Pain Management

Question 1

Short term pain

Answer 1

acute pain

often warn us that something is wrong but can usually be fixed

Question 2

Long term pain

Answer 2

persistent or chronic pain

no useful purpose
pain lasts for 3 months or more
constant or flare ups
often comes with other symptoms - such as numbness or burning sensations
emotions make pain worse

Question 3

What are the receptors that detect pain called?

Answer 3

Nociceptors

Question 4

Myelinated v non-myelinated nociceptors

Answer 4

myelinated = conduct at fast speeds and initiate pain
non-myelinated = conduct at slower speeds for longer and dull pain

Question 5

What is the tract called that carries nociceptive signals to the brain?

Answer 5

Spinothalamic

Question 6

Where is the brain do nociceptive signals get carried to?

Answer 6

the somatosensory area in the thalamus

Question 7

Where does somatic pain come from?

Answer 7

musculoskeletal structures and certain soft tissues such as bones, joints, muscles, skin and mucous membranes

Question 8

Where does visceral pain come from?

Answer 8

originates in internal organs of the chest, abdomen or pelvis and the tissues that cover them

Question 9

Pain scoring tools

Answer 9

numerical rating scale - scale of 0-10
Wong-Baker faces - pointing to faces that describe how the patient feels

Question 10

Before administering pain relief what should you do?

Answer 10

full history take
decide on a differential diagnosis
explain what you would like to do
gain consent

Question 11

How to understand chronic pain and how it is differing to normal

Answer 11

on a scale of 1-10 what was your worst pain?
What does you average pain feel like?
Is it interfering with daily activities?
Interference with social life?
How long have you been away from work?

Question 12

Pain relief options (not everything is medicinal)

Answer 12

Psychological - reassurance, distraction
Physical - cooling, dressing, splinting and immobilisation
Pharmacological - medication

Question 13

What should be given for mild pain

Answer 13

entonox
non-opioid analgesics (paracetamol and ibuprofen)

Question 14

action of paracetamol

Answer 14

blocks the production of prostaglandins which are involved in pain transmission

Question 15

What should be given for moderate to severe pain

Answer 15

morphine sulphate
IV paracetamol
codeine
diazepam

Question 16

oral vs IV morphine

Answer 16

oral = slower and safer. first pass effect = medication undergoes metabolization = decreased concentration

IV = mixed with sodium chloride, must be titrated

Question 17

action of morphine

Answer 17

binds to opioid receptors in the CNS = reduced pain sensation

Question 18

Considerations when administering morphine

Answer 18

It can cause respiratory depression

some patients may have prescription zomorph or zapain - be careful not to overdose them.

Question 19

What does “balanced analgesia” mean?

Answer 19

the dose of morphine can be reduced by 40-50% if administered alongside paracetamol or ibuprofen

Question 20

Barriers to effective pain relief (7)

Answer 20

patient factors: general condition, communication and cooperation

lack of knowledge, experience or training

environment

personal, cultural or religious beliefs

dementia

lack of understanding

the fear that pain relief will eliminate the cause = pt feels they wont be believed

Question 21

why is pain management important?

Answer 21

patients are more cooperative when comfortable = earlier diagnosis

pain measurements and reassessments will help to monitor progress.

Question 22

6 medication “rights” in documentation

Answer 22

right patient
right reason
right medicine
right route
right dose
right documentation