B7-005 Pain 2 Flashcards

1
Q

acute pain goes through the […] system

A

spinothalamic

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2
Q

carried by unmyelinated C fibers
dull, burning pain-poorly localized

A

slow pain

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3
Q

carried by A-delta thinly myelinated fibers
sharp pricking pain
accurately localized

A

fast pain

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4
Q

slow pain is carried in the […] tract

A

paleothalamic

has several “waypoints” on way to thalamus, envokes “memories” of pain

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5
Q

fast pain is carried in the […] tract

A

neothalamic

goes straight to thalamus

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6
Q

why does slow pain invoke an emotional response?

A

it is diffusely projected throughout the cortex

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7
Q

why does pain persist after the noxious stimuli is removed?

A

peripheral :sensitization by chemical mediators (they depolarize the receptor and make it more sensitive to subsequent stimuli)

central: decreased pain receptor thresholds and changes in synaptic central circuits over time

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8
Q

similar to slow pain, affecting the internal organs

A

visceral pain

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9
Q

why is visceral pain hard to localized?

A

very high percentage of C fibers going through paleothalamic tract which projects diffusely

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10
Q

has characteristics of slow pain
is commonly referred to overlying somatic structures

A

visceral pain

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11
Q

describe the mechanism of referred pain

A

convergence of cutaneous and visceral nociceptors onto same dorsal horn
OR
branching pattern of sensory nerve

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12
Q

secondary to disruption of normal pain physiology caused by abnormal sensitization, conduction, modulation, or perception

A

chronic (abnormal) pain

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13
Q

mildly painful stimuli perceived as more painful that it is

A

hyperalgesia

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14
Q

nonpainful stimuli perceived as pain

A

allodynia

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15
Q

painful tingling (like foot asleep)

A

dysesthesia

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16
Q

persistant hyperpathia associate with vasomotor changes after an injury

usually after a period of immobilization, affected limb may have color changes

A

Complex Regional Pain Disorder

AKA reflex sympathetic dystrophy, causalgia (with nerve injury)

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17
Q

focal area of demyelination with cross talk between bare axons

A

neuralgia

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18
Q

treatment of trigeminal neuralgia

A

carbamezapine
surgery

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19
Q

treatment of Complex Regional Pain Disorder [3]

A

aggressive mobilization
pain control
sympathetic blockade

20
Q

damage to somatosensory systems, associated with numbness

presumed secondary to decreased modulation

A

defferentation pain

21
Q

describe the gate control theory of pain

A

modulation of pain wants the non-painful and painful stimuil to be balanced

a decrease in either one would cause an increase in the other and vice versa

22
Q

loss of non-painful sensory inputs causes a relative pain increase, pain is perceived

A

defferentation pain

23
Q

inhibitory pain pathway
triggered by fight or flight

A

central pain modulation

24
Q

describe the central pain modulation pathway

A

periaqueductral gray –> opiate receptors –> rostroventral medulla –> NE 5HT –> dorsal horn –> enkephalin interneurons

25
treatment used to decrease sensitization [4]
early mobility capsacin NSAIDs steroids
26
treatment used to decrease pain conduction [3]
nerve block spinothalamic tractotomy (used for cancer with poor prognosis) stabilize nerves with anti-epilepsy drugs
27
treatments used to increase pain modulation [2]
increase non-painful input: mechanical stimulation, trans-cutaneous stimulator, posterior column stimulator, stimulate periaqueductal gray medication: antidepressants, opiates
28
treatments used to change pain perception
behavior/relaxation therapy biofeedback treatment for anxiety/depression
29
recurrent brief episodes of pain in the CN V distribution
trigeminal neuralgia
30
most cases of trigeminal neuralgia are caused by
vascular compression of the CN V root
31
electric "shock" like pain over the jaw triggered by talking, chewing, or touch
trigeminal neuralgia
32
treatment for trigeminal neuralgia
carbamazepine (epilepsy drug) **if no response, they need surgical intervention
33
"burning" pain and allodynia following herpesvirus infection
postherpetic neuralgia
34
describe the pathophysiology of postherpetic neuralgia
decreased modulation from defferentation
35
used to reduce the risk of postherpetic neuralgia
antivirals **diagnosis must be caught early to have better prognosis
36
damage to descending pain inhibitory pathways can cause
decreased modulation
37
treatment of postherpetic neuralgia
amitriptyline
38
acute migraine treatment
triptans (diptans if risk of stroke) antiemetics
39
prophylactic migraine treatment
beta blocker amitriptyline valproate, topiramate (anti-epileptics) botulinum toxin anti-CGRP monoclonal antibodies NSAIDs
40
treatment of deafferentation syndrome
tricyclic antidepressant
41
blocks sodium channels in the nerve
lidocaine
42
[...] syndrome following a thalamic stroke is common
deafferentation pain
43
allodynia with swelling, redness of skin, and skin changes
complex regional pain syndrome/reflex sympathetic dystrophy
44
the projection of pain impulses to the cerebral cortex is [...]
diffuse **extends beyond somatosensory complex**
45
physiologic basis of referred pain
convergence of primary sensory neurons from the skin and affected organ on the same populations of secondary sensory neurons within the spinal cord