pain management

Question 1

describe acute pain

Answer 1

recent onset

limited duration

Question 2

describe chronic pain

Answer 2

lasts 3+ months

often lasts after normal healing with no identifiable cause

Question 3

what are the two mechanisms of pain

Answer 3

nociceptive

neuropathic

Question 4

describe nociceptive pain

Answer 4

also known as physiological/inflammatory
has obvious tissue injury
pain is well localised
has protective function

Question 5

describe neuropathic pain

Answer 5

nervous system damage/abnormality
abnormal processing of pain signals
burning/shooting pain
numbness/tingling

Question 6

what are some causes of neuropathic pain

Answer 6

increased receptor numbers
abnormal sensitisation of nerves
chemical changes in dorsal horn
loss of inhibitory modulation

Question 7

what are simple analgesics

Answer 7

paracetamol

NSAIDs - ibuprofen, diclofenac

Question 8

when can paracetamol be used

Answer 8

for mild pain

for moderate pain in combination with other drugs

Question 9

what can a paracetamol overdose cause

Answer 9

liver damage

Question 10

how do NSAIDs work

Answer 10

reduce prostaglandins and inflammatory process to prevent stimulating nociceptors in periphery

Question 11

what can NSAIDs be used for

Answer 11

nociceptive pain

in combination with paracetamol

Question 12

what are side effects of NSAIDS/when should they be avoided

Answer 12

stomach ulcers (give with PPIs)
hypertension
bronchospasm in asthmatics
avoid in kidney disease

Question 13

what are ‘weak’ opioids

Answer 13

codeine
dihydrocodeine
tramadol

Question 14

what are ‘strong’ opioids

Answer 14

morphine
oxycodone
fentanyl

Question 15

what are common side effects of opioids

Answer 15

constipation 
puritis 
nausea 
altered mental state 
respiratory depression

Question 16

what is codeine good for

Answer 16

mild-moderate nociceptive pain

Question 17

how does tramadol work

Answer 17

mixed opiate and 5HT/NA reuptake

weak opioid effect + inhibits serotonin and noradrenaline reuptake

Question 18

what is morphine used for

Answer 18

moderate-severe nociceptive pain and cancer pain

can be given orally, IV, IM, SC, PR, intrathecally

Question 19

what are anti-convulsants used for

give examples

Answer 19

neuropathic pain
gabapentin
carbamazepine
sodium valproate

Question 20

side effects of gabapentin

Answer 20

very addictive - cocaine effect

only give if confirmed neuropathic pain

Question 21

what anti-depressants can be used for pain

Answer 21

amitriptyline

duloxetine

Question 22

what topical agents can be used for pain

Answer 22

capsaicin

Question 23

what is amitriptyline

Answer 23

tricyclic anti-depressant

Question 24

what is amitriptyline used for

Answer 24

neuropathic pain
depression
poor sleep

Question 25

what are side effects of amitriptyline

Answer 25

glaucoma | urinary retention

Question 26

what are non-pharmacological options for pain management

Answer 26

``` acupuncture massage psychological rest, ice, elevation surgery physio explanation + planning counselling input from social worker ```

Question 27

what is step 1 of the pain ladder

Answer 27

non-opioids aspirin NSAIDs paracetamol

Question 28

what is step 2 of the pain ladder

Answer 28

mild opioids codeine dihydrocodeine tramadol

Question 29

what is step 3 of the pain ladder

Answer 29

strong opioids morphine oxycodone fentanyl

Question 30

what part of the pain ladder do you use for mild pain

Answer 30

just step 1

Question 31

what part of the pain ladder do you use for moderate pain

Answer 31

step 1 + step 2

Question 32

what part of the pain ladder do you use for severe pain

Answer 32

step 1+3

Question 33

when is the pain ladder less applicable

Answer 33

in neuropathic pain

Question 34

what is the RAT approach to pain

Answer 34

recognise assess treat

Question 35

what do you assess the pain for

Answer 35

pain score at rest vs with movement nociceptive or neuropathic other factors like other diseases

Question 36

What medication should be given in severe pain after trauma?

Answer 36

Morphine (+ paracetamol). Ibuprofen - bottom of pain ladder (and NSAID) Tramadol - middle of pain ladder NSAIDS - should not be used after severe trauma to begin with because they increase the risk of bleeding.