Pain Management

Question 0

Tramadol

Answer 0

Opioid
Oral, IV, IM
Limited role in palliative care

Question 1

Pain - non-pharmacological strategies

Answer 1

Relaxation
Mindfulness
Hypnosis
Guided imagery
Yoga
Biofeedback
CBT

Question 2

Tramadol

Side Effects

Answer 2

Dizziness, sweating, nausea, vomiting
Serotonin toxicity
Lowers seizure threshold

Question 4

NSAIDs

Answer 4

Non-selective vs. COX-2 selective (celecoxib, meloxicam)

Analgesic, anti-pyretic, anti-inflammatory effects

Question 4

NSAID

Precautions

Answer 4

Asthma, CV, CVA, GI bleeding, renal impairment

Question 5

Strong opioids

Answer 5

E.g. morphine, oxycodone, buprenorphine, fentanyl
Short term post-op use
Permit required if used for >8/52
Use with caution in chronic non-cancer pain
Most common cause of drug-related death in Aus
Beware: dr. shoppers

Question 6

Other analgesic options

Answer 6

TCA

Anticonvulsants

Question 7

Superficial somatic pain

Answer 7

E.g. burn, laceration, ulcer

Hot, sharp, stinging pain

Question 8

Superficial Somatic Pain

Management

Answer 8

Local anaesthetic, paracetamol/NSAID, opioids if very severe

Question 9

Deep somatic pain

Answer 9

e.g. bone fracture, acute arthritis, lower back pain

Dull, aching, throbbing

Question 10

Deep somatic pain

Management

Answer 10

Codeine, tramadol, opioids (if severe)

Question 11

Visceral pain

Answer 11

Appendicitis, dysmenorrhoea, intestinal/biliary/renal colic

Dull, deep, cramping, colicky

Question 12

Visceral pain

Management

Answer 12

Paracetamol/NSAID, opioids

Question 13

Ischaemic pain

Answer 13

e.g. AMI, ischaemic limb

Question 14

Ischaemic pain

Management

Answer 14

Opioids

Question 15

Neuropathic pain

Answer 15

Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system
e.g. dental, post-surgical, sciatica, diabetic neuropathic pain, neuralgia, MS, phantom limb pain

Question 16

Neuropathic pain

Management

Answer 16

TCA, anticonvulsants, tramadol, strong opioids, pain clinic

Question 17

Cancer pain

Answer 17

Direct pressure of cancer on organs, poor circulation due to blocked blood vessels, fractures, spinal cord compression, brain mets, side effect of drug treatment

Question 19

Cancer pain

Management

Answer 19

Give as much opioids are required regularly and PRN for breakthrough pain
Steroids, radiotherapy, nerve blocks
Psychological
TENS
Massage, acupuncture

Question 20

Chemotherapy induced emesis

Answer 20

Ondanzetron

Question 21

Anticipatory nausea and vomiting

Answer 21

Lorazepam