Chapter 10: Pain: Pathophysiology And Management

Question 1

Largest Diameter afferent fibers
Responds maximally to light touch and/or moving stimuli
Present primarily in the skin

Answer 1

A-beta fibers

Question 2

Primary Afferent Nociceptors (Pain Receptors)

Answer 2

Alpha delta and C fiber afferents

Question 3

Responds maximally only to intense painful stimuli to produce subjective experience of pain when they are electrically stimulated.

Answer 3

Alpha delta and C fiber afferents

Question 4

When intense, repeated, or prolonged stimuli are applied to damage or inflamed tissues, the threshold for activating primary afferent nociceptors is lowered, and the frequency of firing is higher for all stimulus intensities.

Answer 4

Sensitization

Question 5

Stress response to pain (5)

Answer 5

Increased BP
Increased HR
Increased pupil diameter
Increased plasma cortisol levels
Local muscle contraction

Question 6

Responds maximally to light touch and/or moving stimuli; they are present primarily in nerves that innervate the skin. This does not usually produce pain.

Answer 6

Alpha-beta

Question 7

Noxious stimuli (5)

Answer 7

Heat
Intense cold
Mechanical distortion
Changes in pH
Chemical irritants: ATP, serotonin, Bradikynin, Histamine

Question 8

Transient receptor potential cation channel subfamily V member 1
Mediates perception of noxious stimuli

Answer 8

Vanilloid receptor

Question 9

Pain on normally innocuous stimuli

Answer 9

Allydonia

Question 10

Increased pain intensity in response to the same noxious stimuli

Answer 10

Hyperalgesia

Question 11

Major central neurotransmitter for pain

Answer 11

Glutamine

Question 12

Spatial displacement of pain sensation from the site of injury

Answer 12

Referred pain

Question 13

How does referred pain occurs?

Answer 13

Caused by convergence of sensory inputs to a single spinal pain-transmission neuron

Question 14

Injury to this tracy causes produces permanent deficits in PAIN qnd TEMPERATURE discrimination

Answer 14

Spinothalamic Tract

Question 15

Injury to this area produces diminished emotional impact while preserving ability to recognize pain

Answer 15

Frontal Cortex

Question 16

Qualities of Neuropathic pain

Answer 16

Unusual burning, tingling, electric shock-like quality with characteristic SENSORY deficit in the area of pain

Question 17

Neuropathic pain is caused by ______________ in the deranged fiber

Answer 17

Increased density of sodium channels

Question 18

Nerves that supplies the cornea

Answer 18

Aδ and C fiber afferents

Question 19

Inflammatory mediators for Sensitization (4)

Answer 19

Bradykinin
Nerve growth factor
Prostaglandins
Leukotrienes

Question 20

It is a potent vasodilator, causes mast cell degranulation, is a chemoattractant for leukocytes, and increases the production and release of inflammatory mediators.

Answer 20

Substance P

Question 21

Nocebo Effect

Answer 21

The suggestion that pain will worsen following administration of an
inert substance can increase its perceived intensity.

Question 22

Hyperpathia

Answer 22

exaggerated pain response to innocuous or mild nociceptive stimuli, especially when applied repeatedly, is also characteristic of neuropathic pain

Question 23

Only analgesic without anti-inflammatory actions

Answer 23

Acetaminophen

Question 24

Preferred pain meds post-operatively because it has no effects with blood coagulation

Answer 24

Cox-2 selective inhibitors

Question 25

Most potent pain-relieving drugs

Answer 25

Opioids

Question 26

Antidote for opioid toxicity

Answer 26

Naloxone

Question 27

Painful conditions that responds to Tricyclic Antidepressants

Answer 27

``` Postherpetic neuralgia Diabetic neuropathy Fibromyalgia Tension headache Migraine headache Rheumatoid arthritis Chronic low back pain Cancer Central poststroke pain ```

Question 28

1st line drug for neuropathic pain

Answer 28

Anti-convulsants