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Principles of Anesthesia II - Fall 2024 > Acute Pain Basics - Exam 2 > Flashcards

Acute Pain Basics - Exam 2 Flashcards

1
Q

What are examples of superficial somatic pain?

A
  • skin
  • subQ tissue
  • mucous membranes
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2
Q

What are examples of Deep Somatic Pain?

A
  • muscles
  • tendons
  • joints
  • bones
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3
Q

What is Parietal Visceral pain?

A
  • pain localized to the area around the organ
  • ex: acute appendicitis pain
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4
Q

What is referred visceral pain?

A
  • cutaneous pain
  • comes from patterns of embryological development & migration of tissues
  • convergence of visceral & somatic afferent input to CNS
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5
Q

What are 4 goals of pain control?

A
  • pt comfort
  • attenuate adverse physiologic responses to pain
  • prevent chronic pain syndrome
  • control anxiety & agitation
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6
Q

What 2 main things can be done to reach the pain goals?

A
  • preemptive/preventative analgesia
  • multimodal approach (diff. receptors)
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7
Q

What are the 3 phases of pain?

A
  1. acute pain
  2. chronic nociceptive pain
  3. neuropathic pain (DM)

not exclusive

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8
Q

What are some examples of disease states that cause pain?

A
  1. Degenerative joint and disc disease
  2. spinal stenosis
  3. DM
  4. CVD
  5. osteoporosis
  6. cancer
  7. heart disease
  8. polymyalgia rheumatica
  9. wounds
  10. PAD
  11. end of life
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9
Q

What are 3 things that cause pain r/t immobility?

A
  1. loss of functional status (dementia, stroke, DJD, fx, amputation)
  2. neuropathy
  3. PVD (edema/pain)
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10
Q

What are 6 red flags of pain?

A
  1. new loss of bowel/bladder
  2. pain that wakes pt up
  3. immunosuppression (malignancy)
  4. severe/progressive neuro deficit
  5. cold, pale, mottled, cyanotic limb
  6. severe abd. pain/shock peritonitis
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11
Q

The Specificity theory states that pain has —-

Who proposed this theory?

A

its own pathway not involving any other senses

Rene Descartes (French philospher)

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12
Q

Who introduced the intensity theory of pain?

What does the theory state?

A
  • Plato

pain is an emotional experience not a sensory one

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13
Q

Who proposed the Gate Control Theory of Pain?

What is the idea of theory?

A
  • Ronald Melzack and Patric Wall (1965)

pain transmission is modulated by balance of impulses transmitted to spinal cord
* inhibitory interneurons in substantia gelatinosa & cells function as a gate
* regulating transmission of impulses to CNS

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14
Q

What is the physiologic pathway of pain?
1. initial insult:
2. activates:
3. releases:

A
  1. initial insult: thermal, mechanical, & chemical tissue damage
  2. activates: afferent nerve endings of myelinated a-delta and unmyelinated C fibers
  3. releases: histamine & inflamm. mediators
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15
Q

What are the nerve fibers involved in acute pain?

A
  • a-delta
  • C fibers
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16
Q

what are the inflammatory mediators released in response to pain?

A
  • peptides: bradykinin, substance P
  • lipids: PGs
  • neurotransmitters: serotonin, Ach
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17
Q

1st order neurons:

A

periphery to spinal cord
* tissue receptors of skin & proprioceptors (muscle, joints, tendons)
* synapse in spinal cord w/ 2nd order

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18
Q

2nd order neurons:

A

spinal cord to thalamus
* 1st order neurons in dorsal horn
* crosses to contralateral side of spinal cord
* ascends in spinothalamic tract

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19
Q

3rd order neurons:

A

thalamus to post-central gyrus in cerebral cortex
* 2nd order neurons in thalamus
* ascends through internal capsule
* post-central gyrus

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20
Q

How are nerve fibers characterized?

A
  1. myelination status
  2. diameter
  3. velocity of impulse conduction
21
Q

What are the characteristics of A-fibers?

A-beta?

A-delta?

A

fast, myelinated, large

  • A-beta: pressure, touch, proprioception
  • A-delta: fast pain, touch, heat
22
Q

What are the characteristics of C-fibers?

