Peri-op Care: Pain Management

Question 1

How is pain assessed?

Answer 1

Acute = location, intensity (visual analogue scale VAS, numeric rating scale NRS) on rest and movement

Assess neuropathic components

Chronic

• pain history = where, intensity, description, how did it start, relieves/aggregates, what does the pain affect, treatment, depression
• physical examination = general, specific pain evaluation, neurological, MSK, psychological
• specific diagnostic tests = quantitative sensory testing, diagnostic nerve blocks, pharmacological tests, CT, MRI
• TOOLS = Brief Pain Inventory, McGill Pain Questionnaire

Question 2

Outline how acute pain is managed

Answer 2

WHO pain ladder

1 mild = simple +/- NSAIDs - paracetamol

2 moderate = weak opioids - codeine, tramadol

3 severe = strong opioids - morphine, fentanyl

Question 3

Describe the management of pain as part of anaesthesia

Answer 3

Non-opioid = paracetamol

Opioid = tramadol, morphine, subarachnoid morphine

Adjuvant therapy: dexamethasone, amitryptalline, gabapentin

Question 4

Outline the management of pain during the recovery phase of surgery

Answer 4

1) central regional opioid analgesia - epidural, intrathecal
2) PCA with systemic opioids
3) peripheral regional analgesia - intercostal blocks, plexus blocks, local anaesthetic infiltration of incisions

Question 5

What is neuropathic pain and how should it be treated?

Answer 5

Pain caused by damage or disease affecting the somatosensory nervous system

Neuropathic ladder
• Amitriptyline, nortriptyline 
• Duloxetine
• Gapapentin
• Pregabaline 
• Methadone
• Cannabis 

• Localised = capsaicin cream/patch