Week 2 - Evidence-based pain management

Question 1

What drugs work in the pain pathway of the spinal cord?

Answer 1

• Morphine- like drugs

- Neuropathic pain drugs

Question 2

What drugs work in the pain pathway of the brain?

Answer 2

• Paracetamol
• Morphine- like drugs
• Neuropathic pain drugs

Question 3

What drugs work in the pain pathway of the bone, skin and other tissues?

Answer 3

• Morphine- like drugs

- Anti- inflammatory drugs

Question 4

Medications for nociceptive pain:

Answer 4

• Non-steroidal anti-inflammatory drugs (NSAIDs)

- Opioids

Question 5

Medications for neuropathic pain:

Answer 5

• Antidepressants
• Anticonvulsants
• Topical agents
• Opioids

Question 6

What are adjuvant agents?

Answer 6

Used as supplements to make analgesics more effective

Question 7

Examples of NSAIDs:

Answer 7

• Ibuprofen
• Naproxen
• Diclofenac
• Indomethacin
• Ketorolac

Question 8

Examples of opioids:

Answer 8

• Morphine
• Fentanyl
• Oxycodone
• Hydromorphone
• Methadone
• Codeine

Question 9

Management plan three phases:

Answer 9

Assessment, Management, Review

Question 10

Rationale of multi-modal medications:

Answer 10

Target multiple mechanisms of pain conditions, addressing both nociceptive and neuropathic components of pain

Question 11

Classifications of CAM:

Answer 11

• Whole medical systems: e.g. Traditional Chinese Medicine
• Mind‐body medicine: e.g. meditation
• Biologically based practices: e.g. herbs, vitamins
• Manipulative and body‐based practices: e.g. chiropractic, massage

Question 12

What is acupuncture believed to stimulate?

Answer 12

Secretion of endorphins, serotonin, and noradrenaline in the CNS

Question 13

Aim of cognitive therapy:

Answer 13

To alter a person’s belief system and modify undesirable behaviour patterns and perceptions

Question 14

What is CBT?

Answer 14

A psychological technique that can be taught to patients to reframe thoughts and change the pattern of thinking, identify negative thoughts and then change them

Question 15

Why is massage used for pain?

Answer 15

Touch is the most instinctive response to pain

Question 16

What is transcutaneous electrical nerve stimulation?

Answer 16

• Electrical stimuli on the skin preferentially activate low‐ threshold, myelinated nerve fibres
• Inhibits nociception by blocking transmission along fibres to the dorsal horn

Question 17

Pain assessment tools:

Answer 17

• Behavioural Pain assessment scale
• Functional assessment: - The Physical Functional Ability Questionnaire
• Pain Catastrophising scale
• PASS: pain anxiety symptom scale
• DN4: neuropathic/nociceptive discrimination
• Chronic pain grade: pain activity questionnaire

Question 18

Pain questions onset:

Answer 18

When did it start? How long does it last? How often does it occur?

Question 19

Pain questions provoking palliating:

Answer 19

What brings it on? What makes it better? What makes it worse?

Question 20

Pain questions quality:

Answer 20

What does it feel like? Can you describe it?

Question 21

Pain questions region/radiation:

Answer 21

Where is the pain? Does it spread anywhere?

Question 22

Pain questions severity:

Answer 22

How severe is the pain? Right now? At best? At worst? How bothered are you by the pain?

Question 23

Pain questions treatment:

Answer 23

What have you tried? What has worked? Not worked?

Question 24

Pain questions understanding impact:

Answer 24

What do you believe is causing this symptom?

Question 25

Pain questions values:

Answer 25

What is your comfort goal or acceptable level? Do you have any other views about the pain that are important?

Question 26

Where do opioids act in nociception?

Answer 26

Transmission

Question 27

What is morphine derived from?

Answer 27

Opium

Question 28

What does the WHO analgesic ladder consist of?

Answer 28

Paracetamol, NSAIDs, Tramadol, Morphine