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ANESTHESIA > 7 – Pharmacology of Pain Transmission & Modulation > Flashcards

7 – Pharmacology of Pain Transmission & Modulation Flashcards

1
Q

Pain experience comprises

A
  1. Detection of tissue injury by the NS (NOCICEPTION)
  2. CONSCIOUS perception of pain (noxious stimuli)
  3. Behavioural responses or changes which occur to protect the individual from further discomfort
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2
Q

If pain goes untreated

A
  • Goes from acute pain (symptom of a disease) to CHRONIC pain (DISEASE itself)
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3
Q

Sympathetic simulation consequence if don’t treat pain

A
  • Tachycardia
  • Peripheral vasoconstriction
  • Increased myocardial work
  • Increased myocardial O2 consumption
  • Decreased blood flow to abdominal organs
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4
Q

Neuroendocrine consequences if don’t treat pain

A
  • Increased cortisol
  • Increased NE + E
  • Decreased insulin
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5
Q

Stress if don’t treat pain

A
  • Decrease appetite
  • Insomnia
  • Immunosuppression
  • Decreased quality of life
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6
Q

Categories of patients (4)

A
  • Healthy, non-painful
  • Healthy, underly orthopedic issue
  • Chronic condition resulting in mild discomfort
  • Undergone some trauma in recent past
    **at some point they will require anesthesia and surgery
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7
Q

Role of anesthesia: triad

A
  1. Analgesia
  2. Muscle relaxation
  3. LOSS of consciousness
    **if do correctly=wont think it is painful
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8
Q

How does our patient being anesthetized affect the PAIN RESPONSE to injury?

A
  • Not necessarily perceiving the stimulus as ‘pain’
  • Pain pathways are still firing (nociception vs. pain!)
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9
Q

Pain pathways

A
  1. Transduction
  2. Transmission
  3. Modulation (CNS)
  4. Perception (CNS)
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10
Q

If pain goes untreated, ‘steps’

A
  • Peripheral sensitization
  • Central sensitization
  • Hyperalgesia (primary and secondary)
  • Allodynia (non-painful stimulus but get a painful response)
  • Wind-up pain
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11
Q

Techniques to treat and reduce pain

A
  1. Pre-emptive analgesia
  2. Multimodal analgesia
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12
Q

Pre-emptive analgesia

A
  • 1st key strategy when pain is anticipated
  • Providing analgesia BEFORE insult can significantly reduce both intra- and post-operative analgesia requirements
  • *prevents sensitization and wind-up
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13
Q

Multimodal analgesia

A
  • Combines analgesics from 2 or more drug classes or analgesic techniques
    o Target different pain pathways
  • *synergistic effect at LOWER analgesic doses
  • **often side effects are dose dependent)
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14
Q

Mild level of pain examples

A
  • Minor dental procedure
  • Minor laceration repair
  • Cystitis
  • mild otitis
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15
Q

Moderate level of pain examples

A
  • Ovariohysterectomy
  • Uncomplicated laparotomy
  • Urethral obstruction
  • Localized burn
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16
Q

Severe level of pain examples

A
  • Fracture repair
  • Limp amputation
  • Total ear canal ablation
  • Necrotizing pancreatitis
  • Localized/extensive burn
17
Q

Local anesthetics

A
  • Inhibits sodium channels
  • Provide complete pain relief at the effected nerve site
18
Q

Opioids

A
  • Decrease pain perception, anxiety and distress
  • Most effective when given BEFORE pain onset
  • Rapid onset (IV administration), long duration (IM administration)
  • *depends on route and lipophilicity of drug
19
Q

Alpha 2 agonists provide

A
  • Sedation
  • Analgesia
  • Anxiolysis (decrease anxiety and stress)
20
Q

Alpha 2 agonists examples

A
  • Dexmedetomidine (Domitor)
  • Xylazine (Rompun)
21
Q

Alpha 2 agonists effect

A
  • Modulation of perception, central sensitization, and impulse conduction
22
Q

N-methyl-D-aspartate (NMDA) antagonists

A
  • Analgesic properties
  • Important when addressing ‘wind-up’ pain
  • NMDA receptors important in development of central sensitization
  • Low dose=improve opioid efficacy
  • Excitatory effects in the CNS (usually use with sedation)
  • Stimulatory effects on cardiovascular
23
Q

NMDA example

A
  • Ketamine
    o Need to make sure the heart is functioning
24
Q

NSAIDs

A
  • Analgesic
  • Antipyretic
  • Anti-inflammatory
  • Prevent sensitization
25
Q

NSAIDs effect on

A
  • Modulation of spinal pathway
  • transduction
26
Q

Treating pain: mild postoperative pain

A
  • Non-opioid analgesics
    o NSAIDs +
    o local anesthetic infiltration
27
Q

Treating pain: moderate postoperative pain

A
  • NSAIDs +
  • local anesthetic infiltration +
  • intermittent doses of OPIOIDS
28
Q

Treating pain: severe postoperative pain

A
  • NSAIDs +
  • Local anesthetic peripheral neural blockage (with or without catheter) +
  • Use of sustained release of OPIOIDS +/-
  • NMDA antagonist (KETAMINE) +/-
  • Ancillary pain management techniques
29
Q

Ancillary pain management techniques (2)

A
  • Manipulative therapies
  • Alternative therapies
30
Q

Manipulative therapies

A
  • Temperature: application of heat (improve circulation) or cold (decrease inflammation)
31
Q

Ancillary techniques

A
  • Acupuncture
  • Laser therapy

ANESTHESIA (18 decks)

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