Chronic Pain

Question 1

Pain can be modulated at every synapse of the pain pathway. TRUE/FALSE?

Answer 1

TRUE

Question 2

There are no biomarkers for pain. TRUE/FALSE?

Answer 2

TRUE

Question 3

How does peripheral tissue injury change to nervous system.

Answer 3

Peripheral sensitisation
- reduction in threshold of peripheral afferent nociceptors

Central sensitisation
- Increased excitability of spinal neurons

Question 4

What clinical features are often present in Chronic Regional Pain Syndrome (CRPS)?

Answer 4

• Allodynia (pain from non-painful stimulus e.g. cotton wool)
• Hyperalgesia (more pain than expected from painful stimulus e.g. pin prick)
• Swelling
• Blue, white, red
• Hair, nail changes
• Osteopenia

Question 5

What type of pain is felt in CRPS?

Answer 5

Neuropathic pain

Question 6

How do patients describe neuropathic pain?

Answer 6

burning
shooting
tingling
sensory changes also present

Question 7

What other conditions can cause neuropathic pain?

Answer 7

shingles
post-herpetic neuralgia
Diabetic neuropathy
Amputation/ surgery

Question 8

Apart from tricyclic antidepressants and anticonvulsants, what can be used to treat neuropathic pain?

Answer 8

NMDA antagonists (eg ketamine)
Sodium channel blockers (eg lignocaine)
Capsaicin
GABA agonists (eg Baclofen)

Question 9

What agents are more commonly used in children for neuropathc pain?

Answer 9

Topical levomenthol
Topical capsaicin
Lidocaine (patch)

Question 10

How can chronic pain occur in cancer survival?

Answer 10

• Post surgery
• Chemotherapy induced peripheral neuropathies
• Chronic graft vs host disease
• Radiation induced

Question 11

Other than medication, what therapies can a chronic pain clinic offer?

Answer 11

• TENS
• Acupuncture
• Nerve Blocks
• Intrathecal Drug Delivery Systems
• Spinal cord stimulation

Question 12

Patients who develop more pain during the post-op period are at less risk of chronic pain in the future. TRUE/FALSE?

Answer 12

FALSE

At increased risk of chronic pain after

Question 13

Delay of amputation in countries at war proved to increase rates of phantom limb pain. TRUE/FALSE?

Answer 13

TRUE

Question 14

Phantom limb pain can also exist in babies who were never born with a particular limb. TRUE/FALSE?

Answer 14

TRUE

Question 15

When one area of the brain dedicated to an amputated limb is no longer required, what happens?

Answer 15

Brain remapping => other areas of body use this area of brain

Question 16

What types of pain are opioids not useful for?

Answer 16

Neuropathic

Fibromyalgia

Question 17

The poorer countries have lower access to morphine. TRUE/FALSE?

Answer 17

TRUE
due to proportionally more expensive there
=> patients suffer without good opioids for pain

Question 18

How should patients be referred to the pain service in Tayside?

Answer 18

Socrates

PainGo