Essential Pain Management Flashcards
(22 cards)
RAT model
- R = recognise
- A = assess
- T = treat
of pain
Why treat pain:
Pain is a personal, sensory, and emotional experience that can affect the individual, their family, and society. Pain can be acute or chronic.
- Ethical humane practice
- Reduces suffering
- Reduces anxiety
- Improves sleep & appetite
- decreases family stress
- Good for society > out of hospital sooner
Assessing pain
severity, type, and specific scales used
What scales do we use to rate pain
1.Verbal rating scale:
- Ask the patient if the pain is mild, moderate, or severe
- Ask the patient to rate the pain from 0 – 10\
- Visual analogue scale
- Faces pain scale:
- Patient must point to face
- The Wong-Baker FACES pain rating scale is used in children
Hyperalgesia
The sensation of pain experienced is excessive and out of proportion to the stimulus
Dramatic
Primary and Secondary Hyperalgesia
- Primary = changes that occur at site of injury both tissue damage and inflammation release neurotransmitters and cytokines that excite and sensitise dormant nociceptors
- Secondary = hyperexcitability of spinal neurons, previously normal stimuli now recognised as painful
Windup define
prolonged dorsal horn activity after repetitive C nerve fibre stimulation
Allodynia
Pain due to a stimulus which does not normally provoke pain
Neurogenic / Neuropathic pain
Pain initiated / caused by primary lesion or dysfunction in peripheral or central nervous system
Analgesia
Absence or less pain in response to stimulation which would normally be painful
Chronic pain state
Pain that outlasts the precipitating tissue injury
Special Scales for special people groups to assess pain
- FLACC very young
- Abbey non-communicable adults
- PAINAD dementia
- Functional activity scale language barrier (speaks a different language)
Classification of pain
- How long has the patient had pain = acute vs. chronic
- What is the cause of the pain = disease process, cancer, or non-cancer
- What is the mechanism of the pain = nociceptive, neuropathic, or nociplastic
MOA of pain - the different types
o Nociceptive = noxious stimuli.
o Neuropathic = somatosensory nervous system
o Nociplastic = altered function of nervous system without clear lesion or disease
- Chronic neuropathic- and nociplastic (non-nociceptive) pain does not respond well to opioids
Nociceptive Pain
Definition: Pain caused by actual or potential tissue damage that activates nociceptors (pain receptors).
Mechanism: Normal functioning of the somatosensory system — pain signals are transmitted in response to injury or inflammation.
sharp, aching, or throbbing and well-localized.
eg. Post-operative pain, A sprained ankle, Appendicitis, Osteoarthritis
Neuropathic Pain
Definition: Pain caused by a lesion or disease of the somatosensory nervous system (either central or peripheral).
Mechanism: Abnormal processing of pain signals due to nerve damage or dysfunction.
Description: Often described as burning, electric shock-like, shooting, or tingling. Often associated with allodynia (pain from normally non-painful stimuli) and hyperalgesia
eg. Diabetic neuropathy, Post-herpetic neuralgia, Trigeminal neuralgia, Spinal cord injury pain
Chronic doesnt respond to opioids
Nociplastic Pain
Definition: Pain arising from altered nociception despite no clear evidence of tissue damage or nerve injury.
Mechanism: Abnormal pain modulation in the central nervous system, often with central sensitization.
Description: Usually diffuse, widespread, often accompanied by fatigue, sleep disturbances, and mood issues.
eg. Fibromyalgia, Irritable bowel syndrome (IBS), Some chronic low back pain, Tension-type headache
Chronic doesnt respond to opioids
allodynia
pain from normally non-painful stimuli (neuropathic)
RICE
Rest
Ice
Compress
Elevate
Steps in treating cancer pain
- Step 1 / mild = give simple analgesics
- Step 2 / moderate = mild opioid (codeine / tramadol), and continue simple analgesics
- Step 3 / severe = strong opioids (morphine), and continue simple analgesics
- Add other medications for neuropathic = amitriptyline or gabapentin
- When it is acute pain, reverse the steps
Treating Spinal cord pain
- Non-pharmacological
- Local anaesthetics
- Opioids
- Ketamine
- Amitriptyline
- Tramadol
Main opioid S/E we’re worried about
Resp depression
Addiction
What kind of pain are acute burns?
severe, acute, non-cancer, nociceptive pain
