Pain management Flashcards
What are the different definitions of pain?
Chronic pain: more than 12 weeks (3 months)
Chronic primary pain: no clear underlying condition
Chronic secondary pain: Has underlying condition like arthritis.
What is normally connected to chronic pain?
Depression
Which drugs are usually used for mild pain?
Non-opioids:
- Paracetamol
- NSAID
- Aspirin
Which drugs are usually used for mild-to-moderate pain?
Weak Opioids:
- Codeine
- Tramadol
- Low-dose morphine
Can be used in adjuvant to non-opioid
Which drugs are usually used for moderate-to-severe pain?
Strong opioids:
- Morphine
- Fentanyl
- Oxycodone
- Buprenorphine
Can be used in adjuvant to non-opioid
What are NSAIDs, Aspirin & Paracetamol normally used for?
Musculoskeletal pain
What are Opioids normally used for?
Visceral pain - the pain we feel when our internal organs are inflamed, diseased, damaged or injured.
What is used for Sickle cell disease?
Paracetamol & NSAIDs, codeine and dihydrocodeine
Severe crisis - morphine or diamorphine may be needed
Avoid pethidine - can cause seizures
What are the paracetamol doses for children?
1-2 months:
- 30-60mg every 8 hours as required. Max daily dose given in divided doses. Max 60mg/kg per day
3-5 months:
- 60mg every 4-6 hours; max 4 doses per day
6-23 months:
- 120mg every 4-6 hours; max 4 doses per day
2-3 years:
- 180mg every 4-6 hours; max 4 doses per day
4-5 years:
- 240mg every 4-6 hours; max 4 doses per day
6-7 years:
- 240-250mg every 4-6 hours; max 4 doses per day
8-9 years:
- 360-375mg every 4-6 hours; max 4 doses per day
10-11 years:
- 480-500mg every 4-6 hours; max 4 doses per day
12-15 years:
- 480-750mg every 4-6 hours; max 4 doses per day
16-17 years:
- 0.5-1g every 4-6 hours; max 4 doses per day
What are the Ibuprofen doses for children?
3-5 months:
- 50mg 3 times a day
6-11 months:
- 50mg 3-4 times a day
1-3 years:
- 100mg 3 times a day
4-6 years:
- 150mg 3 times a day
7-9 years:
- 200mg 3 times a day
10-11 years:
- 300mg 3 times a day
All max daily doses given in 3-4 divided doses; max 30mg/kg per day
7-11 years - max 2.4g per day
12-17 years:
- Initially 300-400mg 3-4 times a day, increased if necessary up to 600mg 4 times a day; maintenance 200-400mg 3 times a day, may be adequate.
What are the Ibuprofen doses, in bottles, for children?
Strength: 100ml/5mg
Dose every 6-8hrs, 3 doses in 24hrs.
3-6months:
- 2.5ml then 2.5ml after 6hrs if required
3-6months:
- 2.5ml
6-11 months:
- 2.5ml
1-3 years:
- 5ml
4-6 years:
- 7.5ml
7-9 years:
- 10ml
10-12 years:
- 15ml
What can be given for Dental & Orofacial pain?
- NSAIDs (Ibuprofen, Aspirin, Diclofenac), Paracetamol used temporarily
- Benzydamine mouthwash/spray can be used
- Paracetamol, Ibuprofen & aspirin are adequate for dental pain.
- Diazepam - Has muscle relaxant and anxiolytic properties (only prescribe short term)
What drugs can be used to treat Dysmenorrhoea?
- Antiemetic can be used to prevent vomiting.
- Paracetamol or NSAID used for pain relief
- Oral contraceptives used to prevent pain associated with ovulatory cycles
What is Aspirin indicated for and what are some problems associated with it?
Indicated for headache, musculoskeletal pain, dysmenorrhoea & pyrexia.
Can cause G.I problems but can be minimised by taking dose after food.
Enteric coated preps have a slow onset of action & therefore unsuitable.
It interacts with other drugs esp warfarin which is a high hazard.
Is Aspirin or Paracetamol preferred?
Paracetamol because it is safer, esp in elderly.
What can overdosage of paracetamol cause?
Hepatic damage.
When can Nefopam be used?
Used for pain not responding to non-opioid analgesics.
But has more side effects.
What can NSAIDs be used for?
- Chronic disease accompanied by pain & inflammation
- Can be used as short term treatment of mild-to-moderate musculoskeletal pain
- Suitable for dysmenorrhoea
- Can treat pain caused by secondary bone tumours
- Used for post-operative analgesia
What painkiller should patients with high risk of G.I side effects be given?
Selective inhibitors of cyclo-oxygenase-2
Preferred over NSAIDs for these patients.
Is compound analgesics or single ingredient analgesics preferred?
Single ingredient analgesics is preferred due to having to titrate each drug.
What is caffeine used for in analgesics?
It is a weak stimulant and enhances analgesics effects
What caution is given with Opioid analgesics?
- Repeated use can cause dependence and tolerance.
- Caution in impaired respiratory function (avoid COPD), asthma, hypotension, MG, shock and convulsive disorders
What are the side effects of Opioids?
- Respiratory depression: Treated by artificial ventilation or reversed by naloxone
- Dependence & withdrawal: Tolerance can develop during long term use
- Overdose: Cause coma, respiratory depression & pinpoint pupils
- N&V
- Constipation
- Dry mouth
- Drowsiness
- Biliary spasm
Larger doses can cause muscle rigidity, hypotension, respiratory depression
Long terms use can cause hypogonadism & adrenal insufficiency
What can happen when Opioids are used in Pregnancy?
Respiratory depression & withdrawal symptoms have been reported.
Gastric stasis & inhalation pneumonia (infection in lungs)
