Pain Management in Elderly and Palliative Care

Question 1

Define pain

Answer 1

an unpleasant sensory and emotional experience normally associated with tissue damage or described in terms of such damage

Question 2

What is nociceptive pain?

Answer 2

pain that arises from damage to non-neural tissue and is due to the activation of nociceptors. There are two types: visceral and somatic

Question 3

What is neuropathic pain?

Answer 3

pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system. Occurs in distribution of nerve or dermatome

Question 4

What are the main features of visceral pain?

Answer 4

• Diffuse, difficult to locate
• Can be referred from a distant structure
• May be a/w nausea and vomiting
• Dull, deep, gnawing, sickening, crampy, colicky, pressure, tightness
• Due to stretch, ischaemia, inflammation of internal organs or deep tumour masses

Question 5

What are the main features of nociceptive deep somatic visceral pain?

Answer 5

• Due to damage to bones, joints, ligaments, organ capsules, pelura, peritoneum
• Described as a dull, aching, throbbing
• Poorly localised

Question 6

What are the main features of nociceptive superficial somatic pain?

Answer 6

= Due to damage to skin, subcut tissues, mucosa

- IT is described as sharp, well defined and clearly located

Question 7

What is neuropathic pain?

Answer 7

pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system.

Question 8

What is wind up/sensitisation?

Answer 8

• Increased responsiveness of neurons to normal input, and/or generation of a response to normally sub-threshold inputs
• Lowered threshold of nerve activation/ pain threshold after injury
• Increased intensity of pain response
• Stimulation of NMDA receptors in spinal cord involved

Question 9

What is breakthrough pain?

Answer 9

sudden onset, usually short periods of time, between regular disease of analgesia (unpredictable)