A

slow, non-myelinated, small

  • slow pain, heat, touch
23
Q

Elements of Pain Processing

Transduction:

  • what meds work on transduction?
A
  • thermal, chemical, mechanical tissue damage
  • release of inflammatory mediators
  • activate nociceptor

noxious stimuli converted into APs

Meds: LA, NSAIDs

24
Q

Elements of Pain Processing

Transmission:

What meds work on transmission?

A

AP conducted through nervous system
* A-delta & C fibers
* meds: LAs

25
# Elements of Pain Processing Modulation: What meds work on modulation?
**pain transmission alters afferent neural transmission** * happens in dorsal horn of spinal cord * Meds: LAs, opioids, ketamine, alpha 2 agonists
26
# Elements of Pain Processing Perception: What meds work on perception?
**integration of painful input into somatosensory & limbic cortices (post-central gyrus) - S1/SII** * in the frontal cortex * meds: alpha 2 agonists, opioids, general anesthetics
27
# Neuropathic Pain What is allodynia?
**pain response to something that is normally not painful** ex: DM neuropathy
28
# Neuropathic Pain What is hyperalgesia?
**exaggerated response to a normally painful stimulus** * release of local inflammatory mediators that can produce augmented sensitivity to stimuli
29
# Neuropathy What is **primary** hyperalgesia?
* augmented sensitivity to painful response * OR allodynia misinterpretation of non-painful stimuli
30
# Neuropathy What is secondary hyperalgesia?
* increased excitability of neurons in CNS * from Glutamate activation of NMDA receptors
31
# Neuropathy What is a drug we give that can cause hyperalgesia?
* Remifentanil **give w/ Ketamine or something long acting**
32
# Neuropathy What happens w/ central hypersensitivity?
* there is no or minimal & undetectable tissue damage required to induce pain
33
What is the **hallmark** of neuropathy?
* complete denervation of a body part resulting in numbness * **negative symptom**
34
What is the **paradoxical part** of neuropathic pain?
* from nerve trauma and disease * associated w/ postive symptoms
35
What are the postive symptoms of neuropathic pain?
* burning * lancinating * electric * raw skin like * shooting * deep/dull * aching
36
# Elderly & Pharmacology What physiologic changes affect absorption of drugs?
* decreased GI motility & blood flow * gastric acid secretion decreased (elevated pH) * use of meds alters gastric pH more
37
# Elderly & Pharmacology What 5 things have an overall effect on distribution of drugs?
* protein binding * pH - PK/PD * molecular size * water * lipid solubility
38
# Elderly & Pharmacology What physiologic changes affect the distribution of drugs?
* decreased muscle mass * increased proportion of body fat (Vd) * decreased total body water * decreased albumin - PB drugs
39
# Elderly & Pharmacology What physiologic changes affect the metabolism of drugs?
* decreased hepatic blood flow * decreased liver mass & intrinsic metabolic activity
40
# Elderly & Pharmacology What physiologic changes affect the elimination of drugs?
* decreased renal blood flow * decreased GFR * decreased kidney mass & # of functioning nephrons
41
WHO pain relief step 1:
* non-opioids * adjuvant (PT, massage, heat, braces)
42
WHO pain relief step 2
* opioids for mild-mod * non-opioids * adjuvant
43
WHO pain relief step 3
* stronger opioids * non-opioids * adjuvant
44
**Opioid Analgesics** * Act ________. * addiction/dep/tolerance: y or n * controlled? * AE: 3 * anti-inflammatory: y or n * ceiling effects: y or n
* act centrally * yes addiction/dep/tolerance * schedule II, III controlled * AE: sedation, resp. depression, constipation * anti-inflammatory: no * ceiling effects: no (can keep giving more and more)
45
**non-opioid analgesics** * act ________. * addiction/dep/tolerance? * controlled? * AE: (3) * anti-inflammatory: y or n * ceiling effects: y or n
* act peripherally * not habit forming * not controlled * AE: gastric irriation, bleeding, renal toxicity * yes anti-inflammatory * yes ceiling effects (increasing dose does not increase analgesia - causes more SE)
46
Mu receptor effects:
* analgesia * resp. depression * euphoria * decreased GI motility
47
Kappa receptor effects
* analgesia * dysphoria * psychosis * delirium/delusions * miosis * resp. depression
48
Delta receptor effects
* analgesia
49
Do opioids act peripherally or centrally?
**centrally** * dorsal horn - lamina II * somatosensory cortex in brain

Principles of Anesthesia II - Fall 2024 (10 decks)

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