Clinical Demonstration: Pain Patient
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What does SOCRATES stand for?
• Site • Onset • Character • Radiation • Associated symptoms • Time • Exarcebating/Alleviating factors • Severity
What can cause a headache?
• Tension • Glaucoma • Meningitis / Encephalitis • Cluster headaches • Trigeminal neuralgia • Medication misuse • Subarachnoid haemorrhage • Tooth ache • Migraine • Giant cell arteritis
What are some causes of muscular pain?
• Injury • Posture • Rheumatological (polymyositis, dermatomyositis) • Fibromyalgia (diffuse muscular pain over body) • Infections • Rhabdomyolysis • Nutritional deficiency
What causes joint pain and helps alleviate it?
• Arthritis (osteo, rheumatoid, injury) • Topical agents (NSAIDs, menthold, capsaicin) • Glucosamine, chondroitin • Steroid injections • DMARDs
What is consequential regarding back pain?
• Very common • Big contributor to loss of earnings • Affects ADLs • Depression, anxiety Can be a RED FLAG
What can help alleviate back pain?
• Non-pharmalogical (physio, heat/ice packs, acupuncture) • NSAIDs • Neuropathic agents • Surgery
What are treatments for fractures?
• Oral - simple, opiates • Nerve blocks - anaesthetic directly into nerves • Transdermal patches • Prevention
What is the cause of visceral pain?
• Inflammation • Ischemic • Thrombo-embolic • Blockage • Compression
What class of drug is amitriptyline?
TCA - tricyclic antidepressents
What class of drugs are gabapentin and pregabalin?
Anti-epileptic
What is the WHO cancer pain ladder?
The different lines of action on treating pain. • Non-opioid (eg. paracetamol) + adjuvant • Opioid (mild-moderate pain) (tramadol, codeine)* • Opioid (moderate-severe) (morphine)* *+/- non-opioid, +/- adjuvent
What is patient controlled analgesia (PCA)?
PCA – gives an opiate every time patient presses button, has a lock-out time so can’t keep pressing – prevents overdose. Works well in short-term post-op period. Patient has to be able to use it
Why is post-operative pain management useful?
• Early mobilisation • allows for better breathing to prevent chest infection • Helps to identify complications