Week 230 - Pain Flashcards
What three elements are typical of ‘chronic pain syndrome’?
1) fatigue (sleep disturbance - query what causes their waking)
2) depression
3) huge impact on social and family life
What type of pain are these symptoms describing:
Stinging/tingling/electric shocks/ burning pain?
Neuropathic
How is neuropathic pain pathophysiologically different to nociceptive pain?
Neuropathic = nerve damage which doesn't require nociceptor stimulation (can be stimulated by central or peripheral NS) Nociceptive = detected by nociceptors and activation of pain pathways
What sort of relief does oromorph supply?
Short-acting, fast release
Not appropriate for chronic pain
Name 4 first line pharmacological treatments for neuropathic pain?
Gabapentin
Pregabalin
Amitriptyline
Duloxetine
Name 2 second line pharmacological treatments for neuropathic pain?
Tramadol or anti-epileptics (e.g. Carbamazepine)
Which of the following are non-opioids?
Codeine Morphine Paracetamol Naproxen Tramadol Fentanyl
Gabapentin Dihydrocodeine Ibuprofen Amitriptyline Oxycodone
Paracetamol Ibuprofen Naproxen Gabapentin (for neuropathic pain / epilepsy) Amitriptyline (tricyclic AD)
What are the 3 steps on he analgesic ladder and what sort of pain is the ladder suitable for?
The WHO analgesic ladder is appropriate for nociceptive pain.
1) non-opioid +/- adjuvants
2) weak opioid + non-opioid +/- adjuvants
3) strong opioid + non-opioid +/- adjuvants
What is meant by an “adjuvant” analgesic?
A drug that was not initially intended to be used in the management of pain, but for other conditions such as depression and seizures
Give 4 different types of adjuvant analgesics
Bisphosphonates Steroids Muscle relaxants Antidepressants Anticonvulsants
Give 2 weak opioid examples
Codeine
Dihydrocodeine
Is Tramadol a weak or strong opioid?
Moderate
Give 3 examples of strong opioids
Morphine
Oxycodone
Fentanyl
How does paracetamol act
Acts as analgesic and antipyretic
Largely unknown mechanism ?COX3
Minimal anitinflammatory effect
How much IM morphine is equal to 1g IV paracetamol?
10mg
What is the antidote to paracetamol poisoning?
N-acetylcysteine (acts against metabolite N-acetyl-p-benzoquinoneimine