Pain

Question 1

Definition of pain

Answer 1

Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Involves perception of a noxious stimulus by the nervous system

Question 2

What factors exacerbate pain perception

Answer 2

Anxiety
Boredom
Depression
Insomnia
Isolation

Question 3

What factors can reduce pain perception

Answer 3

Mood elevation
Other symptoms relieved
Socialising
Distractions/activities

Question 4

Pain history

Answer 4

Site
Radiation
Quality
Intensity
Timing - onset, duration, progression, cyclical 
Aggravating factors
Relieving factors
Associated symptoms

Question 5

Describe nociceptive pain

Answer 5

Nervous system working normally.

Tissue damage activating nociceptive pain receptors

Question 6

Describe neuropathic pain

Answer 6

Malfunctioning nervous system leads to increased pain receptor firing without a noxious stimulus

Question 7

Percentage of patients with advanced cancer that experience pain at EoL

Answer 7

75-90%

Question 8

Step 1 of WHO analgesic ladder

Answer 8

Non opioid +/- adjuvant

Question 9

Step 2 of WHO analgesic ladder

Answer 9

Opioid mild
+/- non opioid
+/- adjuvant

Question 10

Step 3 of WHO analgesic ladder

Answer 10

Opiate strong
+/- non opioid
+/- adjuvant

Question 11

Examples of step 1 analgesics

Answer 11

Paracetamol

NSAIDs

Question 12

Examples of step 2 analgesics

Answer 12

Codeine
Tramadol
Dihydrocodeine
Co-codamol

Question 13

Examples of step 3 analgesics

Answer 13

Fentanyl
Morphine
Diamorphine
Oxycodone

Question 14

Definition of adjuvant analgesic and give examples

Answer 14

Primary indication is not for analgesia 
E.g:
Duloxetine
Gabapentin
Pregabalin
Dexamethasone
Benzodiazepines

Question 15

Drugs for neuropathic pain

Answer 15

Amitriptyline 10-25mg before bed
Gabapentin 300mg TDS
Pregabalin 75mg BD

Question 16

What types of pain show good and poor response to opioids

Answer 16

Good: Scott tissue, visceral
Poor: neuropathic

Question 17

Common side effects of opioids in EoL

Answer 17

Constipation
N+V (usually lasts 1 week)
Drowsiness
Confusion
Dry mouth

Question 18

DVLA rules on morphine

Answer 18

Can drive if stable on a regular dose
Can’t drive if:
Titrating dose
On oromorph

Question 19

Laxative prescription with morphine

Answer 19

Lactulose

Question 20

Antiemetic prescription with morphine

Answer 20

Metoclopramide (skin reactions when used in syringe driver)

Haloperidol (1st line syringe driver)

Question 21

How to step up from maximum dose codeine

Answer 21

Codeine:morphine = 10:1
240mg codeine: 24mg morphine TDD
Sustained release (1/2 TDD) 15mg BD
Immediate release (1/6 TDD) 5mg PRN

Question 22

What are the SR morphine forms

Answer 22

Zomorph capsules - 10, 30, 60, 100, 200mg

MST tablets - 5, 10, 15, 30, 60, 100, 200mg

Question 23

What are the IR morphine forms

Answer 23

Oromorph 10mg/5ml or 100mg/5ml

Bottles 100, 300 or 500ml

Question 24

How do you titrate morphine down

Answer 24

Decrease TDD by 1/3

Question 25

How to convert oral dose to SC dose (PRN)

Answer 25

Oral:SC = 2:1

Question 26

How to calculate morphine SR dose

Answer 26

TDD / 2 BD

Question 27

How to calculate morphine IR dose

Answer 27

TDD / 6 PRN

Question 28

What to include in morphine TTO

Answer 28

Drug name
Drug form
Drug strength
Amount of drug needed for 14 days written in both figures and words