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)
how do you manage side effects of opioids?
Managing side effects:
- N+V: anti emetics eg cyclizine
- Constipation: all patients starting strong opioids should be prescribed a laxative to prevent constipation
- ABC – start Antiemetic, consider Breakthrough pain, prescribe laxatives for Constipation
what is the clinical toxidome triad for opioid toxicity
reduced consciousness, resp depression and constricted pupils (miosis)
within the clinical toxidome of opioid toxicity which of the triad has the greatest clinical concern?
resp depression
instead of opioids what should you use in renally impaired patients and why?
as many opoids are renally excreted and then increase risk of opioid accumulation and subsequent toxicity
- Renal impaired patients: use oxycodone because it primarily metabolised by the liver
half dose and titrate upwards
how should you stop opioids?
cessation should be tapered slowly to reduce risk of withdrawal- may take weeks/months
what is neuropathic pain?
damage to somatosensory nervous system which can result in allodynia, hyperalgesia and paraesthesia
what is allodynia?
pain due to stimulus which normally would not provoke pain
what is hyperalgesia?
where you become sensitive to pain that was managed and now the same stimulus triggers pain
what are common causes of neuropathic pain?
- Diabetic neuropathy
- Chronic alcohol use
- Infection
- Trigeminal neuralgia – severe facial pain – shooting pain in jaw, up face
- Trauma
- Spinal cord injuries
- MS
- Malignancy
