Advanced forms of pain relief

Question	Answer
pain definition	unpleasant sensory and emotional experience associated with actual or potential tissue damage, described in terms of such damage
type of pain	acute, chronic, nociceptive, neuropathic
acute pain	recent onset, limited duraton identifiable cause, indicayes injury and illness, predicatable course
chronic or persistent pain	persistent, cause is often obscure, sensitisation of noiceptors or nerves, poorly responsive to therapy, including opioids, unpredictable
Nociceptive pain	most common in acute settings stimulation of nociceptors as result of tissue damge pain characteristics - somatic = sharp, ot, stinging visceral = dull, crampy
neuropathic pain	dysfunction in nervous systen - nerve pain e.g. amputation of limb, burning, pulsing, shooting, tingling, hyperalgesia (increased pain with painful stimuli) , allodynia (pain with non-painful stimuli)
prolonged injury response	hyperglycaemia - increased risk of infection, length of stay increase in fatty acids - myocardial o2 consumption increase in coagulation - increase DVT/PE increase muscle protein breakdown - decrease wound healing decrease immune function - increase infection
prolonged sympathetic reponse	increase heart rate, BP, myocardial oxygen, ischaemia, decreased GI motility - ileus
major complications of bed rest	Increase pulmonary complications, decrease lung volumes, hypoxaemia, increase thromboembolism goal: mobilise and cough comfortably
Measuring pain	subjective - only patient knows
assessing pain at	rest and movement - reassess after analgesic administration
FAS	assessment of function, the ability to deep breathe/cough, participate in physio a - no limitation due to pain b - mild limitation c - unable to complete activity
non-pharmacological management	rest, position, elevation, compression, reaasurance, explanation, expectation
Pharmacological management	opioids- IV, PCA, oral, SC non- opioids - paracetamol, NSAIDS, ketamine, anticonvulsant, antidepressants neuraxial - epidural, intrathecal regional
morphine	least lipid soluble - slower onset of action, longer duration active metabolites - M3G M6G renal excretion - caution with elderly SR - kapanol, MS contin
Fentanyl	highly lipid soluble - fast onset, shorter action no active metabolites - safer for renal impairment and elderly SR - transdermal - durogesic patch
Oxycodone	first line opioid semi - synthetic opioid derivative of thebaine not codiene no harmful metabolites - suitable for elderly SR - oxycontin, targin
Tramadol	synthetic - opioid like analgesic combined effect SSRI reduces pain transmission and perception active metabolite - caution elderly lower risk of sedation and resp depression lower risk of constipation
Adverse effect of opioids	nausea and vomiting -- antiemetics Pruritis - naloxone, antihistamines urinary retention constipation sedation and resp depression
opioid effect on resp system	decreased rate, rhythem irregular, decrease tidal volume, increase co2, sedation, depression of upper airway tone and obstruction resp rate is a late and unreliable sign increasing sedation is a better sign
sedation scores	o- wide awake 1- easy to rouse, remains awake 2- easy to rouse but cannot stay awake 3 - difficult to rouse (severe resp depression)
Naloxone	opioid antagonist half life 30-60 minutes
Adjunvants	paracetamol, NSAIDS, ketamine, anticonvulsants, antidepressant are all opioid sparring lead to reductoin of opioid required, fewer side effects
Ketamine	blocks NMDA receptors in the spinal cord side effects : vivid dreams, hallucinations
dermatome	area of skin that is mainly supplied by a single nerve which originates in the epidural space
epidural complications	systemic toxicity tingling, umbenss, metallic taste, light headed, coma, convulsions treatment: stop infusoin, resp and cario support

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Advanced forms of pain relief

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	Created by Elizabeth Then over 6 years ago