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Semester 3 > Case 2 - Pain Management > Flashcards

Case 2 - Pain Management Flashcards

1
Q

what are the 4 components of pain

A
  • transduction
  • transmission
  • perception
  • modulation
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2
Q

what are nociceptors

A

sensory receptors that are activated by noxious stimuli that damage or threaten the body integrity.
nociceptors belong to the slowing conducting afferent a delta and C fibres. they are classified according to their response to mechanical, thermal or chemical stimuli.

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3
Q

what is transduction

A

tissue damage results in the release of inflammatory mediators which bind to nociceptors conveying a thermal, mechanical or chemical insult into an electrical signal

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4
Q

what is transmission

A

occurs at the level of a second order neurones and there are various tracts that go from the spinal cord to different parts of the brain

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5
Q

what is perception

A

information has reached the brain and is being interested through the unique cognitive network

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6
Q

what is modulation

A

descending pathways have quietened down and some of those are sending their electrical impulses and now is integrating the information and modulation from the level of the brain to thespian cord happens at various levels and though different structures in the brain

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7
Q

what are the principles of acute pain management

A
  1. enhanced recovery
  2. management of expectations
  3. multimodal analgesia
  4. opioid sparing
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8
Q

what is the WHO ladder not appropriate for

A

management of acute pain

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9
Q

when was the WHO ladder created

A

1986

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10
Q

diagram of the WHO ladder

A
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11
Q

how do NSAIDs reduce tissue inflammation and nociception

A

by inhibiting prostaglandins

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12
Q

where do NSAIDs mainly act

A

peripherally

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13
Q

where are selective COX inhibitors more potent

A

at the COX2 enzyme

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14
Q

what are the side effects of NSAIDs

A

gastrointestinal irritation and risk to gastrointestinal bleeding

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15
Q

NSAIDs must be used with caution in what patients

A

older patients with impaired renal function and heart failure

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16
Q

diagram showing prostaglandin production

A
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17
Q

what do local anaesthetics not work with

A

abbesses

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18
Q

names of agonist/antagonist opioids

A

nalbuphrine and pentazocine

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19
Q

what do opioids do

A

they reduce pain signal transmission by activating pre-synaptic opioid receptors. this leads to reduced intracellular cAMP concentration, decreased calcium ion influx and thus inhibits the release of excitatory neurotransmitters

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20
Q

what are 2 examples of excitatory neurotransmitters

A

glutamate and substance P

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21
Q

what do opioids do at the post synaptic level

A

opioid-receptor binding evokes a hyperpolarisation of the neuronal membrane which decreases the probability of the generation of an action potential

22
Q

what do opioids also function as

A

inhibitory transmitters of the descending inhibitory pathway

23
Q

what other supraspiinal structures do they affect

A

the thalamus, and the limbic system altering the emotional assessment of pain i.e nociceptive sensations are still perceived but is no longer felt as being unpleasant or threatening

24
Q

what does morphine do

A

by an action on mu receptors, inhibits the release of several different neurotransmitters including acetylcholine, glutamate and substance P

25
Q

what type of pain serves no adaptive purpose

A

chronic pain

26
Q

what is peripheral sensitisation

A

is a reduced threshold and an increase in responsiveness of the peripheral ends of nocicpetors

27
Q

what does central sensitisation imply

A

changes in the spinal cord and brain. central sensitisation is an increase in the excitability of neurones within the central nervous system, so that normal inputs begin to produce abnormal responses. hyperalgesia for example is a phenomenon which is a result of central sensitisation

28
Q

what is central sensitisation from

A

from a low threshold mechanoreceptor and that jumping on results In a low threshold input lie rubbing or touching and being perceived as pain

29
Q

what is hyperalgesia caused by

A

the increase release of glutamate to a given stimulate which increases signalling to the brain

30
Q

what can influence physiological changes

A

biological factors

31
Q

what are psychological factors reflected in

A

the appraisal and perception of internal physiological phenomena

32
Q

what are these appraisals and behavioural responses influenced by

A

social or environmental factors

33
Q

what does the model also propose

A

that psychological and social factors can influence biological factors, such as hormone production, activity in the autonomic nervous system and physical reconditioning

34
Q

what is neuropathic pain

A

pain arising as a direct consequence of a lesion or disease affecting the somatosensory system

35
Q

why does neuropathic pain need to be distinguished from pain

A

die to secondary neuroplastic changes in the nociceptive system resulting from sufficiently strong nociceptive stimulation

36
Q

what is malingering

A

is defined as the conscious fabrication of symptoms to achieve some form of benefits such as attention, to be relieved of undesirable activities, to obtain prescription medication or to qualify for disability compensation

37
Q

what are pain behaviours

A

non-conscious modes of communicating pain and distress and unlike cases of symptom magnification and malingering are not produced intentionally

38
Q

what does catastrophising consist of

A

extremely negative thoughts about ones plight even with minor problems being interpreted as major catastrophes.
catastrophising and consequently adaptive coping strategies are important in determining ones reaction to pain. greater catastrophising and feeling a lower sense of control are among the most important predictors of chronic back pain

39
Q

what is the red circle

A

a psychologically based rehabilitation program delivered in a group setting by an interdisciplinary team,

40
Q

who are the core members of this red circle team

A

clinical psychologist, a physiotherapist and a medical practitioner

41
Q

what are the aims of the red circle

A

help patients move from a medical model of pain to a biopsychosocial model of pain and disability
Build patients self management skills and reduce reliance on healthcare professionals
Educate about the physiological effects of pain
Address psychological, social and emotional barriers to progress

42
Q

what is an interventional destructive pain procedure

A

radiofrequency - denervation of the facet joints

43
Q

what are the non-destructive interventional pain procedures

A
  • local anaesthetics
  • steroids
  • epidural and facet joint injections
  • neuromodulation: SCS and intrathecal opioids
44
Q

what is the traditional tonic stimulation

A
  • relatively low energy
  • recharge every 2 months
45
Q

what is burst stimulation

A
  • parameters within traditional range
  • low-moderate energy
  • average recharge similar to tonic
  • device provides both tonic and burst
  • same expected device life as tonic
46
Q

what is high frequency

A
  • parameters outside traditional range
  • highest energy, daily recharge
  • current device only provides high frequency stimulation
  • reduced device life compared to tonic
47
Q

what is neuromodualtion

A

the alteration of nerve activity though targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body

48
Q

what is TENS

A

transcutaneous electrical nerve stimulation

49
Q

what does TENS do

A

introduction of pulses of low-voltage electricity into tissues for the relief of pain.
- it works by means of a small portable battery operated unit with leads connected to electrodes attached to the skin; the strength and frequency of the pulses, which prevent the passage of Pain impulses to the brain, can be adjusted by the patient
the electrodes are often placed on the area of pain or at a pressure point, creating a circuit of electrical impulses that travel along nerve fibres

50
Q

what are TENS electrodes used to activate

A

large diameter afferent fibres that overlap the site of injury and pain.
- stimulation of the dorsal columns via surface electrodes presumably receives pain because it activates large numbers of A beta fibres synchronously.

51
Q

how are TENS machines thought to work

A
  • high pulse rate triggers the pain gate to close
  • a low pulse rate stimulates the body to make its own endorphins
52
Q

what do pain management programmes work in synergy with

A

CBT to teach how to live successfully with pain

Semester 3 (94 decks)

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