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What is the analgesic ladder?

1 - non opioid (aspirin, paracetamol, NSAID) +/- adjuvant
2 - weak opioid (codeine) +/- non opioid +/- adjuvant
3 - strong opioid (morphine) +/- non opioid +/- adjuvant


How do opioids work?

block pain transmission by binding to receptors in the CNS


What can be used as non pharmalogical pain relief?

acupunctures, TENs machine, heat/ice, yoga, exercise, herbal, psychophysiological therapy, ablimen bust cycle, plan days, occupational therapy


What drugs can be given alongside the analgesic ladder?

gabapentin, pregabalin, antitriptyline


Side effects of opioids?

resp depression, nausea, constipation, drowsiness


Side effects of NSAIDs?

nausea, diarrhea, insomnia, abdominal pain, headaches, stomach ulcers


Side effects of COX-1?

stomach ulcers, intestinal bleeding (safer than NSAIDs for stomach)


What risks are there in pain killers?

watch if on alcohol or antidepressants, can gain tolerance, can gain dependence on the drug, get muscle pain and irritability


What is the QoL scale?

measures function for people with pain, developed by American Chronic Pain Association (ACPA) and should be completed when first seeking treatment, shows effect on work, social, exercise, household chores, mood and ranked 1-10, involves a pain diary or when, where, severity and relieving fatcors


Physiological effects of chronic pain?

reduced ability to work due to future uncertainty and balancing multiple roles, difficulty performing every day tasks, physical disability, problems with medication of side effects, interactions and dependence, becoming physically drained, stop doing things they enjoy


Psychological effects of pain?

marital and family problems, depression, increased suicidal thoughts and suicide attempts, sleep disturbance, helplessness, become irritable, short tempered, impatient, limit social contact, difficulty focusing on simple tasks, anxiety, loss of self esteem


Risk factors for depression?

low self esteem, being too dependent, self critical, pessimistic, traumatic event, bereavement, family history, being different (gay), abuse of alcohol and drugs, medications, chronic illness


Psychological symptoms of depression?

continuous low mood, feeling hopeless and helpless, feeling tearful, feeling guilt ridden, irritable, no motivation, lost interest, poor decision making, not enjoying life, feeling anxious, suicidal thoughts


Physical symptoms of depression?

moving or speaking more slowly, change in appetite or weight, constipation, unexplained aches and pains, lack of energy or loss of libido, changes to menstrual cycle, disturbed sleep


Social symptoms of depression?

not doing well at work, taking part in fewer activities, avoiding contact with friends, neglecting hobbies, difficulties in home and family life


How are chronic pain and depression linked?

they can exacerbate and make each other worse, and if you have one you are more likely to have the other, treating one can also help the other


In who is depression most common?

illness of affluence, occupational stress, poverty, inequality between society