Pain management Flashcards
How can we classify chronic pain?
Body region or pain feature
- Myofascial
- MSK
- Neuropathic
- Fibromyalgia
- Chronic headache
What are common causes of chronic pain in over 65s?
Arthritis
Osteoarthritis
Lumbar/Spinal stenosis
Define acute pain
Common consequence of injury or illness, generally lessening shortly after onset and resolving once healing is complete
<3 months
What are RFs for chronic pain?
Female >45 yrs FHx (Migraine + Fibromyalgia) Prev trauma Acute back pain PMH (malignancy, trauma,
What can be used to treat chronic pain?
Physiotherapy Paracetamol + NSAIDs Occupational therapy Pain mangement psychology Muscle relaxants Anti-depressants
What are the steps on the pain ladder?
Paracetamol/NSAIDs
Weak opioid e.g. codeine
Strong opioid e.g. morphine
What can cause facial pain?
Sinusitis (facial fulness, nasal discharge)
Trigeminal neuralgia (unilateral, brief shock pain, abrupt onset, triggered by light touch/emotion)
Cluster headache
(around one eye, 2x a day 15-120mins)
Temporal arteritis
What are the features of osteoarthritic pain?
Pain exacerbated by exercise and relieved by rest
What are the features of pain in inflammatory arthritis?
Pain in the morning
Define neuropathic pain?
pain which arises following damage or disruption of the nervous system
responds poorly to analgesia
difficult to treat
What might cause neuropathic pain?
diabetic neuropathy
post-herpetic neuralgia
trigeminal neuralgia
prolapsed intervertebral disc
What is the first line treatment drugs for neuropathic pain?
amitriptyline, duloxetine, gabapentin or pregabalin
What might be used for exacerbations of neuropathic pain?
Tramadol
‘rescue therapy’
