Persistant Pain (Non Cancer, Chronic)

Question 1

What is Nociceptive pain

Answer 1

Actual/threatened damage to non-neural tissue

Question 2

What is Neuropathic pain?

Answer 2

Lesions or disease of the nervous system

Question 3

Treatment aims for

ACUTE PAIN

Answer 3

Aim to REDUCE pain

Have a stopping plan, as pain reduces over time.

🚫 avoid slow release meds
-long time to work
- Hard to adjust dose

Question 4

Treatment aims for

CHRONIC PAIN

Answer 4

Aim to improve FUNCTION (decreasing pain is a bonus)
Analgesics reduce pain by 30- 50%

Can use slow release meds

Question 5

Factors that influence Chronic pain

Answer 5

1. Beliefs/concerns about pain
2. Psychological symptoms = anxiety, uncertainty, anger, depression
3. Coping strategies
4. Social context eg. Relationships, changing family role, loss of work..

Question 6

3 non-pharmacological treatments treatments chronic pain

Answer 6

1. Physical techniques (passive, active)
   - passive: assists in desensitisation =
   Thermotherapy, manual therapy (massage)
   -active: assists in functional restoration=
   Exercise, stretches, physiotherapy
2. Mind body techniques
3. Psychological techniques

Question 7

Nociceptive pain
Pharmacological treatments

Answer 7

1. Paracetamol 1g qld
2. NSAIDs/COX2i (used short term only because of CV risk and GASTRO BLEEDS)
   3.Opioids- NOT recommended in chronic non-cancer pain

Question 8

Adverse effects of Long-term use of OPIOIDS

Answer 8

1. Respiratory depression
2. Cardiovascular - fluid retention
3. Dermatological - lower limb cellulitis (due to immune compromise)
4. Neurological = sedation, improved cognition, impaired coordination
5. Gastrointestinal = chronic constipation, nausea and vomiting
6. Musculoskeletal tenderness
7. Urinary retention
8. Neuroendocrine = fluid retention, osteoporosis, low testosterone in men

Question 9

Neuropathic

Pharmacological treatments

Answer 9

1. Amitriptyline *tricyclix antidepressant
2. Gabapentin/ Pregablin (gabapentanoids)
3. Duloxetine

Question 10

PREGABLIN

counselling points?
Adverse effects?

Answer 10

Counsel=
1. May take several weeks to achieve pain relief
2. Start and stop slowly

ADRs
-drowsiness, confusion, impaired balance
-constipation
-peripheral oedema

Question 11

Neuroadaptive and ohysiologicak changes associated with opioid use

Answer 11

1. Opioid tolerance
   = decrease in drug effect over time
2. Physical dependence
   = abrupt Opioid cessation, withdrawal symptoms
3. Opioid indices hyperalgesia
   = Increase sensitivity to pain