Pain Management

Question 1

Types of Pain

Answer 1

• Acute Pain
  * Superficial somatic pain
  * Deep somatic pain - Dull, aching throbbing
  * Visceral pain
  * Ischaemic pain
  * Neuropathic
  • Chronic Non-Cancer Pain (CNCP)
  • Chronic Cancer Pain

Question 2

Non-Pharmacological Pain Management

Answer 2

• Explanation (“Pain does not mean further damage is being caused”)
  
  • Encouragement patient to be active
  • Create a plan to return to normal functioning
  • Exercise program with physiotherapist

Question 3

Pharmacological Pain Management

Answer 3

• Paracetamol
  
  • NSAIDs
  • Opioids
  • Antidepressants
  • Anticonvulsant
  • Corticosteroids - Dexamethasone
  • Topical Preparations - Capsaicin

Question 4

Opioids for Pain Management

Answer 4

• Weak - limited roles in palliative care
  * Codeine
  * Tramadol
  * Strong
  * Morphine sulphate
  * Immediate release
  * Controlled release (MS Contin)
  * Oxycodone
  * Immediate release (Endone)
  * Controlled release (Oxycontin)
  * Fentanyl

Question 5

Antidepressants used for Pain Management

Answer 5

• TCA
  * Amitriptyline
  * SNRI
  * Duloxetine

Question 6

Anticonvulsants used for Pain Management

Answer 6

• Carbamazapine
  * Gapapentin
  * Pregabalin

Question 7

Superficial Somatic Pain Causes and Sensation

Answer 7

Causes
   * Burn
   * Ulceration
   * Ulcer
Sensation
   * Hot
   * Sharp
   * Stinging pain

Question 8

Superficial Somatic Pain Management

Answer 8

• Clean area, moist dressing
  
  • Paracetamol or NSAID
  • Opioids if severe
  • Local anaesthetic use is contentious

Question 9

Deep Somatic Pain Causes and Sensation

Answer 9

Causes
   * Bone fractures or metastases
   * Acute arthritis
   * Low back pain
Sensation
   * Dull
   * Aching
   * Throbbing

Question 10

Deep Somatic Pain Management

Answer 10

• Paracetamol and/or NSAID
  
  • Weak opioid
  • Strong opioids if severe

Question 11

Visceral Pain Causes and Sensation

Answer 11

Causes
   * Appendicitis
   * Period pain
   * Intestinal pain
   * Biliary or renal colic
Sensation
   * Dull
   * Deep
   * Cramping
   * Colicky

Question 12

Visceral Pain Management

Answer 12

• Paracetamol and/or NSAID

* Strong opioids if severe

Question 13

Ischaemic Pain Causes and Sensation

Answer 13

Causes
* Myocardial infarction
Sensation
* Often excruciating pain

Question 14

Ischaemic Pain Management

Answer 14

• Opioids

Question 15

Neuropathic Pain Causes and Sensation

Answer 15

Causes

• Post-surgical
• Sciatica
• Diabetic peripheral neurpathic pain
• Post-herpetic pain
• Cancer related neuropathic pain
• Multiple Sclerosis
• Phantom limb pain
• Trigeminal neuralgia

Sensation

• Dysaesthesia
  
  • Pins and needs, tingling, burning, lancinating/ shooting pain
• Allodynia
  
  • Non-painful stimulus produces pain
• Pain in a numb area
• Pain worse at night
• Autonomic instability
  
  • Pallor, cold

Question 16

Neuropathic Pain Management

Answer 16

• TCA Antidepressant
  * Amitriptyline
  
  • Anti-epileptics
    
    • Gabapentin
    • Pregabalin
  • Weak opioid
    
    • Tramadol
  • Strong opioids
    
    • Morphine
    • Oxycondone
  • Pain clinic referral

Question 17

Chronic Cancer Pain Causes

Answer 17

• Direct pressure on
  * Surrounding organs
  * Nerves (somatic)
  * Spinal cord
  * Blood vessels - ischaemic pain
  • Pathological fractures
  • Brain metastases
  • Medication side effect
    
    • Eg. intestinal colic from faecal impaction

Question 18

Chronic Cancer Pain Management

Answer 18

• Non-Pharmacological
  * Psychological therapy
  * TENS (Transcutaneous Electrical Nerve Stimulation)
  * Massage
  * Acupuncture
  * Radiotherapy
  
  • Pharmacological
    
    • Regular uncapped opioid medication
    • Anticipate side effects
    • Steroids (usually dexamethasone)
    • Nerve blocks