3rd hour of pain day

Question 1

Reflexive pain vs. conscious pain

Answer 1

RP: occurs at level of spinal cord, maybe thalamus;
CP: (semi)conscious pain occurs at level of limbic system and cortex (think ACC with vigilance for where next pain stimulus comes from; OFC and VMPFC for impulse prevention and assigning emotional valience; also hippocampus as part of limbic system to ask who’s going to hurt me next. Also think hypothalamus and thalamus!!)

Question 2

Nonaddictive interventions for the pain:

Answer 2

Exercise/PT to start; NSAIDs and acetaminophen if inflammatory;
low-dose tricyclics; antidepressants and anticonvulsants for non-inflamm;
he mentioned acupuncture as a way to perhaps even activate the opioid system

Question 3

What happens with those put on opioids before surgery as opposed to those who weren’t?

Answer 3

1. With exposure to opioids, these people were hyperalgesic and did not have a large difference in pain before and after
2. If opioid NAIVE, they will be more effective in reducing pain