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Pain Management Flashcards

1
Q

Define pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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2
Q

Define chronic pain

A

Pain present for 3+ months

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3
Q

What are the two aspects to the experience of pain?

A
  • sensory: sensory signal from pain receptor (Nociceptors)`
  • affective: unpleasant emotional reaction to pain
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4
Q

What is pain threshold?

A

The point at which sensory input is reported as painful

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5
Q

What is allodynia?

A

Pain experienced with sensory inputs that do not normally cause pain e.g. light touch

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6
Q

What are pain receptors called?

A

Nociceptors

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7
Q

What are the types of nerve fibres that transmit pain

A

A delta
C

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8
Q

Compare A delta + C fibres

A
  • A delta: fast, sharp, localised pain | myelinated
  • C: slow, dull, diffuse pain | unmyelinated
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9
Q

What pathway is pain a part of?

A

Spinothalamic pathway

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10
Q

Location of 1st, 2nd + 3rd order neurone cell body in spinothalmic pathway

A
  • 1st: dorsal root ganglion
  • 2nd: dorsal horn
  • 3rd: thalamus
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11
Q

Outline the sensory dimension of the spinothalamic pathway

A
  • simtutus detected by Nociceptors (A delta or C fibres)
  • axon synapses on 2nd order neurones in dorsal horn
  • axons deccusate + ascend up to 3rd order neurones in thalamus
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12
Q

What receptors are involved in the pain pathway?

A

Mu receptors

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13
Q

Explanations for referred pain

A
  • nerves may share the innervation of multiple parts of the body
  • pain in one area amplifies the sensitivity in the spinal cord to signals coming from other areas
  • activation of sympathetic nervous system in response to pain > pain in other areas
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14
Q

What is neuropathic pain caused by?

A

Abnormal functioning or damage of sensory nerves

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15
Q

Typical features suggestive of neuropathic pain

A
  • burning
  • tingling
  • pins + needles
  • electric shocks
  • loss of sensation to touch
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16
Q

What can you use to measure pain?

A
  • numerical rating scale 0-10
  • visual analogues scale - rate pain on horizontal line
  • happy to unhappy faces
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17
Q

WHO analgesic ladder

A
  • step 1: non opioid medications e.g. paracetamol + NSAIDs
  • step 2: weak opioids e.g. codeine + tramadol
  • step 3: strong opioids e.g. morphine, fentanyl, oxycodone
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18
Q

What other medications can be combined with the analgesic ladder?
Or for neuropathic pain

A
  • amitryptyline
  • duloxetine
  • gabapentin
  • pregabalin
  • capsaicin cream (topical)
19
Q

What is a common side effect of long term analgesic use?

A

Medication overuse headache

20
Q

Side effects of NSAIDs

A
  • stomach ulcers
  • gastritis with dyspepsia
  • exacerbation of asthma
  • HTN
  • renal impairment
21
Q

Contraindications of NSAIDs

A
  • asthma
  • renal impairment
  • uncontrolled HTN
  • stomach ulcers
  • GORD
22
Q

What are often co-prescribed with NSAIDs and why?

A

PPIs e.g. omeprazole + Lansoprazole
To reduced GI side effects

23
Q

Side effects of opioids

A
  • constipation
  • skin itching
  • nausea
  • altered mental state (sedation)
  • respiratory depression (overdose)
24
Q

Signs of opioid overdose

A
  • pinpoint pupils
  • cyanosis
  • bradycardia, weak pulse, hypotension
  • slow irregular breathing
  • unconscious
25
What is used to in opioid overdoses? How does it work
**Naloxone** Competitive opioid receptor antagonist
26
How do opioids produce their analgesic effect? (MOA)
- bind to Mu receptors - inhibit pain signal transmission by blocking neurotransmitter release - reduce perception of pain
27
Outline use of opioids in palliative care
- **background opioids** *e.g. 12 hourly oral morphine* - **rescue doses** for breakthrough pain
28
Compare rescue dosage of opioid to background dose
Normally 1/6th of background 24 hour dose
29
If a patient is on 30mg modified release morphine every 12 hours, what would the correct breakthrough dose be?
- **1/6th of background dose in 24 hours** - patient is taking 30x2=60mg in 24 hours - 1/6 of 60 = 10mg - rescue doses is 10mg
30
Options for opioid patches as background analgesia
- buprenorphine patches - fentanyl patches
31
Why is adequate post op analgesia needed?
To encourage the patient to; - mobilise - ventilate their lungs fully - have adequate oral intake
32
What does patient controlled analgesia involve?
- IV infusion of a strong opiate attached to a patient controlled pump - patient presses button as pain develops to administer opiate bolus - buttons will stop responding for set time to prevent over use
33
What drugs should be available in case of adverse side effects of patient controlled analgesia?
- ***naloxon*** for respiratory depression - **antiemetics** - ***atropine*** for bradycardia
34
Common areas of chronic pain
- headaches - low back pain - neck pain - joint pain
35
What is chronic primary vs chronic secondary pain?
- **chronic primary pain**: no underlying condition adequately explains the pain - **chronic secondary pain**: there is an underlying condition which explains the pain signal transmission
36
What three physical processes can lead to chronic pain?
- sensitisation of primary afferent Nociceptors by frequent simulation - increased sympathetic nervous system activity - increased muscle contraction in response to pain
37
Managing chronic pain
- supervised group exercise programs - CBT - acceptance and commitment therapy - acupuncture - antidepressants *e.g. amitriptyline, duloxetine*
38
What medications should patients with chronic primary pain NOT be started on?
- paracetamol - NSAIDs - opiates - pregabalin - gabapentin
39
What is the most appropriate medication for a patient with chronic primary pain?
**Antidepressants** *e.g. amitriptyline, duloxetine, SSRIs*
40
What can be used to assess for neuropathic pain?
**DN4 questionnaire** 4+/10 indicates neuropathic pain
41
What are the first line treatments for neuropathic pain? What is their classification
- ***amitriptyline***: antidepressant - ***duloxetine***: SNRI antidepressant - ***gabapentin**: anticonvulsant - **pregabalin**: anticonvulsant - only one can be used at a time
42
Second line options for neuropathic pain
- slowly stop first line med + try alternative - tramadol ONLY as rescue - topical capsaicin cream - Physiotherapy - psychological help
43
What is first line medication for trigeminal neuralgia?
Carbamazepine

Anaesthetics (9 decks)

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