Ch. 43 Chronic Pain Management Flashcards
What is nonciceptive pain?
pain caused by activity in peripheral pain neurons due to ongoing tissue injury
What is neuropathic pain?
pain caused by abnormal function of the nervous system
Osteoarthritis is an example of what type of pain?
nonciceptive
Diabetic neuropathy is an example of what type of pain
neuropathic pain
What is hyperalgesia?
severe pain to a normally minimally painful stimulus
What is allodynia?
pain to normally nonpainful stimulus
What is radicular pain?
leg pain (usually in regards to lower back pain) AKA sciatica
What is time period after which acute low back pain becomes chronic low back pain?
3 months
What occurs with the majority of episodes of acute low back pain?
they resolve without treatment
What is nucleus pulposus?
jelly-like substance in the middle of the spinal disc
What is HNP?
herniated nucleus pulposus or DISC HERNIATION - when some of the gelatinous central nucleus pulposus spills out
What is the annulus fibrosus?
the fibrous surrounding that of the vertebral disc that contains the gel-like nucleus pulposus
What is radiculopathy?
signs of dysfunction including numbness, weakness, or loss of deep tendon reflexes
What is spontaneous pain?
pain that occurs with no stimulus
What type of pain is spontaneous, hyperalgesia andallodynia associated with?
neuropathic pain
Postherpetic neuralgia is a result of what condition?
damage of small unmyelinated nerves from shingles
What is postherpetic neuralgia usually treated with?
TCA’s and anticonvulsants (e.g. gabapentin)
What is the most common cause of neuropathic pain?
DM
What happens in diabetes to cause pain?
small unmyelinated nerve are damaged
Is diabetic neuropathy painful or painless?
it can be both; it may result in chronic neuropathic pain or in sensory loss
Incidence of painful diabetic neuropathy is directly related to what?
control of glucose levels
Complex regional pain syndrome typically occurs from what?
traumatic injury, generally of an extremity
What is the only available COX-2 drug?
celecoxib
Why is a COX-2 inhibiting drug preferred over a non-specific COX inhibiting drug?
lower risk of GI complications such as ulcers
What type of drugs are venlafaxine and duloxetine
venlafaxine (Effexor) and duloxetine (Cymbalta) are seratonin and norepinephrine reuptake inhibitors (SNRI’s)
What type of antidepressants can be used to treat chronic pain?
TCA’s and some SNRI’s
What are side effects of TCA’s?
anticholinergic effects and worsening of heart block
What anticonvulsants are used to treat chronic pain?
gabapentin and pregabalin
How might chronic opioid use worsen pain?
by inducing hyperalgesia
Ketamine has what method of action (in regards to analgesia)?
it is a NMDA receptor antagonist
What is one limit to the effectiveness of injected steroids?
they stop working after about three months of treatment
What are two routes that epidural injection of steroids?
interlaminar route and transforaminal route
How does radiofrequency treatment work?
energy is delivered through a needle that denervates the facet joint
How often does radiofrequency denervation need to be repeated?
every 6-12 months
How does provocative diskography work?
a small amount of fluid is injected into each intervertebral disc until a painful stimulus is achieved and the offending disc can be located
How does intradiscal electrothermal therapy (IDET) work?
a steerable thermal wire is placed along the posterior annulus fibrosus and thermal energy is applied to destroy penetrating nociceptive fiber and to change the cross-linking of glycosaminoglycans, thereby stiffening the intervertebral disk
What does percutaneous plasma disk decompression consist of?
removing a portion of the central nucleus pulposus associaded with a disk bulge
What type of block can last weeks to months?
neurolytic celiac plexus block
The stellate ganglion provides nerves to what parts of the body?
head, neck and upper extremities
The stellate ganglion fuses what two spinal ganglia?
inferior cervical and first thoracic sympathetic
What is hyperhidrosis and how does it relate to the stellate ganglion block?
excessive sweating of the hands; can be controlled by stellate ganglion block
Stellate ganglion block can improve blood flow in what conditions?
angina pectoris, Raynaud’s, frostbite, vasospasm, occlusive embolic vascular disease
Blocking the single recurrent laryngeal nerve would lead to what? bilateral?
single - hoarseness, difficulty swallowing; bilateral - loss of laryngeal reflexes, respiratory compromise
What is the most likely placement complication with a stellate ganglion block? What would be the side effects?
Placement in posterior tubercle and spread of LA into epidural space; possible partial/profound neuraxial block w/ high spinal or epidural including loss of consciousness and apnea
Why is it important to monitor a patient for at least 30 min after stellate ganglion block?
maximal LA effects occur at around 15-20min and apnea can occur if improperly placed
What ganglia innervates all of the abdominal viscera (with the exception of the descenting & sigmoid colon, rectum and pelvic viscera)?
celiac ganglia
What are some advantages of splanchnic nerve block over celiac plexus block?
no risk of puncturing the aorta, smaller volumes of solution, not affected by tumors of the pancreas
In general, celiac plexus and splanchnic nerve blocks are used to control pain arising from where?
intra-abdominal structures (pancreas, liver, gallbladder, from stomach to transverse colon)
What are side effects of a correctly placed celiac plexus block?
diarrhea, orthostatic HoTN
What is sympathectomy?
removal of sympathetic ganglion
What treatment has the best outcomes for unilateral radicular pain?
spinal cord stimulation
What is ziconotide and what is it used for?
non-opioid calcium channel blocker used intrathecal for continuous infusion for pain
Where are intrathecal drug delivery devices usually placed?
within the abdominal wall
What opioid is approved for intrathecal use?
morphine
