Pain Management in Adult Patients

The Pathophysiology of Pain

The Psychology of Pain

Analgesic Agents and Mechanism of Action

Pain Assessment Tools

9 Topics

Verbal Descriptor Tools

Numerical and Combined Rating Scales

The Verbal Numerical Rating Scale

The Combined Verbal and Numerical Rating Scale

Why Use a Pain Scale?

Which Scale Should I Use?

Making a Difference to Your Patients

Pain Assessment Tools in Practice

Properties of Typical Analgesic Agents Used in the ED

3 Topics

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Appropriate Strategies for Addressing Patients’ Pain – Clinical Cases

3 Topics

Musculoskeletal Pain – Clinical Case

Chest Pain – Clinical Case

Abdominal Pain – Clinical Case

Other Painful Presentations

Modifying Analgesic Treatment for Special Patient Groups

5 Topics

Difficult communication with patients

The Unconscious patient

Patients with chronic pain

Patients who routinely use illicit drugs

Pain Management in Adult Patients

Pain Management in Adult Patients

Pain Management in Adult Patients Pain Management in Adult Patients

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Question 1 of 10

1. Question
1 point(s)
Which one of the following statements regarding the pathophysiology and psychology of pain is correct?
- Prostaglandins sensitise pain receptors
- Hypnosis inhibits the transmission of nerve impulses
- Visceral pain pathways allow better localisation of pain than musculoskeletal and dermal pathways
- ketamine has it’s primary effect on opioid receptors’
Question 2 of 10

2. Question
1 point(s)
Which one of the following statements regarding pain assessment is correct?
- Changes in intensity of pain are not easily identified with verbal descriptor scales
- Facial expression scales are generally preferred
- A reduction in pain score of more than 7 mm on a visual analogue scale achieves clinical significance
- Numerical rather than verbal rating scales are more suitable for the elderly
Question 3 of 10

3. Question
1 point(s)
Which one of the following statements regarding opiates is correct?
- Tramadol enjoys a much better safety profile than other opiates, notably less risk of respiratory depression
- Intravenous fentanyl provides analgesia for 60 minutes
- Codeine will have virtually no analgesic effect in one in twenty Caucasians
- Codeine 60 mg four times a day has equivalent analgesic effects to paracetamol 1 g four times a day and to ibuprofen 400 mg three times a day
Question 4 of 10

4. Question
1 point(s)
Which one of the following statements about non-opiate analgesics is correct?
- The adverse effects of NSAIDs include both renal impairment and inhibition of platelet function
- Paracetamol should be avoided in patients with known liver disease
- Intravenous paracetamol has better analgesic properties than either oral or rectal paracetamol in equivalent doses
- Diclofenac has better analgesic efficacy than ibuprofen
Question 5 of 10

5. Question
1 point(s)
A 24-year-old rugby player presents to the emergency department (ED) with a closed, likely midshaft fracture of his right femur. He is splinted and using entonox.

Which one of the following statements regarding his management is false?
- Prophylactic anti-emetics are indicated to prevent opiate induced nausea and vomiting
- The College recommends 9-18 mg of morphine initially, if he weighs 90 kg
- Regional anaesthesia is indicated if an x-ray confirms the fracture
- NSAIDs should be avoided if open reduction and internal fixation is planned
Question 6 of 10

6. Question
1 point(s)
A 55-year-old male presents with typical symptoms suggestive of acute ischaemic chest pain.

Which one of the following statements regarding his analgesic treatment is false?
- His nitrate infusion should be stopped if his systolic blood pressure drops >20 mmHg
- A 50 mg/50 ml nitrate infusion running at 2 ml/h will take 12 min to deliver the same amount of drug as a 400 μg sublingual spray
- Nitrates are contraindicated if he is known to have aortic stenosis
- He should be given intravenous benzodiazepines if he has used cocaine within the last few hours
Question 7 of 10

7. Question
1 point(s)
Which one of the following statements is correct?
- NSAIDs and parental opiates are equally potent in the treatment of renal colic
- Opiates mask the signs and symptoms of abdominal pathology and should be withheld until the diagnosis is established
- Morphine should be avoided in acute pancreatitis
- Parenteral opiates are superior to NSAIDs in biliary colic
Question 8 of 10

8. Question
1 point(s)
One of the following analgesic agents has no proven value for the respective condition. Which one?
- Opiates for acute migraine
- High-flow oxygen for cluster headaches
- Peppermint oil in irritable bowel syndrome
- Calcitonin for vertebral fractures secondary to osteoporosis
Question 9 of 10

9. Question
1 point(s)
Which one of the following statements regarding analgesic prescription in the elderly is false?
- An initial bolus of 0.05 mg/kg of morphine is recommended in octogenarians in severe pain
- Significant inter-patient variability in response to opiates persists in old age
- NSAIDs should be avoided
- Paracetamol is the non-opiate of choice
Question 10 of 10

10. Question
1 point(s)
Which one of the following general statements on analgesia in special patient groups is false?
- Intravenous opiates should be withheld in intravenous drug users in acute pain, since the response is unreliable
- There should be no ceiling to intravenous morphine prescription for those palliative care patients presenting to ED routinely taking oral morphine
- Patients with dementia are just as likely to perceive pain as those without
- Intubated patients on propofol infusions require opiates for painful pathologies

6 Comments

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shajeerk5062 April 4, 2018 at 11:43 am

Brilliant module. I am using it for my mursing education.

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Dr. Sanjay Kumar December 23, 2020 at 9:58 pm

Very informative session

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Dr. Sameer Dulal January 5, 2021 at 5:12 pm

very helpful,loved the pathophysiology description

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Dr Abdelrahman Samy Mohammed October 25, 2023 at 8:15 pm

I very much appreciate some of the cheeky language used in this module! rather refreshing

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Dr Visvakumaran Reddy February 5, 2024 at 4:36 pm

Excellent teaching

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Dr Fady Issa Hussain Dahalan September 7, 2024 at 11:27 pm

a well presented module

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