pain management Flashcards
what is pain?
unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
how can you recognise pain if a pt can not communicate?
look - frowning, body movements, muscle tension
how can you assess pain?
verbal (mild, moderate, severe), numerical (0- no pain, 10- worst pain), visual – visual analogue scale (has faces and numbers), faces pain scale (Baker scale) this method may be more useful in certain groups that can not communicate
where does the pain from spinothalamic tract come from?
everywhere except face
where does pain from trigeminal pain come from?
face
what factors may contribute to pain?
- Beliefs/ concerns about pain
- Psychological factors: anxiety, anger, depression may exacerbate or reduce pain
- Cultural issues – language, expectations
- Other illnesses: chronic pain is a lot harder to manage
- Coping strategies – may have maladaptive coping mechanisms
- Social factors – family, work
what can be used to treat peripheral pain?
- Non drug: RICE
- Anti inflammatory drugs and LA
what can be used to manage spinal cord pain?
- Non drug: acupuncture, massage
- LA, opioids, ketamine (nmda receptor agonist but binds to lots of receptors)
what can be used to manage pain in the brain?
- Non drug: psychological good in chronic
- Drugs: paracetamol, opioids, amitriptyline (useful for neuropathic pain) and clonidine (alpha 2 agonist post op pain and can be used in combo for chronic)
what should you use to manage mild pain?
- Mild: paracetamol ± NSAID
what should be used to manage moderate pain?
- Moderate: paracetamol ± NSAID and codeine
what should be used to manage severe pain?
- Severe: paracetamol ± NSAID and morphine
what are the 5 steps WHO use for prescribing pain?
- Oral administration – used wherever possible
- Analgesia given at regular intervals: duration and dose of medication supporting patients level of pain
- Analgesia should be prescribed according to pain intensity – characterised by patient
- Dosing should start at lowest- titrate up if needed
- Consistent admin: vital for effective pain management
what are side effects of opioids?;
Side effects: constipation, drowsiness and impaired concentration impair ability to drive, N+V (common when starting or increasing dose), dry mouth, flushing, hallucinations, headaches
what are long term complications of opioid prescribing?
Long term: carry risk of dependence and addiction
- Long term Side effects: risk of falls, erectile dysfunction, amenorrhoea, infertility, depression, fatigue and opioid induced hyperalgesia (paradoxical response where they can become more sensitive to noxious stimuli than originally)
