Introduction to Pain Management
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Questions and Answers

Which of the following is a key distinguishing feature of acute pain?

  • It is of recent onset. (correct)
  • It is always linked to nociceptive mechanisms.
  • It lasts for more than 3 months.
  • It persists after normal healing.

    • What type of pain is associated with damage to the nervous system?

  • Inflammatory pain
  • Dysfunctional pain
  • Nociceptive pain
  • Neuropathic pain (correct)

    • Which statement correctly relates to chronic pain?

  • It lasts less than 3 months.
  • It has no emotional impact on individuals.
  • It typically resolves after a short period.
  • It usually signifies ongoing tissue damage. (correct)

    • Which type of pain is characterized by its origin in the body's tissues?

    <p>Nociceptive pain</p> Signup and view all the answers

    What is one common non-pharmacological treatment option for managing pain?

    <p>Cognitive-behavioral therapy</p> Signup and view all the answers

    What characterizes nociceptive pain?

    <p>It serves a protective function related to potentially damaging stimuli.</p> Signup and view all the answers

    Which type of pain is associated with tissue damage and involves immune cells promoting healing?

    <p>Inflammatory pain</p> Signup and view all the answers

    What is a common characteristic of maladaptive pain?

    <p>It often has no identifiable cause.</p> Signup and view all the answers

    Which of the following is NOT typically associated with the burden of chronic pain?

    <p>Improved sleep quality</p> Signup and view all the answers

    What type of pain is characterized by 'sharp' or 'throbbing' sensations and is usually well-localized?

    <p>Inflammatory pain</p> Signup and view all the answers

    Which of the following descriptions accurately describes neuropathic pain?

    <p>Caused by nerve damage or dysfunction</p> Signup and view all the answers

    The concept of adaptive pain is best described as:

    <p>Pain that protects the body and aids in recovery.</p> Signup and view all the answers

    Which of the following is a common consequence of chronic pain?

    <p>Less active lifestyle</p> Signup and view all the answers

    What is a characteristic descriptor of neuropathic pain?

    <p>Burning, shooting, pins and needles</p> Signup and view all the answers

    Which of the following conditions is associated with nociplastic pain?

    <p>Fibromyalgia</p> Signup and view all the answers

    Which of the following best describes the nature of nociplastic pain?

    <p>Substantial pain with no noxious stimulus</p> Signup and view all the answers

    What kind of pain does Ayaan Jessa experience based on the description?

    <p>Neuropathic pain</p> Signup and view all the answers

    What likely contributed to Daphne Monta's symptoms?

    <p>Central sensitization</p> Signup and view all the answers

    What role does neuronal damage play in nociplastic pain?

    <p>No neuronal damage occurs</p> Signup and view all the answers

    Which of the following is a common form of neuropathic pain?

    <p>Trigeminal neuralgia</p> Signup and view all the answers

    In which demographic or condition is diabetic neuropathy typically found?

    <p>Adults with type 2 diabetes over a period of years</p> Signup and view all the answers

    What type of pain may Carole Parkinson be experiencing, considering her symptoms of constant pain and burning sensations?

    <p>Mixed nociceptive and neuropathic pain</p> Signup and view all the answers

    What distinguishes cancer pain from non-cancer pain?

    <p>Cancer pain is usually progressive.</p> Signup and view all the answers

    Which of the following is a common treatment goal for acute pain management?

    <p>Patient comfort and satisfaction</p> Signup and view all the answers

    What type of pain is characterized by having many different causes and may be either acute or chronic?

    <p>Non-cancer pain</p> Signup and view all the answers

    Which symptoms are indicative of chronic pain as opposed to acute pain?

    <p>Chronic back pain and arthritis</p> Signup and view all the answers

    What is a potential characteristic of cancer pain that is frequently differentiated from non-cancer pain?

    <p>It may include both acute and chronic features.</p> Signup and view all the answers

    What type of pain is most commonly associated with conditions like chronic back pain?

    <p>Chronic pain</p> Signup and view all the answers

    Which of the following conditions could potentially lead to cancer pain due to nerve compression?

    <p>Breast cancer</p> Signup and view all the answers

    What is a requirement for a pharmacist working in pain management services?

