants.

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What is neuropathic pain associated with?

Diabetic pain. This is where nerve terminals are irritated.

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What is gabapentin and pregabalin used for?

Neuropathic pain - help in reducing sensitivity of nerve terminals

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What is the stepwise approach to starting opioid medication?

Step 1 - NSAIDs/ Non opioid for mild pain= +/- Adjuvant
Step 2 - Opioid, MILD TO MODERATE + NSAIDs +/- Adjuvant
Step 3 - Opioid + NSAIDS, MODERATE TO SEVERE

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Can you add weak opioids alongside strong opioids?

No, both types of opioids activate the same receptor (nociceptor). The addition of weak opioids causes competition for the receptors and causes a reduction in potency, when just giving a strong opioid

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Can opioids be given alongside NSAIDs?

Yes, opioids act on nociceptors whereas NSAIDs act on COX1 & COX2 inhibiting prostaglandin production

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Give an example of a strong opioid

Morphine

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Give an example of a weak opioid

Codeine

What is the preferred analgesic?

Paracetamol

Why can’t you just start with a strong opioid?

Strong side effects therefore need to work way up. Many fatal side effects ie resp depression

What is PCA?

Patient controlled analgesia
Patient is set up with a machine that allows them to administer their own analgesic whenever they experience pain by pressing a button.
The software used only allows one dose to be administered as it locks until another dose can be taken. For example if a drug is allowed tds but pt wants two doses within one hr - can’t happen

Why is PCA good?

Pt uses less doses - therefore less medicine is wasted.

What is a risk of PCA?

Infection

What are benefits of epidural?

Require less dose as drug is being delivered to the direct site of action (dorsal horn)
Reduces side effects

What is TENs machine used for? How does it work?

Pain Management used in hospitals. Used for 10-15 mins and provides 8 hrs of analgesics

If pt has both chronic and acute pain which does he feel?

Pt is being stimulated by two types of pain acute and chronic; patient will only feel one type of pain- acute. This is due to its conduction speed being greater in the A-delta fiber than the C fiber. Only one fiber can be stimulated at once. Once the impulse reaches the second order neuron it goes into absolute refractory period where it can't receive or transmit any other impulse. Until the current impulse disappears

What is the MOA of a TENS machine?

A-beta is stimulated by the transcutaneous electrical nerve stimulator machine. This causes tingling and high mechanical stimulation. A-beta is the fastest first order neuron and therefore travels and reaches the second order neuron causing absolute refractory period meaning no other pain ie chronic or acute can be felt until the impulse is removed.

Benefits of the TENS machine

Provides 8 hr analgesic Activates endogenous system - endorphins = even more analgesia

What is neuropathic pain? What vitamin complex is used as a prophylactic?

Irritation of the nerve terminal. Common in diabetic pt. Vitamin B complex

If neuropathic pain occurs what is treatment?

Gabapentin and Pregabalin - Adjuvant Treatment Duloxetine Tramadol

How does neuropathic pain form?

As a result of damage to the system that normally signals pain. May arise from a heterogeneous group of disorders that affect the peripheral and central nervous systems

What are three characteristics of neuropathic pain?

Glove and stocking distribution Burning or shooting pain Allodynia - severe pain that isn't normally there

What is used to treat trigeminal neuralgia?

Normally requires surgery but Carbamazepine

If mild trigeminal neuralgia

Carbamazepine and injection of glycine

What is RA?

Where immune cells attack tissues of the body causing inflammation. This affects the synovial joints. It is long life. Hurts bone, lungs, joints

What is treatment for RA?

Methotrexate Sulphsalazine

What are other treatments alongside M&S

DMARDS Oral NSAIDS Low dose aspirin must be taken before substituting or adding other analgesics

What is osteoarthritis?

Joint pain associated with loss of function and reduced quality of life Affects joints in hand, knees and hips. Associated with remodelling of adjacent bone, loss of cartilage and inflammation. Pain is so bad it reduces pt ability to do certain tasks

What is the main difference between osteoarthritis and RA?

Osteoarthritis doesn't progress where as RA does.

What is treatment of Osteoarthritis?

Paracetamol & NSAIDS Insufficient? - Add opioid Topical Capsaicin - Causes depletion of substance P resulting in decreased inflammation.

Should you prescribe glucosamine to osteoarthritic pt?

No, systemic and only successful in early stages (normally not diagnosed)

What is breakthrough pain? How is it treated?

An acute attack of chronic pain. This is controlled with Opioids

What are cluster and tension headaches treated with?

NSAID