Pain & Pain Relief

Question 1

What are the 2 mechanisms by which pain can be experienced?

Answer 1

Nociceptive

Neuropathic

Question 2

How long does pain need to last for it to be considered chronic?

Answer 2

3 months

Question 3

What are the features of nociceptive pain?

Answer 3

Obvious tissue injury or illness

Serves a protective function

Sharp +- dull

Well localised

Question 4

What are the features of neuropathic pain?

Answer 4

Nervous system damage

Tissue injury not always obvious

Burning, pins and needles and shooting pains +- numbness

Poorly localised

Question 5

What are the 4 steps of experiencing pain?

Answer 5

Periphery

Spinal cord

Brain

Modulation

Question 6

What happens in the ‘periphery’ step of pain?

Answer 6

Tissue injury

Release of prostagandins, substance P

Pain receptors stimulated

Signal travels in A or C nerves to spinal cord

Question 7

What happens in the ‘spinal cord’ step of pain?

Answer 7

A or C nerve fibres synapse with second nerve

Second nerve travels up opposite side of spinal cord

Question 8

What happens in the ‘brain’ step of pain?

Answer 8

Ascending nerves connect to main parts of the brain

Pain perception occurs in the cortex

Question 9

What happens in the ‘modulation’ step of pain?

Answer 9

Descending pathway from brain to dorsal horn

Usually decreases the pain signal

Question 10

Where is the 1st relay station in the pain pathway?

Answer 10

Dorsal horn

Question 11

Where is the 2nd relay station in the pain pathway?

Answer 11

Thalamus

Question 12

What are some examples of neuropathic pain?

Answer 12

Diabetic pain

Nerve trauma

Fibromyalgia

Chronic tension headache

Question 13

What are the pathological mechanisms of neuropathic pain?

Answer 13

Increased receptor numbers

Abnormal sensitisation of nerves

Chemical changes in dorsal horn

Loss of inhibitory modulation

Question 14

Give examples of simple analgesics?

Answer 14

Paracetamol

NSAID’s

Question 15

Give some examples of opioids?

Answer 15

Codeine

Dihydrocodeine

Morphine

Question 16

Apart from simple analgesics and opioids, what other types of drugs can be used for pain relief?

Answer 16

Antidepressants

Anticonvulsants

Ketamine

Capsaicin

Question 17

What are non-drug treatments for pain?

Answer 17

Rest

Ice

Compression

Elevation

RICE

Massage

Acupuncture

Psychological

Question 18

What medications can be given for pain in the periphery?

Answer 18

NSAID’s

Local anaesthetics

Question 19

What medications can be given for pain originating in the spinal cord?

Answer 19

Accupuncture

Massage

Local anaesthetics

Ketamine

Question 20

In paracetamol overdose, what organ is damaged?

Answer 20

Liver

Question 21

What are some of the side effects of NSAID’s?

Answer 21

GI

Renal

Question 22

What is the disadvantage of codeine?

Answer 22

Constipation

Question 23

What are the steps of the WHO pain ladder?

Answer 23

Step 1 - NSAID’s/Paracetamol

Step 2 - Mild opioids

Step 3 - Strong opioids

Question 24

If neuropathic pain is not responding to analgesics, what other options are there for pain relief?

Answer 24

Psychological

Question 25

For mild pain, what step of the WHO pain ladder should be prescribed?

Answer 25

Step 1

Question 26

For moderate pain, what step of the WHO pain ladder should be prescribed?

Answer 26

Step 1 and Step 2

Question 27

For severe pain, what step of the WHO pain ladder should be prescribed?

Answer 27

Step 1 + step 3 (miss out step 2)

Question 28

As pain resolves, how should you move down the WHO pain ladder?

Answer 28

Step 3 to Step 2 When on step 1, stops NSAID's first, then finally stop paracetamol

Question 29

What is the RAT approach to pain?

Answer 29

Recognised Assess Treat

Question 30

How is pain assessed?

Answer 30

What is the severity? 0-10 How is the pain affecting them? Can they still work? What is the pain type? (acute, chronic, nociceptive, neuropathic etc.)

Question 31

What drugs can be used for neuropathic pain and what their classes?

Answer 31

Tricyclics - Amitryptyline Anticonvulsants - Gabapentin Serotonin- Norepinephrine reuptake inhibitor - Duloxetine