    <p>To be registered with the General Pharmaceutical Council</p> Signup and view all the answers

    Which of the following is essential for pharmacists involved in pain management?

    <p>Undergoing continuous professional development activities</p> Signup and view all the answers

    What must pain services have access to for expert advice?

    <p>A medicines information service</p> Signup and view all the answers

    What distinguishes a pharmacist acting as a 'practitioner with a special interest' in pain management?

    <p>They require accreditation to perform their role</p> Signup and view all the answers

    What is vital for centers that provide epidural or intrathecal drug delivery?

    <p>Availability of sterile manufacturing facilities</p> Signup and view all the answers

    Which class of medications includes gabapentin and pregabalin?

    <p>Anti-epileptics</p> Signup and view all the answers

    What is one of the main objectives of hospital pharmaceutical services?

    <p>Facilitating safe, effective and economic use of medicines</p> Signup and view all the answers

    Which of the following is a non-pharmacological self-care strategy for pain management?

    <p>Cognitive behavioural therapy</p> Signup and view all the answers

    Who is NOT considered a member of the multidisciplinary team in pain management?

    <p>Data analysts</p> Signup and view all the answers

    Which of the following is classified as a corticosteroid?

    <p>Prednisone</p> Signup and view all the answers

    What is the role of pharmacotherapy in self-care pain management?

    <p>To enhance the effectiveness of self-care strategies</p> Signup and view all the answers

    What approach does acceptance commitment therapy typically emphasize?

    <p>Embracing pain and values</p> Signup and view all the answers

    Which invasive technique is commonly used for pain management?

    <p>Deep brain stimulation</p> Signup and view all the answers

    Study Notes

    Introduction to Pain

    • Pain is not uniform; different types of pain exist.
    • This lecture will classify pain, outline approaches to classifying pain, and describe the role of pharmacists in pain management.
    • Key features distinguishing acute and chronic pain will be identified.
    • Four types of pain, based on their underlying mechanism, will be explained.

    Aims of the Lecture

    • Outline different approaches to classifying pain
    • Identify key features distinguishing between acute and chronic pain
    • Explain four types of pain by their underlying mechanism (aetiology): nociceptive, inflammatory, neuropathic, and nociplastic
    • Describe the physical and emotional impacts of living with pain
    • Outline pharmacological and non-pharmacological pain treatment options
    • Describe the pharmacist's role in pain management

    Main Types of Pain Classification

    • Not all pain is the same
    • Key considerations include duration, etiology (mechanism), cause, location, (e.g., headache, visceral, musculoskeletal) and whether it's cancer-related or not
    • Pain is classified into acute and chronic, and further subdivided into nociceptive, inflammatory, neuropathic, and nociplastic pain

    Pain Classification by Duration

    • Acute Pain:*

    • Recent onset, usually short-lived

    • Linked to clear tissue injury (e.g., injury, surgery, burn)

    • Severity varies with the extent of injury

    • Predictable time course

    • Generally, responds well to treatment

    • Chronic Pain:*

    • Lasting more than 3 months

    • Can occur after expected healing

    • May have no discernible cause or pathological process

    • Intensity might not correlate with tissue injury

    • Time course is unpredictable

    • Often difficult to treat

    Burden of Chronic Pain

    • Chronic pain can negatively impact quality of life
    • Associated with depressive feelings
    • Sleep disturbances
    • Fatigue
    • Impaired physical functioning
    • Difficulty concentrating
    • Increased time off work
    • Reduced activity levels

    Pain Classification by Aetiology

    • Adaptive pain:* Has a function

    • Nociceptive pain

    • Inflammatory pain

    • Non-adaptive pain:* (maladaptive, pathological)

    • Neuropathic pain

    • Nociplastic pain ((dys)functional pain)

    Aetiology: Nociceptive Pain

    • 'Good' pain, protective function
    • Sensation from potentially tissue-damaging noxious stimuli
    • Example scenario: a 5-year-old child burns their hand on a hot kettle

    Aetiology: Inflammatory Pain

    • Obvious tissue injury or illness
    • Associated with tissue injury and immune cell infiltration
    • Adaptive, protective function
    • Descriptors: sharp, dull, aching, throbbing, well-localised, characteristic case study (Ayaan Jessa)

