Term
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Definition
| an unpleasant sensory & emotional experience associated with actual or potential tissue damage |
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Term
| Variable link between pain and injury |
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Definition
severity of injury != degree of pain
location of pain != site of injury
time course of pain != time course of injury |
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Term
| Emotional component of Pain |
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Definition
Past experiences
Suggestion (e.g. placebo)
Emotional state (particularly fear and anxiety)
Simultaneous activation of other sensory modalities |
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Term
| Temporal descriptions of Pain |
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Definition
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Term
| Neurobiological descriptions of Pain |
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Definition
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Term
| Spatial descriptions of Pain |
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Definition
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Term
| Physiological pain experience |
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Definition
Pain proportional to intensity of noxious stimulus
Protects against further injury |
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Term
| Pathological pain experience |
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Definition
Pain greater than apparent noxious stimulus
Detrimental
For example: phantom limb pain |
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Term
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Definition
NOCICEPTOR: Generates an action potential (transduction)
AFFERENT FIBRE: Conducts action potential to CNS (transmission)
SPINAL CORD: Processing occurs at the level of the dorsal horn (modulation)
BRAIN: Conscious experience of pain |
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Term
| Major Brain Areas related to nociception |
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Definition
Primary and secondary sensory cortex
Thalamus
Midbrain
Pons
Brainstem |
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Term
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Definition
| detection of noxious stimuli that actually or potentially cause damage to an organism |
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Term
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Definition
| An increased response to a stimulus which is normally painful |
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Term
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Definition
| Pain due to a stimulus which does not normally provoke pain |
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Term
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Definition
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Term
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Definition
Over activity of second-order neurons in the dorsal horn leads to enhanced pain transmission
Associated with changes within and between neurons
Can be transitory or permanent |
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Term
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Definition
| an absence of pain or a reduction in intensity of pain perceived |
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Term
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Definition
Local anaesthetics
Opioids
Non-steroidal anti-inflammatory drugs
2-adrenoceptor agonists
Miscellaneous (Ketamine, Nitrous oxide) |
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Term
| Non-pharmacological Analgesia |
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Definition
Nursing care
Physiotherapy
Acupuncture
Transcutaneous electrical nerve stimulation (TENS) |
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Term
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Definition
Brain - Sensory cortex e.g. opioids interfere with central conscious perception of pain
Spinal Cord - Dorsal horn e.g. opioids & 2-agonists modulate neurotransmission
Afferent fibre e.g. local anaesthetics inhibit transmission
Nociceptor e.g. NSAIDs reduce production of inflammatory mediators |
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Term
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Definition
| the administration of analgesic drugs throughout the peri-operative period to prevent or limit the development of sensitisation induced by pre-, intra- or post-operative noxious stimulation |
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Term
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Definition
| the use of a combination of drugs that act at different points in the nociceptive pathway, More effective analgesia. Fewer adverse effects |
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Term
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Definition
| relates to any substance (endogenous or synthetic) that produces morphine like effects that can be blocked by naloxone |
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Term
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Definition
| restricted to synthetic morphine like drugs with non-peptidic structure |
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Term
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Definition
| is an extract of the juice of the poppy Papaver Somniferum – contains many alkaloids related to morphine |
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Term
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Definition
Many endogenous peptides with opioid activity
3 families:
Enkephalins
Endorphins
Dynorphins |
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Term
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Definition
m (mu; Mu Opioid Peptide; MOReceptor)
k (kappa; KOP; KOR)
d (delta; DOP; DOR) |
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Term
| Opioid Mechanism of Action |
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Definition
Bind to opioid receptors in brain, spinal cord, periphery
All opioid receptors are GPCR
inhibit adenylate cyclase -> decrease cAMP
promote opening of K+ channels
inhibit opening of voltage gated Ca2+ channels
Leads to Decrease neuronal excitability and transmitter release |
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Term
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Definition
Analgesia/sedation: central and peripheral, acute and chronic
Euphoria
Nausea and vomiting (& defaecation): via chemoreceptor trigger zone, usually transient
Respiratory depression: decreased sensitivity of the respiratory centre to PCO2
Depression of cough reflex
Pupillary constriction
GIT Effects: inc. tone, decr. motility -> constipation |
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Term
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Definition
oral absorption is variable
considerable first pass metabolism
33% plasma protein bound (morphine)
t½ 3-6 hours
hepatic metabolism
usually conjugation by glucuronide
de-methylation e.g. pethidine
hydrolysis e.g. diamorphine morphine
excreted in urine and bile |
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Term
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Definition
To relieve pain (moderate / severe)
To provide sedation (alone or in combination with other drugs)
To reduce the dose of general anaesthetic required
To treat diarrhoea
To control coughing |
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Term
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Definition
Existing hypoventilation: with exceptions, e.g. fractured ribs where pain is inhibiting adequate respiration
Head injuries: many opioids increase intracranial pressure (due to increase in PCO2) |
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Term
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Definition
| morphine, pethidine, methadone, fentanyl, alfentanil, loperamide, codeine, dextro-propoxyphene, etorphine |
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Term
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Definition
| buprenorphine, butorphanol, nalbuphine |
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Term
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Definition
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Term
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Definition
| spaces outside/around the dura |
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Term
| subarachnoid anaesthesia definition |
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Definition
| in SUBARACHNOID space, space between the pia mater and arachnoid membrane |
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Term
| Drug Classes for Neuraxial anaesthesia |
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Definition
Local anaesthetics
Opioids
Alpha2 adrenoceptor agonists
Ketamine |
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Term
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Definition
| affect mood and behaviour |
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Term
| Psychotropic drugs classifications |
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Definition
Chemical structure
Biochemical target
Behavioural effect
Clinical use |
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Term
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Definition
Glutamate
Gamma-aminobutyric acid (GABA)
Glycine
Noradrenaline
5-HT (Serotonin)
Dopamine
Acetylcholine |
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Term
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Definition
Glutamate ‘NMDA’ receptor: Ketamine (General Anaesthetic/Analgesic)
GABAA receptor: Benzodiazepines (sedative, antiepileptic, anxiolytic)
Several general anaesthetics |
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Term
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Definition
Alpha2-adrenoceptor: Sedative/analgesic
Noradrenaline/5-HT (Serotonin) degradation/reuptake: Monoamine Oxidase Inhibitors, Tircyclic antidepressants, Selective serotonin reuptake inhibitors (SSRIs)
Dopamine D2 receptors: Sedative/tranquilisers, Antiemetic drugs |
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Term
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Definition
“Dissociative” Anaesthetic
interrupts the association between limbic and cortical regions
Mechanism: inhibits NMDA receptors by Receptor antagonist or Channel blockade |
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Term
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Definition
Sensory loss with analgesia
Increased muscle tone
Eyes open ± slow nystagmus
Active reflexes incl. laryngeal/ pharyngeal reflexes
Less profound CVS & respiratory depression |
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Term
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Definition
facilitate the opening of GABA activated chloride channels
BZP binding site is distinct from GABA-A site |
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