ANLEGESICS

Question 1

what are the 3 types of pain

Answer 1

There are three main types of pain—nociceptive, neuropathic and nociplastic pain.

Question 2

what is neropathic pain

Answer 2

2. Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory nervous system.

Question 3

what is Nociplastic pain

Answer 3

3. Nociplastic pain is a diagnosis of exclusion. It is characterised by altered or abnormal function of the nociceptive pathways or cerebral cortex in the absence of a nociceptive stimulus or neuropathic lesion.

MS, Fibromyalgio

Question 4

Nociceptive pain

Answer 4

1. Nociceptive pain arises from activation of nociceptors due to actual or threatened tissue damage.

ei BONE FRACTURE or BURN

Question 5

acute pain vs chronic pain

Answer 5

Acute pain usually occurs due to an acute illness (eg appendicitis), or following surgery or trauma. It lasts LESS than 3 months, **and there is an expectation of recovery and return to usual function.

Chronic pain is a complex medical condition were pain persists or recurs for LONGER THEN 3 months. It is affected by multiple dimensions of a patient’s life, including their: social environment, thoughts and emotions, physical health, sleep and nutrition

Question 6

types of NON-OPIOD anlegesic

Answer 6

asprin

Question 7

NSAID

what is asprin used for

Answer 7

Aspirin is used to manage mild to moderate pain at higher doses of 300–900 mg every 4–6 hours.

At lower doses of 100mg daily it has antiplatelet action. It has analgesic, antipyretic, anti-inflammatory and antiplatelet actions.

It is a nonselective NSAID, preventing synthesis of prostaglandins by non-competitively inhibiting both forms of cyclo-oxygenase, COX1 and COX2

high dose for migraine, low does antiplatelet

Question 8

contraindications of ASPRIN

Answer 8

people who have asthma where it can cause bronchospasm. It is also contraindicated
in patients with active bleeding such as peptic ulcer disease.

Question 9

PANADOL

Answer 9

Paracetamol is
used to manage mild to moderate pain.

MOA stops central prostaglandin synthesis and modulation of inhibitory descending serotonergic pathways.
Paracetamol is hepatotoxic in overdose, therefore in patients with chronic liver disease, should refrain/
use wcaution.
well tolerated but in very rare cases can result in hypersensitivity safe to use in pregnancy and breastfeeding.

Question 10

what are the side/adverse effects of opoid anlgesia

Answer 10

nausea and vomiting
dyspepsia,
drowsiness,
dizziness,
headache,
orthostatic hypotension,
itch, dry mouth
constipation

Question 11

Opiod mode of action

Answer 11

• Opioid analgesics act on receptors in the CNS and GIT
• Opioid analgesics include morphine, codeine, and fentanyl. These drugs work by binding to opioid receptors in the brain, which reduces the perception of pain

Question 12

Buprenorphine

Answer 12

Buprenorphine is a weak partial mu-opioid receptor agonist and a weak kappa-opioid receptor antagonist used for the treatment of severe pain
s/e = constipation, sedation

non-selective competitive opioid receptor antagonist.
(blocks pain receptor).

Question 13

Types of pain

Answer 13

Nociceptive pain - pain resulting from actual or threatened tissue damage.
Neuropathic pain - pain results from impaired somatosensory nervous system
Nociplastic pain - pain resulting from altered or abnormal function of nociceptive pathways or cerebral cortex.

Question 14

Opioid analgesics

Answer 14

Indication:
- Moderate to severe pain, usually acute pain, or cancer-associated pain
Mechanism of action:
- Opiods bind to opiod receptors, namely mu, delta, kappa receptors. Receptors are found in the brain, GIT, and spinal cord
-
- Most are mu receptors, therefore called ‘mu agonists’
- Tramadol and tapentadol produce analgesia via non-opioid pathways
Pure agonists:
- Morphine
- Oxycodone
- Codeine
- Tramadol
- Tapentadol
- Methadone
- Pethidine

Partial agonists:
- Buprenorphine

Adverse effects:**
- Constipation
- Respiratory depression
- Sedation
- Nausea and vomiting
- Dispepsia

Specific opioids:
- Oxycodone-naloxone (Targin) - naloxone helps with opioid-induced GI effects such as constipation

Practice Points:
- used in combination with laxatives
- tapering off when coming off the drugs
- partial agonists have a ceiling effect
- monitor pain and sedation

Question 15

Intrapartum pain management - anelgesia

Answer 15

1. Nitrous oxide and oxygen
2. Systemic opioids
3. Neuraxial anaglesia

Question 16

Nitrous oxide and oxygen

Answer 16

indication:
* - intrapartum pain management
* - use at start of or during contraction
* - relieves anxiety, increases autonomy
* Mechanism of action:
* - usually self-administered
* - rapid onset of action (usually 50 seconds)
* - rapid offset of action
* - crosses the placenta but does not affect APGAR
Adverse effects:
- nausea
- vomiting

Practice points:
- less effective than neuraxial analgesia

Question 18

Systemic opioids

Answer 18

Indication:
- intrapartum pain management
- not being used as much
Mechanism of action:
- readily crosses into placenta - impacts fetal heart rate
- women can still experience pain despite administration
Examples:
- morphine
- fentanyl
- remifentanil

Question 19

Neuraxial analgesia

Answer 19

Inidication
- intrapartum pain management
Mechanism of action
- can come in the form of epidural (spinal or combined)
Adverse effects:
- hypotension
- itchyness
- shivering
- motor blockage
- urine retention - catheter
- fever
Compared to women who have opioids:
- more hypotension
- higher satisfaction
- less nausea and vomiting
- less respiratory depression
- increased lnegth of labour
- more instrumental birth