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Specialities - Anaesthetics > Pain & Pain Relief > Flashcards

Pain & Pain Relief Flashcards

1
Q

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

A

Nociceptive

Neuropathic

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2
Q

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

A

3 months

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3
Q

What are the features of nociceptive pain?

A

Obvious tissue injury or illness

Serves a protective function

Sharp +- dull

Well localised

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4
Q

What are the features of neuropathic pain?

A

Nervous system damage

Tissue injury not always obvious

Burning, pins and needles and shooting pains +- numbness

Poorly localised

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5
Q

What are the 4 steps of experiencing pain?

A

Periphery

Spinal cord

Brain

Modulation

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6
Q

What happens in the ‘periphery’ step of pain?

A

Tissue injury

Release of prostagandins, substance P

Pain receptors stimulated

Signal travels in A or C nerves to spinal cord

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7
Q

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

A

A or C nerve fibres synapse with second nerve

Second nerve travels up opposite side of spinal cord

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8
Q

What happens in the ‘brain’ step of pain?

A

Ascending nerves connect to main parts of the brain

Pain perception occurs in the cortex

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9
Q

What happens in the ‘modulation’ step of pain?

A

Descending pathway from brain to dorsal horn

Usually decreases the pain signal

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10
Q

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

A

Dorsal horn

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11
Q

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

A

Thalamus

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12
Q

What are some examples of neuropathic pain?

A

Diabetic pain

Nerve trauma

Fibromyalgia

Chronic tension headache

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13
Q

What are the pathological mechanisms of neuropathic pain?

A

Increased receptor numbers

Abnormal sensitisation of nerves

Chemical changes in dorsal horn

Loss of inhibitory modulation

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14
Q

Give examples of simple analgesics?

A

Paracetamol

NSAID’s

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15
Q

Give some examples of opioids?

A

Codeine

Dihydrocodeine

Morphine

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16
Q

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

A

Antidepressants

Anticonvulsants

Ketamine

Capsaicin

17
Q

What are non-drug treatments for pain?

A

Rest

Ice

Compression

Elevation

RICE

Massage

Acupuncture

Psychological

18
Q

What medications can be given for pain in the periphery?

A

NSAID’s

Local anaesthetics

19
Q

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

A

Accupuncture

Massage

Local anaesthetics

Ketamine

20
Q

In paracetamol overdose, what organ is damaged?

A

Liver

21
Q

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

A

GI

Renal

22
Q

What is the disadvantage of codeine?

A

Constipation

23
Q

What are the steps of the WHO pain ladder?

A

Step 1 - NSAID’s/Paracetamol

Step 2 - Mild opioids

Step 3 - Strong opioids

24
Q

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

A

Psychological

25
Q

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

A

Step 1

26
Q

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

A

Step 1 and Step 2

27
Q

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

A

Step 1 + step 3 (miss out step 2)

28
Q

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

A

Step 3 to Step 2

When on step 1, stops NSAID’s first, then finally stop paracetamol

29
Q

What is the RAT approach to pain?

A

Recognised

Assess

Treat

30
Q

How is pain assessed?

A

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.)

31
Q

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

A

Tricyclics - Amitryptyline

Anticonvulsants - Gabapentin

Serotonin- Norepinephrine reuptake inhibitor - Duloxetine

Specialities - Anaesthetics (5 decks)

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