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MM Test 1 > B6.017 Pain Management > Flashcards

B6.017 Pain Management Flashcards

1
Q

most common reason people seek health care

A

pain

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2
Q

somatosensation

A

physiological process by which physical stimuli results in the perception of touch, pressure, or pain

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3
Q

nociception

A

physiological process of activation of neural pathways by stimuli that are potentially or currently damaging to tissue

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4
Q

pain

A

conscious experience compared to nociception
unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage, or both

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5
Q

how are primary afferent fibers classified

A

conduction velocity and cutaneous stimuli by which they are activated
-conduction velocity varies directly with axon diameter and presence of myelination

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6
Q

3 important characteristics o somatosensation

A
  1. minimal afferent traffic in the absence of stimulation
  2. increasing intensity of the stimulus results in increase in discharge frequency
  3. different axons may respond more efficiently to a particular stimulus
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7
Q

AB fibers

A

large diameter, fastest conducting, myelinated
low threshold (Pacinian corpuscles)
light touch, pressure, vibration/hair movement

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8
Q

C fibers

A

unmyelinated, very slow conducting, pain transmitting
high threshold thermal, mechanical, and chemical stimuli
free nerve endings
*predominant fiber in afferent nerves
conveys slower onset, burning second pain

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9
Q

Ad fibers

A

lightly myelinated, slow conducting (but faster than C), pain transmitting
conveys rapid onset, first pain sensation

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10
Q

describe the ascending nerve pathway

A

nociceptive inputs enter the CNS at the dorsal horn where primary afferent terminals synapse on second order projection neurons

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11
Q

how do primary afferents activate second order neurons?

A

release excitatory neurotransmitters : glutamate, substance P, CGRP

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12
Q

NMDA receptors

A

glutamate

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13
Q

mGlu R receptors

A

glutamate

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14
Q

neurokinin (NK1) receptors

A

substance P

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15
Q

CGRP receptors

A

CGRP

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16
Q

what is the overarching “point” about the descending pain pathway

A

brain can inhibit OR enhance pain nociceptive inputs

ex: walking miles on a broken leg to get help, brain modulates pain down

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17
Q

describe the descending pain pathways

A

periaqueductal gray sends projections to the rostroventral medulla
RVM produces bidirectional pain modulation

18
Q

cause of nociceptive pain

A

inflammation or damage

19
Q

clinical features of nociceptive pain

A

pain is well localized

consistent effect of activity on pain

20
Q

treatment of nociceptive pain

A

NSAIDs
injections
surgery

21
Q

classic examples of nociceptive pain

A

OA
autoimmune disorders
cancer pain

22
Q

cause of neuropathic pain

A

nerve damage or entrapment

23
Q

clinical features of neuropathic pain

A

follows distribution of peripheral nerves
dermatome or stocking glove
episodic, lancinating, numbness, tingling

24
Q

treatment of neuropathic pain

A

aimed at nerve: surgery, injections, topical

CNS acting drugs

25
Q

classic examples of neuropathic pain

A

diabetic painful neuropathy
post herpetic neuralgia
sciatica
carpal tunnel

26
Q

cause of centralized pain

A

CNS or systemic problem

27
Q

clinical features of centralized pain

A

pain is widespread and accompanied by fatigue, sleep, memory and/or mood difficulties
previous pain elsewhere in body

28
Q

treatment of centralized pain

A

CNS acting drugs

non pharm therapies

29
Q

classic examples of centralized pain

A 
fibromyalgia
functional GI disorders: IBS
TMJ
tension headache
interstitial cystitis, bladder pain syndrome
30
Q

components of history when discussing a pain issue

A 
OLDCARTS about pain
comorbid conditions
personality/mental status
psych symptoms
what they've tried previously
31
Q

physical exam with pain issue

A 
palpation
range of motion
inspection
provocative tests
neuro: strength, sensory, reflexes, coordination, gait, cranial nerve
32
Q

what do you have to be careful of when ordering imaging?

A

can contribute to patient disability
often over ordered
try conservative first if chronic pain

33
Q

use of EMG and NCM

A 
identify:
site of nerve or muscle condition
types of nerves involved
nature of alteration
time course
severity
34
Q

overview of opioid use

A

produce reliable analgesia
can be an integral part of an approach to acute and chronic pain
optimization of other treatments recommended first, not first line treatment

35
Q

general adverse side effects of opioids

A

constipation
nausea/vomiting
sedation
resp depression

36
Q

tolerance

A

physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce a specific effect

37
Q

physical dependence

A

state of adaptation manifested by drug signs and symptoms that can be produced by abrupt cessation, rapid dose reduction, or antagonist administered

38
Q

pseudo addiction

A

misinterpretation of relief seeking behaviors as if they are drug seeking behaviors
resolve with analgesic therapy

39
Q

addiction

A

psychiatric disorder where there is use of a substance characterized by loss of control, compulsive use, preoccupation, and continued use despite harm

40
Q

use of physical therapy for pain

A

best to use initially as conservative treatment as functional restoration is as important as pain reduction

41
Q

injections for pain management

A 
epidurals, nerve blocks
ablative procedures
joint injections
trigger point injections
plexus block
42
Q

neuromodulation for pain

A

spinal cord stimulation

dorsal root ganglion stimulation

MM Test 1 (20 decks)

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