24 Questions
What influences the perception of pain experience at a certain point in pain processing?
Social and environmental cues, as well as cultural conditioning and past personal experiences
What should be restored first in patients with severe hypotension or decompensated shock before administering analgesia?
Circulatory volume
Which of the following is a neuroendocrine adverse effect of pain?
Poor wound healing
What is a potential consequence of administering analgesia to patients with severe hypotension or decompensated shock?
Blunted stress response
Which of the following is a psychological adverse effect of pain?
Anxiety
What is the primary goal of pre-hospital analgesia?
To hasten the relief of discomfort
What is a challenge in pain management, according to the text?
Lack of appropriate treatment options
Which of the following is a respiratory adverse effect of pain?
↓ lung volumes
What is the primary goal of combining analgesic drugs from different classes in a multimodal approach?
To maximize pain relief at lower analgesic doses
What is the primary function of inflammation in response to tissue damage or injury?
To destroy invading organisms or irritants
Which of the following is a mediator of the pain response involved in increasing the perception of pain?
Prostaglandins
What is the main advantage of using a multimodal approach to pain management?
It reduces the risk of adverse drug effects
Which pathway is involved in the production of prostacyclins?
Cyclo-oxygenase Pathway
What is the primary role of prostaglandins in the body?
To act as local signals to achieve different responses in different tissues
What is the main mechanism by which prostaglandins are inactivated in the body?
They are quickly changed from active to inactive products at the site of use
Which of the following is NOT a mediator of the pain response?
Immobilisation
What is the primary purpose of the Numeric Rating Scale in pain assessment?
To help assess the extent of an individual's pain and improve communication regarding pain with health care providers
What should be done if a patient exhibits evidence of sedation or other serious adverse effects after receiving analgesic medication?
Stop further administration of the medication
According to the latest Clinical Practice Guidelines, what pain scale should be considered for patients over 12 years old?
Self-report scale, such as the Numeric Rating Scale
What is a limitation of the Numeric Rating Scale in pain assessment?
It only evaluates one aspect of pain - intensity
What is an advantage of using the Numeric Rating Scale in pain assessment?
It can be administered verbally and in writing
What is the recommended course of action if a patient is still in significant pain after receiving analgesic medication?
Re-dose the medication at half the initial dose
What type of pain is Penthroxyflurane typically used to treat?
Moderate to severe pain, such as trauma or bone fractures
What is an important consideration when administering analgesic medication?
The timing of dosing in relation to medication half-life and onset of action
Study Notes
Pain Processing
- Perception of pain experience is influenced by social and environmental cues, as well as cultural conditioning and past personal experiences.
Adverse Effects of Pain
Neuroendocrine
- Activation of stress response
- Poor wound healing
- Impaired immune function
- Hyperglycaemia
- Weight loss / muscle wasting
Musculoskeletal
- Spasms
- Impaired muscle mobility and function
- Immobility
- Weakness
- Fatigue
Psychological
- Anxiety
- Fear
- Sleep deprivation
- PTSD
Cardiovascular
- ↑ heart rate
- ↑ blood pressure
- ↑ myocardial oxygen demand
- Hypercoagulation
- Unstable angina
- Myocardial infarction
- Deep vein thrombosis
- Pulmonary embolism
Respiratory
- ↓ lung volumes
- ↓ cough
- Splinting
- Pneumonia
- Hypoxaemia
- Atelectasis
Gastrointestinal
- ↓ bowel motility
- ↓ gastric emptying
- Constipation
- Anorexia
Pre-Hospital Analgesia
- Hastens the relief of discomfort rather than waiting for pain medication administration in EDs
- Historically only entonox and morphine have been available for pre-hospital pain management
- Many new additions such as Ketamine
Multimodal Approach
- Combines analgesic drugs from different classes and employs analgesic techniques that target different mechanisms of pain
- Inclusive of non-pharmacological therapy
- Its synergistic effect maximizes pain relief at lower analgesic doses
- Reduces the risk of adverse drug effects
Inflammation
- Protective function in response to tissue damage/injury
- Body uses inflammation to destroy invading organisms or irritants, remove toxins and start the process of tissue repair
- Sometimes this inflammation is not appropriate and can become harmful
Prostaglandins
- Huge mediator of the pain response
- Made by all tissues in very small quantities
- Act as local signals to achieve different responses in different tissues
- Two pathways to the production of these mediators:
- Cyclo-oxygenase Pathway
- Lipooxygenase Pathway
Pain Assessment
- Use an age-appropriate pain scale to assess pain
- Latest Clinical Practice Guidelines suggest:
- >12 years: Consider using a self-report scale, such as the Numeric Rating Scale
- Numeric Rating Scale:
- Preferred due to ease of use and high compliance
- Designed to help assess the extent of an individual's pain and improve communication regarding pain with health care providers
- Pros:
- Takes less than a minute to complete
- Takes less than a minute to administer and score
- The numeric scale allows it to be used internationally without translation difficulties
- Deemed valid and reliable for rating pain intensity
- Can be administered verbally and in writing, making it accessible for more people
- Cons:
- Only evaluates one aspect of pain - intensity
- Does not factor in past pain experiences
- Does not factor in fluctuations in pain
- Only evaluates pain experienced in the last 24 hours or "an average pain intensity"
Analgesic Agents
- Consider the timing of dosing in relation to medication half-life and onset of action
- Mild to moderate pain:
- Paracetamol (oral / IV)
- Acetyl salicylic acid
- Diclofenac
- Ibuprofen
- Moderate to severe pain:
- Penthroxyflurane (inhaled)
- Fentanyl (IV / IN)
- Morphine (IV)
- Ketamine (IV / IM / IN)
This quiz covers the psychological and environmental factors influencing pain perception, as well as the negative effects of pain on the body, including neuroendocrine and stress responses.
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