Term
| What is an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage that is described in terms of such damage . |
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Definition
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Term
True or false:
Tissue damage must occur to experience pain. |
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Definition
False
Tissue damage does not have to occur |
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Term
True or false:
60-80% of subjects entering the medical system motivated by pain |
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Definition
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Term
True or false:
One third of US population will be treated for a chronic pain during life |
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Definition
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Term
True or false:
Professionals have adequate training in evaluation and treatment of pain. |
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Definition
false
minimal training for professionals in evaluation and treatment |
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Term
| What are the different classifications of pain? |
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Definition
Anatomic (where it's coming from)
Etiologic (why it's coming from there)
Qualitative
Temporal (Acute or Chronic) |
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Term
| What type of pain is short-acting, disease process or event specific? |
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Definition
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Term
True or false
Acute pain will only resolve with treatment |
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Definition
False
would resolve even if no treatment due to healing |
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Term
| What is the type of pain that persists longer than it is supposed to or recurrent? |
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Definition
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Term
True or false:
Chronic pain is pain often without precisely define etiology so are difficult to treat |
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Definition
True
Can't put a put a name on the pain |
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Term
| What are the 3 treatment-related chronic pain classifications? |
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Definition
Nociceptive (tissue damage)
Neuropathic (neuro injury)
Mixed |
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Term
Which pains respond to treatments with traditional analgesics?
Nociceptive
Neuropathic
Mixed
All of the above |
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Definition
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Term
| Which pains respond to treatments best with "adjuvant" analgesics? |
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Definition
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Term
| What type of pain is the pain of neuroanatomy textbooks/the pain we understand the most? |
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Definition
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Term
| In nociceptive pain, _____ and _____ nerve fibers are activated by thermal, chemical, and mechanical stimuli. |
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Definition
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Term
| What type of pain is associated with actual or potential tissue damage of non-neural structures (has a definable pathology but symptoms may be out of proportion to it) |
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Definition
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Term
| What are the (4) evidence of ongoing tissue damage (nociceptive)/inflammation? |
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Definition
redness
swelling
warmth
vascular changes |
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Term
| What are the ways to find evidence for nociceptive pain? |
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Definition
look for inflammation
physical exam to look for focal tenderness
imaging of tissue destruction
Laboratory (histologic)
For deep pains important to consider visceral, myofascial, and articular |
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Term
In nociceptive pain, what increases your HR and BP?
What increases during the stress response? |
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Definition
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Term
What is NOT a response to nociceptive pain?
Increased catecholamines (HR, BP)
Decreased cortisol
Increased respiratory
Autonomic effects
Aversion and distress |
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Definition
decreased cortisol
Will increase cortisol (stress response) |
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Term
| What type of pain is due to injury of neural structures anywhere along the "pain pathway" |
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Definition
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Term
True or false:
Neuropathic pain may be immediate or delayed |
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Definition
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Term
True or false:
Neuropathic pain may appear bizarre. |
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Definition
True (more emotional)
Pain appears way out of proportion to the pathology since no defined local pathology |
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Term
| What is the only effect of neuropathic pain that is reliable? |
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Definition
psychological effects
May not have increased catecholamines
May have decreased cortisol
Unreliable respiratory effects
Unpredictable autonomic effects |
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Term
What is the term call when something that shouldn't be producing pain is producing pain?
What is it called hone something that produces a little pain is producing a lot of pain? |
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Definition
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Term
Clinical Manifestations of Neuropathic Pain Disorders:
-Often _______ dysfunction
-Sometimes ______ changes
-Occasional _____ impairment
-Signs of _____ dysfunction |
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Definition
Often autonomic dysfunction
Sometimes trophic changes
Occasional motor impairment
Signs of neural dysfunction |
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Term
| What are the different neuropathic pain types? |
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Definition
Compressive
Inflammatory
Deafferentation-type
Central injury
Sympathetic nervous system |
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Term
True or false:
Most neuropathic pains is consistent. |
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Definition
False
Most neuropathic pains consist of a series of peaks and valleys of pain |
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Term
| What things do we look for in a patient's history when diagnosis neuropathic pain? |
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Definition
Etiological factors suggestive of nerve injury (diabetes, shingles, chemo, etc)
Spontaneous nature to pain
Atypical stimulus relationship
Activity-related onset (repetitive motion, disc herniation) |
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Term
| What are the abnormal functional neurophysiological studies to test for neuropathic pain? |
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Definition
Nerve conduction velocity
Electromyogram
Sympathetic function (GSR)-test sweat glands |
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Term
| Do we know what causes neuropathic pain? |
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Definition
| No (just know changes in the our system that is coding for pain) |
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Term
| When a person comes in with acute pain, do we assume it nociceptive or neuropathic? |
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Definition
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Term
| How do we treat acute pain? |
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Definition
| traditional analgesics BUT really just give it time and primary etiology treatment |
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Term
| When a person comes in with can we assume it is nociceptive? |
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Definition
| no (because it didn't get better) |
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Term
| What are the differences (4) in opioids? |
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Definition
Differences in potency
Differences in route
Differences in duration
Differences in side effect profiles |
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Term
| Most opioids are ____ opioid receptor agonists and have identical efficacy (if you give enough, they all get to the same point). |
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Definition
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Term
| What are the 3 opioid receptors in our body? |
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Definition
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Term
Isolated _____ opioid receptor agonists have lesser efficacy.
