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Neurology Week 5 2018/19 > 2: Pain management > Flashcards

2: Pain management Flashcards

1
Q

What is pain?

A

Unpleasant sensory or emotional experience

Associated with actual tissue damage OR described in terms of it

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2
Q

Different individuals have different ___ to pain.

A

sensitivities

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3
Q

What is the function of pain?

A

Protective

Stops you from exposing yourself to dangerous stimuli

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4
Q

When does acute pain resolve?

A

Once healing has occurred

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5
Q

Chronic pain is (adaptive / maladaptive).

A

maladaptive

i.e there’s no point to it

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6
Q

How is pain measured?

Why is this problematic?

A

Scales / ratings

Pain is subjective, different people have different sensitivities

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7
Q

What are physiological responses to pain?

A

Hypertension

Tachycardia

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8
Q

___ and ___ are physiological responses to pain.

(brady/tachycardia, hypo/hypertension)

A

Tachycardia

Hypertension

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9
Q

Patients must be allowed to ___-___ the severity of their pain.

A

self-report

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10
Q

Which brain structures receive nociceptive signals?

A

Amygdala

Hypothalamus

Thalamus

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11
Q

Which brain structures are responsible for

a) attention
b) sensation

in response to nociceptive signals?

A

a) Amygdala and hypothalamus
b) Thalamus (spinothalamic tract, to post-central gyrus i.e sensory strip)

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12
Q

What is nociceptive pain?

A

Appropriate response to painful stimuli by an intact nervous system

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13
Q

What is neuropathic pain?

A

Inappropriate response to stimuli by a dysfunctional nervous system

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14
Q

What history should you take from anyone complaining of pain?

A

SOCRATES

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15
Q

Allodynia and hyperalgesia are types of neuropathic pain.

What do these words mean?

A

Allodynia - pain in response to non-painful stimuli e.g cotton wool

Hyperalgesia - exaggerated pain in response to a painful stimulus e.g pin prick

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16
Q

What is a chronic pain condition often seen after shingles?

A

Post-herpetic neuralgia

17
Q

What is a chronic pain condition sometimes seen after back surgery?

A

Failed back syndrome

18
Q

Which endocrine disease causes peripheral neuropathy, of which chronic pain can be a symptom?

A

Diabetes

19
Q

What is phantom pain?

A

Chronic pain in amputees, felt where the limb should be

20
Q

Which pathway should be used when managing pain conditions?

A

WHO pain ladder

21
Q

What are some examples of non-opioid drugs used to manage low grade pain?

A

Aspirin, Ibuprofen, Naproxen, Diclofenac (i.e NSAIDs, which act on cycloxygenase 1, lots of side effects)

Paracetamol

22
Q

Name three examples of NSAIDs.

Which enzyme do they inhibit?

Which inflammatory mediator does this action affect?

A

Aspirin, ibuprofen, diclofenac, naproxen, indomethacin

COX (cyclo-oxygenase 1 or 2, depends on the drug)

Prostaglandin (so NSAIDs dampen down inflammation)

23
Q

What are some of the side-effects of NSAIDs?

A

Peptic ulceration

Renal toxicity

(COX-2 inhibitors, -coxibs, have cardiovascular side effects)

24
Q

What is an important side effect of paracetamol?

A

Hepatotoxicity

ESPECIALLY with alcohol

25
Q

What are some examples of weak opioids used to treat pain?

A

Co-codamol

Tramadol

26
Q

What are some examples of strong opioids?

A

Morphine

Oxycodone

27
Q

What are some opioid side-effects?

A

N&V

Constipation

Sedation

28
Q

What are some adjuvant drugs which can be used to treat chronic pain?

A

Anti-depressants (amitriptyline, duloxetine)

Anti-convulsants (carbamazepine, gabapentin, pregabalin)

29
Q

Name a

a) tricyclic antidepressant
b) anticonvulsant
c) selective serotonin reuptake inhibitor (antidepressant)

which can be used as an adjuvant analgesic?

A

a) Amitriptyline

b) Carbamazepine, gabapentin, pregabalin

c) Duloxetine

30
Q

Which analgesics can be applied topically and don’t affect the brain itself?

A

NSAIDs

Capsaicin

Lidocaine (local anaesthetic)

31
Q

Apart from drugs, what therapies exist for chronic pain?

A

Complimentary therapy e.g reiki, acupuncture, massage, mindfulness

Physiotherapy

Occupational therapy

32
Q

What is TENS?

A

Transcutaneous electrical nerve stimulation

33
Q

What is intrathecal drug delivery?

A

Delivery of drugs directly into the spinal cord

Neurology Week 5 2018/19 (11 decks)

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