User:Bron766/Pain

Toolbox:
 * SOCRATES
 * Pain severity scales
 * 1-10 numerical scale
 * Visual analogue etc...
 * Assessment in children
 * Assessment in the elderly
 * Assessment in unconscious patients
 * Consequences of untreated pain


 * Position
 * Exercises
 * Heat / cold packs
 * Massage / rubbing
 * Alternative medicine ideas (and lack of evidence to support these), including accupuncture, laser...
 * Pain support groups (and evidence)
 * Cognitive behavioural therapy


 * Paracetamol
 * Dose and variation in children / elderly
 * Efficacy alone and in combination
 * Overdose
 * Routes - PO, IV vs PR (pharmacokinetics, cost etc)
 * Brands, combinations and formulations (e.g. extended release)
 * NSAIDs


 * Weak
 * Codeine
 * Tramadol
 * Buprenorphine
 * Strong
 * Morphine
 * Fentanyl
 * Oxycodone
 * Remifentanyl
 * Alfentanyl
 * Methadone
 * Pethidine


 * Antidepressants
 * Amitriptylline
 * Antiepileptics
 * Gabapentin
 * Anaesthetics (local/regional/systemic)
 * Lignocaine etc
 * Ketamine
 * EMLA

(peripheral, plexus, epidural, sympathetic blocks)
 * Steroids
 * Epidural / facet joint injections
 * Other
 * Clonidine, propranolol, baclofen
 * Capsaicin
 * Medical marijuana
 * Spinal cord stimulators
 * Intrathecal delivery
 * Transcutaneous electrical nerve stimulation

Treatment Principles
 * Assess pain severity
 * Multimodal
 * Individualised (including comorbidities)
 * Analgesic ladder
 * Opioid sparing
 * Paracetamol synergism
 * Patient-controlled analgesia

Choosing medications
 * Pharmacokinetics
 * Routes
 * Side effect profiles and interactions
 * Cost
 * Mechanisms of pain
 * Comorbidities e.g. Renal / hepatic failure (also age, pregnancy, children etc.)

Difficult analgesia case studies
 * Difficult analgesia

Areas of caution
 * Opioid tolerance, dependence and addiction
 * Recognise withdrawls
 * NSAID contraindications
 * Elderly dosing
 * Opioids for chronic back pain
 * Chronic pain syndromes (CRPS etc)
 * Combination medications
 * Brand name confusion
 * Opioid conversions
 * Interactions e.g. serotonin
 * Potency e.g. hydromorphone
 * Head injury and opioids (link to coroner's cases?)
 * Neuralgias
 * Phantom limb pain

Current issues
 * Ketamine - intranasal
 * Short acting fentanyl derivatives


 * Renal colic - paracetamol vs morphine?
 * Intranasal analgesia

Diagnose a cause
 * Anatomical subdivisions (but beware overlap):
 * Headache
 * Facial pain
 * Jaw pain
 * Neck pain
 * Chest pain
 * Abdominal pain
 * Pelvic pain
 * Back pain
 * Limb pain


 * Pathophysiological subdivisions
 * Inflammation / infection
 * Ischemia / infarction
 * Toxins / irritants
 * Thermal extremes - heat, cold
 * Rupture / trauma
 * Pressure
 * External compression
 * Obstruction (of a hollow viscus)
 * In the lumen
 * In the wall
 * Outside the wall
 * Neoplasia / Cancer (combination of the rest)

And/or subdivide by:
 * Acute pain
 * Chronic pain
 * Cyclical pain
 * Intermittent pain
 * Constant pain
 * Post-op pain
 * Neuropathic pain
 * Visceral pain
 * Parietal pain...
 * Dermatomal pain
 * Myotomal pain

etc...