pain management Flashcards
what is nociceptive pain ?
obvious tissue injury or illness
protective function
sharp/dull
well localised
what is neuropathic pain ?
nervous system damage or abnormality tissue injury not obvious no protective function burning/shooting/numbness not well localised
what nerves transmit pain signals ?
A delta
C nerves
how does pain travel up spinal cord ?
dorsal horn relay
second nerve travels up opposite side of cord
where is pain relayed in the brain ?
thalamus is second relay station
connects to cortex, limbic system, brainstem
pain perception is in cortex
what can cause neuropathic pain ?
nerve trauma
diabetic pain
fibromyalgia
chronic tension headache
what are pathological mechanisms for neuropathic pain ?
increased receptor number
abnormal sensitisation
chemical changes in dorsal horn
loss of normal inhibitory modulation
what are other analgesics not opiates or simples ?
tramadol - opiate 5HT/NA reuptake inhibitor
nefopam - NMDA R antagonist
antidepressants - amitriptyline, duloxetine
anticonvulsants - gabapentin
ketamine
what are periphery pain treatments ?
ice rest compression elevation NSAIDS locals
what are spinal cord pain treatments ?
acupuncture
massage
TENS
locals
opioids
ketamine
what are brain pain treatments ?
psycho therapy
paracetamol
opioids
amitriptyline
clonidine
what are cons to codeine ?
constipation
bad for chronic pain
what are pros of tramadol ?
less respiratory depression
can be used with opioids and simples
not controlled
what are cons to tramadol ?
nausea and vomiting
what are cons to morphine ?
constipation
respiratory depression
addiction
controlled drug
