12. Chronic Pain

Question 1

Difference between neuropathy, neuralgia, and neuritis

Answer 1

Neuropathy= Pain resulting from systemic disease

Neuralgia= Pain arising from Nervous system in response to non-painful stimuli

Neuritis= Pain from irritative non-neural disease

Question 2

Examples of neuralgia, nueropathy and neuritis

Answer 2

Neuralgi= TN, MS, Vagoglossopharyngeal
Neuropathy= DM, Lupus, burning mouth (nutritional def.)
Neuritis=Odontogenic, post trauma, etc

Question 3

What are the two types of Receptors responsible for activation of pain pathways

Answer 3

-EAA and tachykinin

Question 4

EAA and Tachykinin neurotransmitters are

Answer 4

EAA= aspartate and glutamate 
Tachykinins= Substance P and neurokinin

Question 5

What are the two different kinds of EAA receptors

Answer 5

AMPA and NMDA

Question 6

Describe the difference between AMPA and NMDA

Answer 6

AMPA

• First pain
• Responds to low level release of glutamate
• Rapid and transient

NMA

• Second pain
• Response is delayed and prolonged due to aspartate release
• Delayed and prolonged

Question 7

Antagonists of EAA receptors

Answer 7

Opioids

Question 8

Antagonists of Tachykinin receptors

Answer 8

• Opioids
• Alpha 1 antagonists
• Alpha 2 agonist (cloniidine)
• TCA
• GABAB agonist (baclofen)

Question 9

Side effects of long term NSAID use

Answer 9

• Gastric upset .
• Ulcers
• Blood dyscrasias (platelet inhibition)
• Potential teratogen

Question 10

MOA of corticosteroids

Answer 10

Inhibition of Phopholipase A (decreases inflammation)

Question 11

Uses for corticosteroids

Answer 11

• painful RA

- Nerve injury (adjuvant therapy)

Question 12

Side effects of long term corticosteroid use

Answer 12

• Impaired wound healing and immunity
• Adrenal suppression
• Gastric irritation
• Hyperglycemia

Question 13

MOA of Capsaicin

Answer 13

• Depletion of substance P

- Anti-inflammatory

Question 14

Uses of capsaicin

Answer 14

• Poster herpetic neuralgia

- Osteoarthritis (painful)

Question 15

Action of baclofen

Answer 15

GABAB agonist –> analgesia

Question 16

Uses of baclofen

Answer 16

Neuropathic pain (TN, myofascial pain)

Question 17

(more/less) abuse of baclofen compared to benzons

Answer 17

-less abuse than benzo

Question 18

Uses of benzons

Answer 18

neuropathic pain (myofascial pain)

Question 19

Side effects of benzons

Answer 19

• Dependence
• Withdrawl
• Teratogen

Question 20

MOA of opioids (

Answer 20

Bind kapa receptors

Question 21

Use of opiods

Answer 21

chronic pain

Question 22

Side effects of opiods

Answer 22

• Abuse/dependence

- Sub-optimal pain control with recommended doses

Question 23

MOS of TCA

Answer 23

inhibition of serotonin reuptake –> modulation of descending pain pathways

Question 24

Uses of TCAs

Answer 24

Neuropathig pain (poster herpetic neuralgia, burning mouth, myofascial pain)

Question 25

Side effects of TCA use

Answer 25

-Anti-cholinergic effects (i.e dry mouth)

Question 26

Example of an alpha 1 antagonist is

Answer 26

guanethidine

Question 27

Alpha 1 antagonist (increases/decreases) SNS activity Alpha 2 agonist

Answer 27

both decrease

Question 28

Alpha 1 antagonist and Alpha 2 agonist used to treat

Answer 28

sympathetically mediated pain

Question 29

Side effects of alpha 1 antagonists and alpha 2 agonists

Answer 29

-postural hypotension

Question 30

Phenytoin is what class of drug

Answer 30

anticonvulsant

Question 31

anticonvulsants are used to treat

Answer 31

neuralgias (conditions that result from damage to the nervous system)

Question 32

Side effects of anti-convulsants used to treat neuralgias

Answer 32

Phenytoin= gingival hyperplasia | -Both result in ataxia, blood dyscrasia (i.e anemia and leukopenia)

Question 33

Pregabalin is what drug classification

Answer 33

anti-convulsant

Question 34

Pregabalin is similar to

Answer 34

gabapentin

Question 35

Gabapentin is what class of drug

Answer 35

anti-convulsant

Question 36

MOA of gabapentin

Answer 36

unknown- it is a gaba analog but doesn't act on GABA receptor

Question 37

Uses of gabapentin

Answer 37

TN

Question 38

Side effects of gabapentin

Answer 38

ataxia, blood dyscrasia (leukopenia) , dizziness, same as other anti-convulsants

Question 39

Uses of pregabalin

Answer 39

- Post herpetic neuralgia | - TN

Question 40

Caution for pregabalin should be taken due to

Answer 40

life-threatening angioedema

Question 41

Nerve blocks are used to treat

Answer 41

-myofascial pain, neurogenic pain

Question 42

Sider effects with long term use of nerve block

Answer 42

- tissue trauma - Scarring - Infection