Pain Management

Question 1

how is pain usually managed?

Answer 1

using the WHO pain ladder - start at the bottom and titrate up as needed

Question 2

what are the three categories of analgesia?

Answer 2

• simple analgesics
• weak opiate analgesics
• strong opiate analgesics

Question 3

what are considered ‘simple analgesics’?

Answer 3

paracetamol or NSAIDs

Question 4

how do NSAIDs help with pain?

Answer 4

they are COX inhibitors, stopping the production of prostaglandins, which reduces the inflammatory response that causes pain

Question 5

what are the side effects of NSAIDs?

Answer 5

mnemonic: I-GRAB
I: interactions with other drugs (warfarin)
G: gastric ulceration - may need a PPI
R: renal impairment - use sparingly on these patients
A: asthma sensitivity
B: bleeding risk - they inhibit platelet formation

Question 6

what are classed as ‘weak opiates’?

Answer 6

codeine and tramadol

Question 7

what are classed as ‘strong opiates’?

Answer 7

morphine, oxycodone, fentanyl

Question 8

how do opiates help with pain?

Answer 8

by activating opioid receptors (MOP, DOP, and KOP) throughout the CNS which inhibit pain transmission

Question 9

what are the side effects of opiates and how should these be treated?

Answer 9

constipation, nausea
patients should be given laxatives and anti-emetics
sedation, confusion, respiratory depression, tolerance and dependence

Question 10

true or false: if a patient is on opiates, they also should be prescribed a non-opioid analgesic

Answer 10

true.

this is to reduce their requirement for opiates

Question 11

which opiate should be given to a patient with renal impairment?

Answer 11

oxycodone or fentanyl (NOT MORPHINE)

Question 12

true or false: oral morphine and IV morphine have the same bioavailability

Answer 12

false.

IV morphine is 80% bioavailable whereas oramorph is only 30% bioavailable