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Flashcards in Chronic pain lecture Deck (19)
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1

What are the two different types of pain?

Neuropathic - nerve damage
Nociceptive - tissue damage

2

Describe somatic nociceptive pain.

Well localised - dermatomal
Sharp, aching and gnawing pain
Constant

3

Describe visceral nociceptive pain.

Vague distribution, diffuse
Dull, cramping and digging pain
Can be periodic
Causes nausea, vomiting, sweatiness, CV symptoms

4

What are the symptoms of neuropathic pain?

Shooting
Electric shock like
Burning
Tingling
Numbness

5

What are some possible sources of lower back pain? (Disc, vertebrae, joints, muscle and ligaments)

Disc - bulge, rupture
Vertebrae - osteoarthritis
Joints - facet, sacro-iliac
Muscle - paravertebral, gluteal
Ligaments - anterior and posterior longitudinal

6

What kind of pain is lower back pain? (neuropathic, nociceptive)

Local nociceptor activation = nociceptive
Compression and inflammation of nerve root = neuropathic

7

What's the difference between somatic referred back pain and radicular pain in the leg?

Somatic referred pain - nociceptive pain affecting large areas of the posterior thigh
Radicular pain - neuropathic pain radiating down lower limb to the heel in a narrow band

8

How can pain be measured?

NRS - numerical rating scale
VAS - visual analgoue scale

9

Name some of co-morbidities associated with neuropathic pain.

Poor appetite
Anxiety
Depression
Difficulty concentrating
Drowsiness
Lack of energy
Difficulty sleeping

10

What are the 6P'S of pain treatment?

Preventative
Pathology - treat it
Physical therpaies
Pharmacotherpaies
Procesural - analgesia
Psychologically based

11

Describe the WHO analgesic ladder

1 - Paracetamol, NSAIDs
2- Codeine, dihydrocodeine
2-3 Tramadol
3 - Morphine, methadone, oxycodone

12

What are the possible side effects of NSAIDs?

GI ulceration
Bleeding
Renal problems
Asthma
Decreased bone healing

13

Which hormone is needed to convert codeine to morphine within the body?

Cytochrome P450

14

What criteria must be looked at before prescribing opioids?

Appropriate
- pain model
- pain patient
- pain prescription

15

From most to least effective, list conditions opioids can be used in.

Arthritis
Nueropathic pain
Lower back pain
Visceral pain
Fibromyalgia

16

Name some adjuvants which can be used for neuropathic analgesics.

Anti-depressants
Anti-convulsants
Anti-arrhythimcs

17

From least severe pain, to most severe pain, list the types of psychological treatment that can be received.

Clinicians explanation
Education class
Support groups
Pain management programme
1:1 psychology
1:1 psychiatry

18

Describe the lumbar facet syndrome.

Lower back pain to groin, hip or thigh
Worse on back extension/rotation
Tender over paraspinal region

19

How is lumbar facet syndrome diagnosed?

X-ray shows nothing
local anaesthetic to medial branch of dorsal primary rami