_____ opioid receptor agonists have uncertain effects without mu ovoid receptor agonists. |
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Definition
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Term
True or false:
Mixed agonists-antagonists have greater efficacy |
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Definition
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Term
| Where are the opioid sites of action? |
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Definition
everywhere along the pain pathway
Supra spinal
Spinal (Primary afferent terminals, Dorsal horn neurons)
Peripheral |
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Term
| What are the two types of anti-inflammatory analgesics? |
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Definition
|
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Term
cyclo-oxygenase inhibitors are steroidal or non-steroidal?
What does cyclooxygenase make? |
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Definition
non-steroidal
prostaglandins (help renal blood flow, maintain stomach lining, sensitize nerve ending that create redness, swelling, and pain) |
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Term
| What type of non steroidal analgesic is selective to not hurting our "good" prostaglandins? |
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Definition
| Cyclo-oxygenase 2 selective inhibitors |
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Term
| Are steroidal or non steroidal typically used for chronic pain? |
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Definition
| steroid (corticosteroids) |
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Term
| Glucocorticoids are normally made by what glands? |
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Definition
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Term
| Hormone-GR binding results in immediate release of ___________. |
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Definition
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Term
When a glucocorticoid-receptor complex gets into DNA and alter gene transcription to activate things that is called _________?
When the activated glucocorticoid-receptor blocks binding of NF-alpha/beta or AP-1 linked cytokine responses that is called ________? |
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Definition
transactivation
transrepression |
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Term
| What are the forms of steroids given? |
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Definition
oral forms -topical forms
Parenteral forms
-non-particulate (soluble forms)
-particulate (depot forms) |
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Term
True or false:
Clinically used steroids have greater effects at mineralocorticoid receptors and lesser effects on glucocorticoid receptors. |
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Definition
False
Clinically used ones have lesser effects at mineralocorticoid receptors and lots of effects on glucocorticoid receptors. |
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Term
True or false:
The realistic goal of neuropathic pain medications is not zero pain, but to make the peaks lower and farther apart |
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Definition
True
(we would have to give general anesthesia to get to zero pain, we're doing neuromodulation, not neurosuppresion) |
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Term
What is NOT a drug usually use to treat neuropathic pain?
Antidepressants
Anticonvulsants
Anti-arrhythmics
Topicals
Pain medication |
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Definition
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Term
True or false:
All antidepressants are effective for neuropathic pain |
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Definition
False
classic antidepressants(tricyclic) may work but huge side effects, newer antidepressants (SSRIs) may not have any analgesic effect and just works on depression |
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Term
Of the following antidepressants used for pain, which one is the most preferred to prescribe?
tricyclic antidepressants
SSRIs
SNRIs |
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Definition
| SNRIs - works like tricyclic but not as much side effects-FDA happy |
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Term
What two anti-convulsant drugs are used for pain because they're clean drugs (No protein binding, No enzyme induction)?
What is their mode of action? |
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Definition
Pregabalin and Gabapentin (Differences in potency, binding affinity & penetration of CNS)
Calcium channel blockers (not GABA) |
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Term
What type of neuropathy drug is a sodium channel blocker?
What is wrong with some of these drugs? |
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Definition
Anti-arrhythmics
some are pro-arrhythmogenic (may suppress funny heart rhythms but may also create new ones) |
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Term
| A patient with pain in his knee associated with movement, full sensation, local redness and swelling. What type of medication would you prescribe him? |
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Definition
| anti-inflammatory and opioids (nociceptive) |
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