Chronic pain

Question 1

List the disadvantages of pain under the following categories:
CNS
CVS
RESP
GI Tract
Genitourinary S
Muscle
Metabolic

Answer 1

CNS: anxiety, depression, sleep impairment
CVS: high BP, HR and Ischemic Heart disease

RESP: inhibits coughs, hyperventilation
GI: nausea, vomiting
GUS: urinary retention, uterine inhibition
Muscle: restless, immobility (DVT)
metabolic: increase in catabolic hormones e.g. cortisone, glucagon, GH, catecholamines
reduction in anabolic hormones e.g. insulin, testosterone
reduction in plasminogen which increases coagulation

Question 2

how does nociceptive pain differ from neuropathic? Give an example of disease causing each type

Answer 2

Neuropathic = pain from nerve damage e.g. painful diabetic neuropathy  
Nociceptive = pain from tissue damage e.g. rheumatoid arthritis/OA

Question 3

compare somatic and visceral nociceptive pain in terms of site, radiation, character, periodicity and associations

Answer 3

Somatic:
Localised
Dermatomal 
sharp, aching
Constant 
No associations 

Visceral:
vague distribution
to body surface
dull, cramping 
often periodic 
associated nausea, sweatiness, HR and BP

Question 4

What are the essential parameters to be assessed in a full holistic appraisal of pain?

Answer 4

history, physical assessment, investigations

Characteristics (10): 
site, radiation, quality, severity
duration, frequency, periodicity
precipitating and receiving factors
associated phenomena 

Impact of pain on quality of life

Question 5

List the 6 main components of pain management (6 P’s)

Answer 5

Preventative
pathology (treat it)
physical therapies (maintain activity)
pharmacotherapy (drug therapy)
Procedural (analgesia, injections)
Psychologically based (education, relaxation, distraction)

Question 6

List the 6 main components of pain management (6 P’s)

Answer 6

Preventative (back care, exercise)
pathology (treat it)
physical therapies (maintain activity)
pharmacotherapy (drug therapy)
Procedural (analgesia, injections)
Psychologically based (education, support group, relaxation, distraction)

Question 7

what is the pharmacological treatment plan for nociceptive MSK pain?

Answer 7

Step 1: paracetamol and NSAIDs/COX 2 inhibitors
Step 2: codeine, dihydrocodeine (mild opioids)
Step 3: morphine, tramadol, fentanyl (stronger opioids)