Anaesthetics - Pain

Question 1

What are the benefits of treating pain?

Answer 1

Physical - improved sleep, appetite, fewer complications
Psychological - Reduced depression, anxiety
Family - functioning
Society - Lower health costs

Question 2

What are the classifications of pain?

Answer 2

Duration - acute/chronic
Cause - cancer/non-cancer
Mechanism - nociceptive/neuropathic

Question 3

What is nociceptive pain?

Answer 3

Obvious injury/illness
Physiological or inflammatory
Protective function
Sharp, well localised

Question 4

What is neuropathic pain?

Answer 4

NS damage/abnormality 
Not obvious tissue injury 
Not protective 
Burning/shooting + numbness
Not well localised

Question 5

What are the steps in pain physiology?

Answer 5

Periphery
Spinal cord
Brain
Modulation

Question 6

What is the function of the periphery in pain?

Answer 6

Tissue injury
Release of chemicals (prostaglandins, substance P)
Stimulates pain receptors
Adelta and C fibres to spinal cord

Question 7

What is the function of the spinal cord in pain?

Answer 7

Second nerve travels up opposite side of cord

Dorsal horn is first relay station

Question 8

What is the function of the brain in pain?

Answer 8

Thalamus is second relay station

Pain perception in cortex

Question 9

What is the function of modulation in pain?

Answer 9

“Gate theory”
Descending pathway
from brain -> dorsal horn
Usually decreases the signal

Question 10

What are the mechanisms for neuropathic pain?

Answer 10

Increased receptors
Abnormal nerve sensitisation
Chemical changes in dorsal horn
Loss of normal inhibitory modulation

Question 11

What are the simple analgesics?

Answer 11

Paracetamol

NSAIDs

Question 12

What are the opioids?

Answer 12

Mild - Codeine

Strong - Morphine, Fentanyl

Question 13

Name some other drugs for analgesia not simple/opioid?

Answer 13

Tramadol
Nefopam
Antidepressants
Anticonvulsants 
Ketamine

Question 14

What pain treatments affect pain in the peripheral step?

Answer 14

RICE
NSAIDs
Local anaesthetics

Question 15

What pain treatments affect pain in the spinal cord step?

Answer 15

TENS
Local anaesthetic
Opioids
Ketamine

Question 16

What pain treatments affect pain in the brain step?

Answer 16

Psychological therapy
Paracetamol
Opioids
Amitriptyline
Clonidine

Question 17

What are the advantages/disadvantages of paracetamol?

Answer 17

Adv: Cheap, safe, oral/rectal/IV
Dis: Liver damage in overdose

Question 18

What are the advantages/disadvantages of NSAIDs?

Answer 18

Adv: Cheap + safe, nociceptive pain (+paracetamol)
Dis: GI/Renal/Bronchospasm

Question 19

What are the advantages/disadvantages of Codeine?

Answer 19

Adv: Cheap, mild/moderate
Dis: Constipation, no use in chronic pain

Question 20

What are the advantages/disadvantages of Tramadol?

Answer 20

Adv: less resp depression, used with analgesics
Dis: N+V

Question 21

What are the advantages/disadvantages of morphine?

Answer 21

Adv: Cheap, safe, multi-routes
Good for chronic and severe acute pain
Dis: Constipation, resp depression, addiction

Question 22

What are the advantages/disadvantages of amitriptyline?

Answer 22

Adv: cheap, safe, neuropathic pain, depression
Dis: Anti-cholinergic sides (glaucoma, urinary retention)

Question 23

What are the advantages/disadvantages of anticonvulsant drugs for pain?

Answer 23

Adv: Neuropathic pain

Question 24

Which anticonvulsants are used as pain med?

Answer 24

Carbamazepine
Sodium valproate
Gabapentin

Question 25

What is the RAT approach to pain?

Answer 25

Recognise Assess - severity, type Treat - Drug/non-drug

Question 26

How do you Recognise pain?

Answer 26

Ask patient Look at patient Ask people who know them

Question 27

What are the pain assessment scores?

Answer 27

``` Verbal rating Numerical rating Visual analogue Smiling faces Abbey pain scale Functional pain ```

Question 28

What pain scale is used in confused patients?

Answer 28

Abbey pain scale

Question 29

How is pain assessed?

Answer 29

``` Pain score (at rest vs movement) How is pain affecting the patient ```

Question 30

How do you assess pain type?

Answer 30

Acute or Chronic Cancer or non-cancer Nociceptive or neuropathic

Question 31

What are the non-drug treatments for pain?

Answer 31

RICE Nursing care Surgery, TENS Psychological

Question 32

Outline the WHO pain ladder?

Answer 32

``` Mild = Paracetamol (+NSAIDs) Moderate = Paracetamol (+NSAIDs) + codeine/alternative Severe = Paracetamol (+NSAIDs) + morphine ```

Question 33

How is neuropathic pain managed?

Answer 33

Don't use WHO ladder Other drugs Non-drug treatments