WEEK 6 Pain Management Flashcards
(57 cards)
Identify 5 principles for optimal pain management
- Balanced analgesia
- Dosage and timing
- Consider patient co morbidities
- Utilise administration modalities
- Tailor treatment
Describe the concept of balanced analgesia (Principle for optimal pain management)
Class of medication should be determined by the pathology of the pain and the effect
Describe the concept of dosage and timing (Principle for optimal pain management)
Pre emptive (Don’t wait until they tell you they are in pain)
Regular analgesia
Break through analgesics
Treat side effects promptly
Describe the concept of considering co morbidities (Principle for optimal pain management)
Age, opioid tolerance, substance abuse, respiratory compromise
Describe the concept of tailoring treatment (Principle for optimal pain management)
Patient involvement, regular assessments of adequacy of analgesia, reassessment of pain
Describe acute pain in terms of pain management
Limited trajectory (Healing process), individually tailored approach, predominantly nociceptive pain
Describe persistent pain in terms of pain management
Often multifactorial, neuropathic and nociceptive, requires multimodal approach, individualised approach
Identify 3 populations why may require particular attention within pain management
Children
Pregnant patients
ATSI/CALD groups
Outline the components of the biopsychosocial model in terms of pain management
BIO: Assess for changes/injury in physical body
PSYCHO: Address anxiety/stress
SOCIAL: Consider social situation/home environment
Outline the 3 components of a pain management plan
- Assessment (History, Physical exam, further investigations)
- Management (Pain management options, information, assurance and advice encouraging normal activity)
- Review (Reassess and revise plan)
Identify the 3 WHO strategies
- WHO: Pharmacological Treatment Strategy
- WHO: Guidelines for pain management
- WHO: Analgesic Ladder
Describe the WHO: Pharmacological Treatment Strategy
Underlying cause of pain should be treated where possible , Individualised therapy, use a systematic approach (Ladder)
WHO: Guidelines for pain management
Non pharmacological approach first, non opioid medicines first, co analgesics and adjuvant medicines
Describe the WHO: Analgesic Ladder
Idea is that you start from the bottom and build up as required
Describe step 1 of the WHO: Analgesic Ladder
Non opioids (With or without adjuvants), Non pharmacological approaches and or Paracetamol
Describe step 2 of the WHO: Analgesic Ladder
Weak opioid (With non-opioid) (With or without adjuvants) NSAID and/or oral opioid
Describe step 3 of the WHO: Analgesic Ladder
Strong opioid and non-opioid (With or without adjuvants) with increased dose of oral opioid or an IV/IN Fentanyl
Discuss how choice of medication should be made
Based on underlying pain mechanisms
Acute pain: Regulated by opioidergic system
Persistent pain: Associated with neuropathic componenet were central sensitisation requires a reduced role of opioids/increased contribution of adjuvant
Identify the recommended medications for nociceptive pain
NSAIDS and Opioids
Identify the reccomended medications for neuropathic pain
1st line: Antidepressants, anticonvulsants and topical agents
2nd line: Opioids
Describe simple analgesics for pain management
Paracetamol for soft tissue/musculoskeletal origin and NSAIDS for muscular skeletal inflammation and tissue injury
Identify the 3 types of NSAIDS with example for each
NON selective: Ibuprofen
COX-2 Specific: Celecoxib
Long Acting: Meloxicam
Describe opioids for pain management and an example
For moderate to severe pain, 3 primary receptors (Mu, Delta and Kappa), morphine and oxycodone
Describe Tramadol for pain management
Opioid receptor agonist, Enhances noradrenergic and serotonergic inhibition, less constipating
