Behav. Sci. Pain

Question 1

function of pain

Answer 1

protect tissue

Question 2

chronic regional pain syndrome

Answer 2

limb is cold, red, muscle wasting, nail changes

Question 3

opioids

Answer 3

any drug that occupies opioid receptors; fentanyl, methadone

acts as hormone in blood - has lots of receptors in the body

Question 4

opiates vs NSAIDS

Answer 4

opiates: hits receptor: don’t notice pain
NSAIDS: inflammatory pain

Question 5

what is endogenous opioid synthesized from?

Answer 5

POMC -> B-lipotropin

Question 6

mechanism of endorphin activity in pain management

Answer 6

CNS: involved in inhibiting GABA and thus disinhibiting dopamine
peripheral: inhibition of substance P (pain driver) and other tachykinin release

Question 7

peripheral mechanism of release of endorphin

Answer 7

peripheral mediated by stress and ACTH co-release

-corticotrophs in the anterior pituitary synthesize ACTH and b-endorphin in equimolar amounts

Question 8

central mechanism of release of endorphin

Answer 8

involves innervation of the hypothalamus, midbrain, and rostral medulla
-cell bodies of opioidergic neurons in the median eminence of the hypothalamus

Question 9

what are the release mediators of endorphins?

Answer 9

5-HETE, LTA4, LTB4
angiotensin-II
5HT

Question 10

what is the result of heroin on pain tolerance?

Answer 10

hyperalgesia

Question 11

what is the #1 pain driver? how do we know?

Answer 11

glutamate - when it is blocked, there is no pain

Question 12

NSAIDS mechanism

Answer 12

inhibit COX - enzyme for conversion of arachidonic acid to prostaglandins and thromboxane which provoke tissue inflammation
also reduces fever (because it’s caused by prostaglandin E2)

Question 13

NSAIDS vs opioids

Answer 13

opioids = neuropathic pain
NSAIDS = inflammatory pain (post traumatic, post-surgical)

Question 14

AEDs

Answer 14

antiepileptic drugs: function by lowering a neuron’s ability to fire by hyperpolarization and disallowing depolarization

Question 15

what are other uses of AEDs? why do they work for these?

Answer 15

bipolar, anxiety, substance withdrawal, migraines, fibromyalgia, diabetic neuropathy
why? these conditions involve neuronal excessive firing rates

Question 16

pain on molecular level

Answer 16

significant Ca and Na influx

Question 17

neuropathic pain on molecular level

Answer 17

Na, Ca, and GLU release

Question 18

what are the AED Na channel blockers?

Answer 18

carbamazepine, lamotrigine, topiramate

Question 19

what are the AED Ca channel blockers?

Answer 19

gabapentin and pregabalin

Question 20

what are the side effects of AEDs

Answer 20

sedation, psychomotor/cognitive impairment, ataxia, tremor

Question 21

topiramate uses and side effects

Answer 21

MIGRAINES

weight loss, acidosis, olighydrosis, glaucoma

Question 22

pregabalin uses and SE

Answer 22

DIABETIC NEUROPATHY, FIBROMYALGIA

mild addiction, weight gain, sedation

Question 23

gabapentin uses and SE

Answer 23

DIABETIC NEUROPATHY

weight gain, sedation

Question 24

lamotrigine uses and SE

Answer 24

NO PAIN APPROVAL

stevens johnson syndrome rash

Question 25

carbamazepine uses and SE

Answer 25

TRIGEM NEURALGIA

aplastic anemia, requires blood levels, p450 3A4 inducer

Question 26

what can antidepressants be used to treat?

Answer 26

several anxiety disorders, fibromyalgia, and neuropathic pain
also treat vasomotor symptoms of menopause, premenstrual disorders, urinary incontinence

Question 27

why do antidepressants work?

Answer 27

send NE south causing less firing in spinal cord (fires more GABA interneurons dampaning the ability of ascending pain fibers to fire and pain symptoms may resolve)

Question 28

which antidepressants are used for pain?

Answer 28

duloxetine and milnacipran (SNRI)

amitriptyline (TCA)