Pain Management Flashcards
What is nociceptive pain ?
Arises from direct activation of nociceptors located in the peripheral somatosensory nervous system
What is neuropathic pain ?
Pain occurring with an abnormally functioning somatosensory nervous system
If nociceptive pain is somatic how would the pain be described ?
Sharp, aching or throbbing
If nociceptive pain is visceral how would the pain be described ?
Crampy
How is neuropathic pain described ?
Burning, tingling
Numbness
Shooting
Stabbing
Electric like feelings
What can cause neuropathic pain as a result of a primary nervous system lesion ?
Ischaemia
Compression
Infiltration
Metabolic injury
Transaction of the nerve
What are the 3 major categories of pain syndromes in cancer ?
Direct tumour involvement
Pain associated with cancer therapy
Pain not related to therapy or cancer
What are the 3 steps of the WHO analgesic ladder ?
Non-opioid analgesics - paracetamol and NSAIDs
Weak opioids - codeine and tramadol
Strong opioids - fentanyl, morphine, oxycodone
How do NSAIDs work ?
Inhibiting cycle-oxygenate which is an enzyme that converts arachidonic acid to prostaglandins.
What are some adverse effects of NSAIDs ?
Gastropathy
Renal failure
Inhibition of platelet aggregation
If dehydrated or have renal failure what alterations should be made for opioids ?
Doses should be lower than normal with increased intervals between doses to avoid excessive accumulation of active drug.
What are some common adverse effects of opioids ?
Constipation
Sedation
Nausea and vomiting
What are some steroid adjuvants for pain management ?
Prednisolone
Dexamethasone
What are some antidepressants adjuvants for pain management ?
Amitriptyline
What are some anxiolytic adjuvants for pain management ?
Diazepam
Lorazepam
What are some anticonvulsants adjuvants for pain management ?
Gabapentin
Clonazepam
What are some medications for neuropathic pain ?
TCA’s
Anticonvulsants
Clonazepam
What are some mediations for visceral pain ?
Steroids
Anti-spasm agents
What are some medications for somatic soft tissue pain ?
NSAIDs
Steroids
What are some medications for bone pain ?
NSAIDs
Bisphosphonates
Calcitonin
What are some weak opioids ?
Codeine
What are some strong opioids ?
Fentanyl
Oxycodone
Morphine
When can radiation therapy be used for pain relief ?
Bone mets
CNS involvement
Visceral pain
Pain due to obstruction
Where are opioids broken down and excreted ?
Metabolised - liver
Excreted - kidneys
What are some adverse effects of taking opioids ?
Constipation
Sedation
Nausea and vomiting
