Anaesthetics Pain management Flashcards

1
Q

What characteristics do we use to categorise pain?

A

Duration
Cause
Mechanism

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2
Q

When does acute pain become chronic?

A

IF it lasts for >3 months, after normal healing and/or has no identifiable cause

Pain can also be acute-on-chronic

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3
Q

What are the mechanisms of pain?

A

Nociceptive:

  • Obvious injury
  • Sharp or dull
  • well localised

Neuropathic:

  • Nerve damage or NS dysfunction
  • Burning, shooting, numbess or Pins/needles
  • Not well localised
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4
Q

What types of analgesics do we have?

A

Simple analgesics (PCM & NSAIDS)
Opiods
Others

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5
Q

What are the pros and cons of simple analgesics?

A

Both are cheap and safe.
PCM can be given orally, rectally or IV

NSAIDs are synergistic with PCM but come with GI, renal and asthmatic side effects

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6
Q

Give an example of mild and strong opioids?

A

Mild - Codeine or Dihydrocodeine

Strong - Morphine

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7
Q

Opioids can be compined with PCM and are mostly cheap and safe. What are their cons?

A
Constipation
Respiratory depression (mostly stronger ones)

Strong opioids are controlled so can be practically more difficult to deliver

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8
Q

What’s included in the “Other analgesics” category?

A
  • Tramadol
  • TCA e.g. Amitriptyline
  • Anti-convulsants e.g. Gabapentin or NaValproate
  • Ketamine
  • LA
  • Topical agents e.g. Capsaicin cream
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9
Q

How do TCAs help with pain?

A

Increase modulatory effect of desc inhibitory pathways.
This makes them good for neuropathic pain
They also help with sleep problems and depression

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10
Q

How do Anti-convulsants help with pain?

A

Reduce abnormal firing of nerves which is good for neuropathic pain

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11
Q

How do we treat pain non-pharmacologically?

A

RICE
Acupuncture & massage
TENS

Explanantion, reassurance and counselling can make a huge amount of difference, patients knowing the pain is expected, normal and where applicable temporary can handle it much better

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12
Q

How do we treat nociceptive pain?

A

Follow the WHO analgesic ladder:
Mild - Simple analgesics
Moderate - Mild opioids + Simple analgesics
Severe - Strong opioids + simple analgesics

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13
Q

How do we wean people off analgesics?

A

Go back down the WHO analgesic ladder in steps.

Stop PCM last (as it has the least side effects)

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14
Q

How do we treat neuropathic pain?

A

Start non-pharmacologically

Then try alternative analgesics such as Amitriptyline, Gabapentin and duloxetine

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15
Q

What is the RAT approach to pain relief?

A

Recognize
Assess (severity, cause, type and other factors)
Treat

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16
Q

How do we assess the severity of pain?

A

1) verbal rating (mild –> severe)
2) Numerical scale (1 –> 10)
3) Visual analogue scale
4) Faces
5) Abbey pain scale

17
Q

How does a visual analogue scale work?

A

Draw a line and ask patients to mark along the line where their pain sits

18
Q

What is an abbey pain scale for?

A

Confused patients