    Aetiology: Neuropathic Pain

    • Caused by damage to or disease of the sensory nervous system
    • Tissue injury may not be immediately obvious
    • Does not have a protective function
    • Descriptors: burning, shooting, pins and needles, numbness, less well-localised
    • This type of pain can be caused by certain conditions or medications (e.g., stroke, chemotherapy, certain viral infections)

    Neuropathic Pain Scenarios

    • Peripheral: Drugs (e.g., chemotherapy), amputation (phantom limb), infections (e.g., shingles), trigeminal neuralgia, diabetes
    • Spinal: Spinal injury, MS
    • Brain: Stroke, tumour

    Case study: Daphne Monta

    • 61-year-old woman with type 2 diabetes
    • Experiences constant tingling and burning pain in both feet
    • Pain interferes with daily activities and sleep.

    Aetiology: Nociplastic Pain

    • Substantial pain without noxious stimuli or minimal peripheral inflammatory pathology
    • No neuronal damage or injury
    • Abnormal function of the pain axis; related to central sensitization and nerve memory
    • Associated with various conditions (e.g., fibromyalgia, IBS, tension-type headaches)
    • Case study: Carole Parkinson (chronic widespread pain, pain in various locations, fatigue, sleep disturbances)

    Cancer v Non-cancer Pain

    • Cancer pain:*

    • Often progressive

    • Might be a combination of acute and chronic pain

    • Can be related to nerve compression, chemotherapy, or disease progression

    • Non-cancer pain:*

    • Various underlying causes

    • Can be acute or chronic

    • Examples include fractures, appendicitis, chronic back pain, or arthritis

    • May be mixed nociceptive and neuropathic

    Cancer Pain Examples

    • Uterine cervical cancer, breast cancer, bone metastases (spread of cancer to the bones), due to nerve compression, chemotherapy

    Non-cancer Pain Examples

    • Fracture, appendicitis, myocardial infarction (heart attack), chronic back pain, arthritis

    Goals of Treatment

    • Acute pain:*

    • Patient comfort and satisfaction

    • Earlier mobilization

    • Reduced hospital stay

    • Minimize stress response and neuroendocrine effects

    • Minimize adverse effects on various systems (respiratory, cardiovascular, etc.)

    • Chronic pain:*

    • Improved function

    • Pain management

    • Reduction in healthcare utilization

    • Greater understanding of ongoing pain

    • Less fear associated with physical activity

    Management Strategies

    • Pharmacological:*

    • Paracetamol

    • NSAIDs and coxibs

    • Opioids

    • Local anaesthetics

    • Ketamine

    • Corticosteroids

    • Antidepressants (tricyclics, serotonin-norepinephrine reuptake inhibitors)

    • Anti-epileptics (gabapentin, pregabalin, carbamazepine)

    • Non-pharmacological:*

    • Self-care (heat/cold, activity and exercise, pacing activities, sleep hygiene)

    • Cognitive behavioural therapy

    • Acceptance commitment therapy

    • Acupuncture

    • Transcutaneous electrical nerve stimulation (TENS)

    • Pain management programs

    • Invasive devices (spinal cord stimulation, deep brain stimulation)

    Members of the Multidisciplinary Team

    • Doctors
    • Nurses
    • Pharmacists
    • Physiotherapists
    • Psychologists
    • Occupational therapists
    • Person with pain

    Pharmacist's Evolving Role

    • Hospital pharmaceutical services aim to ensure the preparation, assembly, efficient procurement, and safe storage and distribution of quality medicines, facilitating safe and efficient medicine use.
    • Pharmacists are integral to the multidisciplinary team managing pain, possessing knowledge of medicines, interactions and appropriate therapies, offering advice and support.

    Summary

    • Pain classification is essential, with consideration of acute/chronic, cancer/non-cancer, nociceptive/neuropathic types.
    • Pharmacists are crucial members of the pain management team.
    • Treatment varies depending on the type of pain.

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    Clinical 01 - Pain Classification PDF

    Description

    This quiz covers various aspects of pain, including its classification into acute and chronic types. Key features and underlying mechanisms of different pain types will be explored, alongside the role of pharmacists in managing pain. Learn about both pharmacological and non-pharmacological treatment options.

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