Pain and analgesia

Question 1

Pain pathways

• perception is mediated by ? ? ? - nociceptors
• ?-? fibres give rise to perception of ? ? pain
• ? fibres = ? onset, ? pain
• sensory impulses enter the cord via the ? ? and then ? in the dorsal ? column or the ? tract
• ? pathways to and from the ? then mediate the ? components of pain

Answer 1

free nerve endings
A-delta - immediate sharp
C-fibres - slower, prolonged
dorsal root
ascend
posterior
spinothalamic
thalamic
cortex
emotional

Question 2

Pain has multiple ? effects.

Also lead to ? release, with resultant ? leading to increased ? work and delayed ?

Answer 2

psych
catecholamine
vasoconstriction
cardiac
healing

Question 3

WHO pain ladder
1 - ? +/- adjuvant - eg paracetamol +/- ?
2 weak ? +/- ? +/- adjuvant eg codeine/? +/- paracetamol +/- ?
3 strong ? +/- ? +/- adjuvant eg morphine/? +/- paracetamol +/- ?

Answer 3

non-opioid
nsaid
opioid
non-opioid
tramadol
nsaid
opioid
non-opioid
fentanyl
nsaid

Question 4

Paracetamol

indicated in ?-? pain and ?
weak anti-? properties
oral doses achieve peak plasma conc within ?
SE are uncommon
dose - ? PO/IV ?ds up to ?/day
dose is reduced in patients under what weight?
dose of ?/day is recommended if RFs for ? eg ? age, poor nutrition, or ?

Answer 4

mild-mod, pyrexia
inflam
1hr
1g, qds, 4g
50kg
3g, hepatotoxicity
old
alcoholism

Question 5

NSAIDS
some ? effect, best for ? pain.
work by inhibited prod of ? enzymes - which normally promote prod of ? and ?
inhibition of ? enzyme relate to benefit from nsaids, with inhibition of ? enzyme leading to SE

Answer 5

antipyretic
inflamm
COX
PG + Thromboxanes
cox2
cox1

Question 6

Nsaids
cox 1 - expressed in ? tissues, with the PGs produced involved in tissue ? eg -> platelet ?, ? blood flow autoregulation and ?? protection
cox 2 - induced in ? ? cells by ? and ?
- sensitises ? to inflam mediators such as ? peripherally
- sensitises ? pain fibres in the ? ? centrally

Answer 6

most
homeostasis
aggregation
renal
GI

active inflam
IL-1, TNF a
nociceptors
bradykinin
afferent
dorsal horn

Question 7

Nsaids
Absolute contraindications? 2
SE
- ? and gastric ?
- ? (in aspirin sensitive asthmatics))
- ? insufficiency
- ?toxicity
- decreased ? count
- ? reactions

Answer 7

severe HF
Hx of GI bleeds/ulceration

dyspepsia, ulceration
bronchospasm
renal
cardio
platelet
skin

Question 8

Nsaids
? 20mg od should always be co-prescribed with NSAIDS
Caution in ?, the ?, ?pathies or ?/?/? impairment
- ? CId with high ?? risk, ? best for these patients

? nsaid ? and ? can also be given - safe/effective for arthritis analgesia, esp ?

Answer 8

omeprazole
asthma
elderly
coagulopathies
cardiac/renal/hepatic
diclofenac 
CV
naproxen
topical
creams
gels
OA