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Anesthesiology > Chronic Pain > Flashcards

Chronic Pain Flashcards

1
Q

Protopathic pain is conducted by what nerve fibers?

A

A-delta and C nerve fibers (noxious)

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2
Q

What is epicritic sensation?

A

Non-noxious: touch, pressure, proprioception, temperature

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3
Q

What is a rhizotomy?

A

Transection of dorsal nerve root of the spinal cord

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4
Q

Why do you have continued pain after rhizotomy?

A
  1. Some C fibers enter the ventral nerve root

2. 1st order neurons can travel up or down 3 segments in Lissaur’s tract

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5
Q

Where do opioids primarily act upon in the pain pathway?

A

Dorsal horn of the spinal cord

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6
Q

What are wide dynamic range neurons responsible for?

A

Central sensitization of pain secondary to “wind up” (repeated stimulation leading to huge pain transduction)

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7
Q

What nerve fibers carry fast pain?

A

A-delta fibers (myelinated)

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8
Q

What nerve fibers carry delayed pain?

A

C fibers

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9
Q

How do NSAIDs and aspirin help with pain?

A

Decreases prostaglandin formation which is responsible for nociceptor sensitization

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10
Q

How does peripheral sensitization occur?

A

Chemical mediators (bradykinin, prostaglandins, substance P, etc.), heat, frequency of stimuli

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11
Q

How does central sensitization occur?

A

Wind up (repeated stimulation leading to a huge increase in pain transduction) and neurochemical mediators (CGRP, substance P, etc.)

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12
Q

Mechanism of action for tramadol?

A

Weak mu-receptor agonist, increased serotonin release, decreased NE reuptake, NMDA receptor antagonist, capsaicin (VR1) receptor agonist

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13
Q

What treatment option can prevent the pain syndrome of post-herpetic neuralgia?

A

Epidural anesthesia (sympathectomy) since post-herpetic neuralgia has a sympathetic component

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14
Q

CRPS I vs II

A

I: Reflex sympathetic dystrophy
II: Causalgia

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15
Q

When would you use an EMG for CRPS?

A

To differentiate between CRPS I and II (abnormal in II)

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16
Q

Progression of CRPS can be evidenced by: increased opioid use, warm/red extremities, osteoporosis, sweat testing, EMG

A

Osteoporosis (stage 2 of CRPS)

17
Q

Most effective treatment for early CRPS?

A

Stellate ganglion blocks (~3-12 injections)

18
Q

Which gender is more prone to developing CRPS?

A

Women (3:1)

19
Q

Treatment for phantom limb pain?

A

Anticonvulsants, TCAs, Alpha-2 agonists, NMDA antagonists, opioids

20
Q

What type of anesthesia should be avoided in patients with phantom limb pain?

A

Spinal anesthesia

21
Q

Definition of dysasthesia

A

Unpleasant sensation with or without a stimulus

22
Q

Definition of anesthesia dolorosa

A

Pain in an area that lacks sensation

23
Q

Definition of neuralgia

A

Pain in the distribution of nerves

24
Q

Definition of allodynia

A

Perception of non-noxious (epicritic) sensation as pain

25
Q

How do transcutaneous electrical nerve stimulation (TENS) work?

A

Stimulating large afferent epicritic fibers (i.e. rubbing a painful area to help “distract” from the pain)

26
Q

Which is an unexpected complication from a stellate ganglion block: hoarseness, nasal stuffiness, ptosis, miosis, anhidrosis

A

Hoarseness: blockage of the recurrent laryngeal nerve

27
Q

Stellate ganglion block is done by locating which transverse process?

A

Chassiaignac’s tubercle of C6

28
Q

Celiac plexus is found at which vertebral level?

A

L1

29
Q

Common side effect of a successful celiac plexus block?

A

Hypovolemia from the upper abdominal sympathectomy (decreased SVR and increased venous pooling)

30
Q

What is the advantage of using an intrathecal pump for opioids vs. PO?

A

Decreased doses are used so less likely to have side effects (still have tolerance and withdrawal effects)

31
Q

Patient with disk herniation and radiculopathy had lumbar epidural steroid injection done with minimal relief, what is the best next step?

A

Repeat LESI with same dose of steroid; can take up to 3 injections to be successful

32
Q

Interventional treatment for facet syndrome?

A

Medial branch steroid injection (level above and at the level)

33
Q

Lower back pain, worse with sitting and walking down stairs with normal ABIs

A

Spinal stenosis

34
Q

Which psych disorder does not correlated with chronic pain: bipolar, borderline personality disorder, somatization, conversion, MDD

A

Bipolar disorder

Anesthesiology (21 decks)

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