Pain Management Flashcards
What are some primary analgesics and some secondary?
Paracetamol, opioids, NSAIDs.
Antidepressants, anticonvulsants, local anaesthetics.
Side effects of cox 1 and 2?
Cox 1 Gi irritation, peptic ulcer, inhibition of platelet aggregations
Cox 2 those risks reduced but more risk renal dysfunction and cardiovascular side effects esp older patients
Dangers for weak and strong opioids?
Weak opioids, nephrotoxicity,
Strong, hypogonadism, immunological changes, addiction, misuse.
What is the who ladder?
A framework physicians can use when developing treatment plans for cancer pain.
The new version is a framework for treatment including acute pain, chronic non cancer pain and cancer pain
What are the new 2010 changes to the who ladder?
A fourth step up that includes neurosurgical procedures, invasive techniques. Also for paediatric pain, e.r departments, and used in a bilateral manner, going up for chronic and cancer pain and down from severe acute
cB therapy is based on literature that demonstrates …?
That behavioural, cognitive, affective factors contribute to human behaviour which includes how pain is perceived and responded to,
What is classical conditioning and what factor does it comprise of?
CB therapy behavioural factor,
Neutral vs threatening situations paired, when neutral situation alone, the response is the same.
A physical therapist treatment puts patient in pain. Patient becomes conditioned to experience negative response of pain in anticipant of physical therapist. May produce muscle tension and amplify pain.
What is another behavioural factor in CB?
Operant conditioning. If consequence of given behaviour is rewarding, may increase likelihood of behaviour. Vice versa.
Pain behaviours eliciting positive responses by peers.
Acute pain elicits pain behaviours as protection
If well behaviours are not rewarded what does operant conditioning do?
These behaviours may become extinct or reduced.
What is the relationship between chronic pain and emotions? Which factor in the CB is this?
Affective, emotional, factor. 50% chronic pain patients have depression which anxiety and anger are also prevalent.
Experience of pain may elicit negative thoughts and arouse fears of inciting more pain and injury and fear of future impact. This can create significant impact on level of function and pain tolerance. Eventually leading to fear avoidance. Less anxiety leads to improved distress. Movement, fear and activity.m
Summarise cognitive factor CB
Belief pain is serious, unending, disabling and good for excuses and avoidance of things will create maladaptive responses. Compliance with physical activity unlikely, belief of further intervention and that exercise will make it worse.
What does CB focus on
Giving patients techniques to gain a sense of control over the effect of pain on his or her life, as well as modifying the behavioural, cognitive and affective and sensory facets of pain and problems associated with.
What does changing behaviour do?
Helps show patients they are capable more then they thought increasing sense of self competence.
Cognitive techniques are? And do what?
Uses self monitoring to identify relationships among thoughts, mood and behaviour, distraction using imagery and problem solving. These help to place affective, behavioural and cognitive and sensory responds under patients control.
Steps of CB?
Help patients identify maladaptive patterns and acquire, develop and practise more adaptive ways of responding.
Patients need to become aware of and monitor the impact negative thoughts and feelings play in the maintain thence of maladaptive behaviours.
To do this patients must recognise connections between behaviour, affective, cognitive and physiological responses together with their joint consequences.
Secondly, the patients then encouraged to test the effects of their appraisals, expectations and beliefs by means of selected homework assignments.
