Week 2 - Evidence-based pain management Flashcards
What drugs work in the pain pathway of the spinal cord?
- Morphine- like drugs
- Neuropathic pain drugs
What drugs work in the pain pathway of the brain?
- Paracetamol
- Morphine- like drugs
- Neuropathic pain drugs
What drugs work in the pain pathway of the bone, skin and other tissues?
- Morphine- like drugs
- Anti- inflammatory drugs
Medications for nociceptive pain:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Opioids
Medications for neuropathic pain:
- Antidepressants
- Anticonvulsants
- Topical agents
- Opioids
What are adjuvant agents?
Used as supplements to make analgesics more effective
Examples of NSAIDs:
- Ibuprofen
- Naproxen
- Diclofenac
- Indomethacin
- Ketorolac
Examples of opioids:
- Morphine
- Fentanyl
- Oxycodone
- Hydromorphone
- Methadone
- Codeine
Management plan three phases:
Assessment, Management, Review
Rationale of multi-modal medications:
Target multiple mechanisms of pain conditions, addressing both nociceptive and neuropathic components of pain
Classifications of CAM:
- Whole medical systems: e.g. Traditional Chinese Medicine
- Mind‐body medicine: e.g. meditation
- Biologically based practices: e.g. herbs, vitamins
- Manipulative and body‐based practices: e.g. chiropractic, massage
What is acupuncture believed to stimulate?
Secretion of endorphins, serotonin, and noradrenaline in the CNS
Aim of cognitive therapy:
To alter a person’s belief system and modify undesirable behaviour patterns and perceptions
What is CBT?
A psychological technique that can be taught to patients to reframe thoughts and change the pattern of thinking, identify negative thoughts and then change them
Why is massage used for pain?
Touch is the most instinctive response to pain
What is transcutaneous electrical nerve stimulation?
- Electrical stimuli on the skin preferentially activate low‐ threshold, myelinated nerve fibres
- Inhibits nociception by blocking transmission along fibres to the dorsal horn
Pain assessment tools:
- Behavioural Pain assessment scale
- Functional assessment: - The Physical Functional Ability Questionnaire
- Pain Catastrophising scale
- PASS: pain anxiety symptom scale
- DN4: neuropathic/nociceptive discrimination
- Chronic pain grade: pain activity questionnaire
Pain questions onset:
When did it start? How long does it last? How often does it occur?
Pain questions provoking palliating:
What brings it on? What makes it better? What makes it worse?
Pain questions quality:
What does it feel like? Can you describe it?
Pain questions region/radiation:
Where is the pain? Does it spread anywhere?
Pain questions severity:
How severe is the pain? Right now? At best? At worst? How bothered are you by the pain?
Pain questions treatment:
What have you tried? What has worked? Not worked?
Pain questions understanding impact:
What do you believe is causing this symptom?
Pain questions values:
What is your comfort goal or acceptable level? Do you have any other views about the pain that are important?
Where do opioids act in nociception?
Transmission
What is morphine derived from?
Opium
What does the WHO analgesic ladder consist of?
Paracetamol, NSAIDs, Tramadol, Morphine
