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Neurology > Chronic Pain > Flashcards

Chronic Pain Flashcards

1
Q

What is acute pain?

A

Sudden onset of pain in response to injury, infection

Resolves as the underlying cause resolves

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2
Q

What is the difference between recurrent acute pain and chronic pain?

A

Recurrent acute pain is lots of minor attacks of the body causing pain

Chronic pain is pain that persists after the stimulus/cause has resolved

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3
Q

What is meant by chronic neuropathic pain?

A

A neurological condition

That results from damage to, or dysfunction of the sensory nervous system

The pain persists in absence of tissue damage

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4
Q

Neuropathic vs nociceptive?

A

Nociceptive: pain caused by trauma to tissues, activation of nociceptors

Neuropathic: pain caused by damage to the sensory nervous system

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5
Q

What is neurogenic pain?

A

Pain caused by damage/dysfunction of the peripheral nervous system

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6
Q

What are some causes of chronic neuropathic pain?

A 
Trauma
Post-operative
Viral
Diabetes
Unknown cause
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7
Q

What type of pain is chronic neuropathic pain? I.e. what does it feel like?

A

Burning: hot and cold sensations

Electric shocks, shooting pain

Deep, achy

Poorly localised, may be in a dermatomal pattern

Numbness, paraesthesia

Hypersensitive skin

Worse at night, or when not distracted

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8
Q

What type of pattern/distribution is chronic neuropathic pain seen in?

A

Dermatomal patterns often

For the patient it feels poorly localised

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9
Q

What is a dermatome?

A

The region of skin supplied by a particular spinal nerve root

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10
Q

Briefly explain what is meant by ‘illness behaviour’?

A

The fact that people respond differently to pain and illness

Some people feel pain more than others

A lot of it depends on upbringing, environment, culture

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11
Q

What type of people are at risk of suffering from chronic neuropathic pain?

A

Work pressures

People going through litigation, benefit, claim processes

Poor social circumstances

Lack of family support

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12
Q

Why does pain persist to become chronic neuropathic pain in some people?

A

Poorly understood

We think, that there is increased afferent activity or synaptic transmission at the affected level of the spinal cord

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13
Q

What are C fibres?

A

Small, afferent, unmyelinated nerve fibre

Involved in the transmission of pain from the peripheries to the CNS

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14
Q

Are C fibres high or low velocity conductors?

A

Slow, since they are unmyelinated and have a small diameter

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15
Q

What is the difference between afferent and efferent?

A

Afferent: transmission from peripheries TO the CNS

Efferent: transmission FROM the CNS to the peripheries

Remember latin:
Ad = to, towards
E, ex = of, from

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16
Q

Describe the journey of a pain impulse from the nociceptor to the brain?

A

Nociceptor is activated

Pain impulse travels from nociceptor along C (or other similar) fibre

Enters the spinal cord

Synapses with a second order neuron in the dorsal horn, substantia gelatinosa

Impulse travels up spinothalamic tract to the brain, via the thalamus

17
Q

Which part of the spinal cord is involved in the transmission of pain impulses?

A

The substantia gelatinosa

Found in the dorsal horn of the spinal cord

18
Q

What neurotransmitter is involved in the transmission of a pain impulse from the C fibre to the second order neuron in the substantia gelatinosa?

A

Substance P

Is the neurotransmitter for the synapse of pain fibres in the substantia gelatinosa

19
Q

What is neuralgia?

A

Intense intermittent pain along the course of a nerve

E.g. trigeminal neuralgia

20
Q

What is neuropathy?

A

Damage, dysfunction of a peripheral nerve, resulting in weakness or numbness

21
Q

What is hyperalgesia?

A

Abnormally heightened sensitivity to pain

22
Q

What is causalgia?

A

Severe pain in a limb caused by injury to a peripheral nerve

23
Q

What is hyperpathia?

A

Activation of nociceptors evokes exaggerated levels of pain

24
Q

What is allodynia?

A

When normal, non-painful stimuli evoke pain

25
Q

What is lumbago?

A

Pain of the muscles and joints of the lower back

26
Q

Investigation of a patient with chronic pain?

A

History:

  • other medical conditions
  • history of trauma, anything that could have triggered
  • SOCRATES

Examination:

  • of pain
  • neurological exam

X-rays, MRI of spine

Serology

27
Q

What does SOCRATES stand for?

A

Site

Onset: when, sudden/gradual

Character: ache, stabbing

Radiation

Associations: any other problems associated with the pain

Time course: diurnal?

Exacerbating / relieving factors

Severity: scale of 1-10

28
Q

Management of patient with chronic pain?

A

Counselling, CBT to improve state of mind

Pain management program: agreed objectives

Explanation that there is no damage occurring, and encourage exercise

Drug treatment
Other treatments

29
Q

What drugs are used to treat chronic neuropathic pain?

A

Weak and moderate strength

Anti-depressants: tricyclic + SSRIs

Anti-convulsants

N-methyl D-aspartate receptor antagonists

30
Q

How do anti-convulsants help treat chronic neuropathic pain?

A

They dampen down excitation of neurons

Reducing the transmission of pain impulses

31
Q

What is N-methyl D-aspartate?

A

A chemical involved in pain transmission

Involved in presynaptic excitation where C fibres synapse with second order fibres (in the substantia gelatinosa)

Inhibiting it can reduce pain

32
Q

How do N-methyl D-aspartate receptor antagonists help treat chronic neuropathic pain?

A

N-methyl D-aspartate is involved in presynaptic excitation of the synapse where C fibres and second order fibres meet in the s. gelatinosa

Inhibiting its action will inhibit transmission of pain from the C fibres to the brain

33
Q

What is tranacutaneous electrical nerve stimulation?

A

Method of pain relief

Uses a mild electrical current which can reduce pain signals to the brain and release endorphins that also help reduce pain

34
Q

Name some topical preparations used to treat chronic neuropathic pain?

A

Capsaicin: chilli, intense burning followed by pain relief

Lignocaine: transient pain relief effect

35
Q

What are some protective mechanisms we can do to prevent chronic pain?

A

Regional blocks, such as epidural while amputating a leg
This reduces phantom limb pain

Peri-operative gabapentin or pregabalin

Holistic approach to surgery

36
Q

Name an anti-convulsants drug used for pain?

A

Gabapentin

Neurology (23 decks)

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