Chapter 1- PAIN Flashcards
Define visceral nociceptive pain
Hollow organs and smooth muscle, usually referred
Define neuropathic
Pain initiated or caused by a primary lesion or disease in the somatosensory nervous system
Define hyperalgesia
Heightened response to stimuli that is normally painful
Define allodynia
Pain caused by stimulus that does not normally provoke pain
Define inflammatory
A result of activation and sensitisation of the nociceptive pain pathway by a variety of mediators release at a site of tissue inflammation
Name 5 types of pain
1) nerve pain
2) bone pain
3) soft tissue pain
4) phantom pain
5) referred pain
What is fibromyalgia
Means pain coming from the muscles and fibrous tissues such as tendons and ligaments
Is fibromyalgia a chronic condition
YEAH 💊
What changes in amount of neurotransmitters are present in fibromyalgia
1) low levels of serotonin
2) low levels of NA
3) low levels of DA
Also high levels of substance P in CSF
What an you treat fibromyalgia with
Low dose TCAs e.g amitriptyline but tolerability and durability is poor
Can you use SSRIs to treat fibromyalgia
Yes but can cause insomnia do take in morning also although better tolerated than TCAs the beneficial aspects can be less reliable
Can you use SNRIs to treat fibromyalgia
Yeh u can
What drugs can be used in treating fibromyalgia
1) TCAs
2) SSRIs
3) SNRIs
4) pregabalin/gabapentin
5) tramadol
6) muscle relaxants e.g baclofen
7) zolpidem for sleep
8) antispasmodics for IBS
Name two random drugs that have proved promising in fibromyalgia
Pramipexole and pregabalin
Define acute pain
Pain of less than 3-6 months duration
Define chronic pain
Pain lasting more than 3-6 months duration, or persisting beyond the course of an acute disease, or after tissue healing complete
Define acute on chronic pain
Acute pain flare superimposed on underlying chronic pain
What’s first line for breakthrough pain and why
Oramorph due to its known and trusted therapeutic profile and low cost
When are fentanyl patches considered for breakthrough pain
1) intolerance to morphine
2) patient unable to swallow
3) rapid onset and short duration of breakthrough pain
Define somatic nociceptive pain
Musculoskeletal, cutaneous, often well localised
Name 4 pain rating scales
1) verbal rating scale
2) numerical rating scale
3) visual analogue score (on a line)
4) visual recognition (faces)
What are the 3 key side effect of opioids
1) constipation
2) nausea and vomitting
3) respiratory depression
What is post herpetic neuralgia
Persistent nerve pain that occurs at the site of a previous attack of shingles
Name 6 neuropathic clinical syndromes
1) post-herpetic neuralgia
2) trigeminal neuralgia
3) complex regional pain syndrome
4) phantom pain
5) central post stroke pain
6) neuropathic cancer pain
What’s first line in the management of neuropathic pain
TCA or gabapentinoids
Name three drugs not licensed for neuropathic pain
Amitriptyline
Imipramine
Nortriptyline
What drug is licensed for painful diabetic neuropathy
Duloxetine
What topical drug is licensed for post herpetic neuralgia
Lidocaine
Pregabalin is licensed for what
Central and peripheral neuropathic pain
What do you offer initially for trigeminal neuralgia
Carbamazepine
What does CSCI stand for
Continuous subcutaneous infusion
What are the 4 common places of subcutaneous infusion
Upper arm
Anterior/posterior chest wall
Abdomen
Thigh
What does PCA stand for?
Patient controlled analgesia
