Principles of Pain Management Flashcards
(26 cards)
What is pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage
How do we assess pain?
Pain History:
1. Character, intensity, location, underlying cause, associated symptoms, and current analgesic use (SOCRATES)
2. Patient’s ideas & concerns in relation to pain, and their expectations with regard to analgesia
3. History can be repeated after treatment to monitor progress
Why do we treat pain?
Basic human right!
↓ suffering
↓ complications
↓ likelihood of chronic pain development
↑ patient satisfaction
↑ speed of recovery → ↓ length of stay → ↓ cost
↑ productivity and quality of life
Why do we not manage pain better?
- Failure in assessment,
- underuse of effective analgesic techniques,
- poor protocol availability or application,
- insufficient knowledge
Those at risk of inadequate analgesia?
- Extremes of age
- Critically ill
- Communication difficulties
- Hx of substance misuse
- Chronic pain already on opioids
Classification of pain?
- Duration
- Mechanism
Acute pain?
Pain of recent onset & probable limited duration
- Usually there is identifiable temporal & causal relationship to injury or disease
Chroic pain?
Persist beyond the time of hearing of an injury
- Frequently no identifiable cause
Acute vs chronic pain?
- Pain can be acute ( pain for less than 3 months) or chronic ( pain for more than 3 months)
- Sometimes, a patient in pain may experience additional acute pain ( acute on chronic pain)
- Poorly treated acute pain is more likely to become chronic pain
Nociceptive pain?
- Commonest type of pain following tissue injury
- Sometimes called physiological or inflammatory pain
- Has a protective function
- Patients describe pain as sharp, throbbing or aching and is usually well localised.
Neuropathic pain?
- Caused by a lesion or disease of the sensory nervous system and is sometimes called pathological pain.
- Tissue injury may not be obvious and doesnt have any protective function.
- Patient describe neuropathic pain as burning or shooting.
- They may complain of numbness or pins and needles
- The pain is often not well localised
What is pain assessment?
Pain is subjective experience, severity can be influenced by:
- Previous experience of pain
- Cultural background
- Coping mechanisms
- Fear, Anxiety, Depression
How to assess pain?
Pain can be assessed using the following scales
1. Verbal Rating Scale
2. Numerical Rating Scale
3. Visual Analogue Scale
Verbal rating scale?
Ask the patient: “Which of the following words best describes the pain your are experiencing at the moment?”
None 1
Mild 2
Moderate 3
Severe 4
Non-pharmacological treatment?
- RICE (rest, ice, compression and elevation) of injuries
- Splinting
- Acupuncture
- Physiotherapy
Pharmacological treatment?
- Systemic analgesia
- Topical
- Transdermal patch
- Nerve blocks
WHO analgesic ladder?
Step 1: Non-opiods e.g. NSAIDS, PCM
Step 2: Weak opiods e.g. codeine, tramadol
Step 3: Strong opiods e.g. morphine, oxycodone, methadone, fentanyl
What are adjuvants?
medication that can be used along any step of the ladder
Name adjuvants?
- amitriptyline - antidepressant
- gabapentin - anticonvulsant
- diazepam - anxiolytics
- dexamethasone - cortiocosteroid
Adverse effects of pain management on the GI system??
Indigestion, gastric ulceration, GI bleeding and perforations associated with chronic NSAID use
Adverse effects of pain management on the renal system?
- reduced renal blood flow leading to ischemia can occur in patients with prostaglandin-regulated renal blood flow who receive NSAIDs
- Allergic nephritis can also occur.
Adverse effects of pain management on the CVS system?
NSAIDS aside from low dose-aspirin increase the risk of myocardial infarction and stroke.
Adverse effects on Respiratory system?
atelectasis, pneumonia
Adverse effects on the hepatic system?
elevations in serum liver enzymes can occur in chronic NSAID use.
