Chronic Pain

Question 1

any time you see central sensitization or “wind-up phenomenon” you want to think:

Answer 1

WDR neuron (wide dynamic range) neuron
NMDA receptor (plays a big role in pain)
treat with ketamine

Question 2

conversion of nociceptor specific neurons to sensitized WDR neuron:

Answer 2

light touch, stubbing toe all horrific pain

Question 3

complex regional pain syndrome:

Answer 3

pain history mnemonic:
p provokes
q uality
r reduction
s everity
t ime

Question 4

morphine and end stage renal disease patients:

Answer 4

morphine is broken down and the metabolites can build up and cause:
delirium, seizures, psychosis, respiratory failure:
NOT THE FIRST CHOICE FOR DIALYSIS PATIENTS

Question 5

Complex regional pain syndrome:

Answer 5

roots based in the over activity of the sympathetic nervous system: this makes it the target for intervention
TREAT WITH INJECTIONS INTO THE STELLATE GANGLION BLOCK: CAUSE INSTANT HORNERS

Question 6

Goal of treating chronic pain:

Answer 6

improve functionality

Question 7

TREATMENT OF CHRONiC PAIN INCLUDES:

Answer 7

WHO step ladder of increasing treatment:
NMDA antagonist: KATAMINE
ANTICONVULSANT: PREGABALIN GABAPENTIN to treat NEUROPATHIC PAIN

Question 8

diabetic neuropathy:

Answer 8

snri or tca

Question 9

of all the side effects of opiods, the one side effect that you never develop a tolerance for is:

Answer 9

constipation

Question 10

what is one of the best treatments for someone who is alerady taking medication (norco) and is now reaching the top of the WHO step ladder of pain treatment?

Answer 10

PT, TCA amytryptaline, nortryptaline, gabapentin, anticonvulsants, bupor patch, spinal cord stimulatoor, stellative ganglion block

Question 11

Which of the following are appropriate for the treatment of this patient with Complex Regional Pain Syndrome?
Start Amitriptyline
Refer patient to physical therapist to learn desensitization exercises
Assess her risk of developing addiction to opioid medications
All of the above

Answer 11

all the above

Question 12

if you have a patient that has a TENS unit (low voltage electrical stimulus to the spinal cord and this overwhelms the sensory nerve fibers that usually carry back sensation of pain) or similar treatment for chronic pain. This is thought to work via the gate control theory of pain suggests that the nerve stimulous is reducing the chronic pain, so one of the mechanisms of action of the gate controlled theory of pain would be:

Answer 12

activation of alpha beta fibers, which reduces the ability of pain inputs in the spinal thalamic tract

Question 13

if you have a patient on codeine (different than morphine bc it has to be metabolized to be effective) if you have a paitent that is not getting good pain relief on codeine. How is codeine matabolized?

Answer 13

its metabolized to morphine by deacetylating enzymes in the brain

Question 14

if you have a patient with a spinal cord stimulator, one of the ways it’s thought to reduce pain is by:

Answer 14

activating the body’s endogenous peptides that are important in pain relief, and one of these is encephlin (an endogenous peptide releasd by the body as a response to injury and inflammation, enkephlin also binds to opiod receptors, and it inhibits further neurotransmitter release to reduce pain

Question 15

you have a patient in the ED that is overdosing, he has pinpoint pupils and tracks, he is overdosing on ______ and should be given_______. How does this work?

Answer 15

morphine, IV NALOXONE (aka narcan, naltrexone), is an antogonist of opiates at the receptor site and acts by displacing it from the opiod from its receptor

Question 16

if you have a heroin addict, and you’re going to treat them with morphine replacement therapy (there are various substance abuse clinincs that give buponorfron as well, etc) which of the following is the first line treatment for this patient?

Answer 16

METHADONE (much better than narcan) is a long term replacement (or clonidine). Methadone is longer lasting and is much more controlled so it is ideal for helping with the withdrawl and weaning process. You still have constipation
partial antagonist (neltrexone, etc)

Question 17

patient has been taking opiods for a long time and has a high tolerance. Which of the following best characterises the tolerance in this patient?

Answer 17

tolerance has developed in the mu receptor in the brainstem, but he is still constipated.
You would predict that with opiod treatment, you would get constipation, horners (ptosis, meiosis, and anhydrosis) pupil constriction and naseau and vomitting

Question 18

opiods cause:

Answer 18

constipation, miosis, naseau vomitting, horners, etc

Question 19

which of the following is true about morphine
used therapeutically to reiieve pain?
withdrawl symptoms can be relieved by naloxone?
causes diarrhea?
most effective orally?
rapidly enters body tissues, including the fetus?

Answer 19

rapidly enters body tissues, including the fetus

naloxone CAUSES withdrawl symptoms bc its an opiod receptor antagonist

Morphine causes CONSTIPATION

Question 20

which of the following is true about morphine
used therapeutically to reiieve pain?
withdrawl symptoms can be relieved by naloxone?
causes diarrhea?
most effective orally?
rapidly enters body tissues, including the fetus?

Answer 20

rapidly enters body tissues, including the fetus

naloxone CAUSES withdrawl symptoms bc its an opiod receptor antagonist

Morphine causes CONSTIPATION