Chronic pain management Flashcards
Which laminae are involved in pain detection?
Lamina I and V
Which fibres carry information about pain?
A delta
C fibres
Difference nociceptive pain and neuropathic pain?
Nociceptive is an appropriate response to pain stimuli
Neuropathic caused by dysfunction in nervous system
What is allodynia?
Pain from a stimulus that is not normally painful
What is hyperalgesia?
More pin than expected from painful stimulus
Pharmacological approaches to pain management?
WHO ladder
Adjuvants
- AntiD’s (amitriptylline, duloxetine)
- Anticonvulsants (Gabapentin, pregabalin)
- Topical (Capsaicin, lidocaine)
Local anaesthetic
Mode of action NSAIDs
Inhibits cyclooxygenase 1 which decreases prostaglandin synthesis
Mode of action of opioids?
Stimulate receptors in limbic system–> eliminates subjective feeling pain
Affect descending pathways that modulate pain perception
Reduce ascending pain signal transmission in spinal cord
S/E of opiods?
N + V Constipation Dizziness Somnolence Dry skin
Mode of action TCAs
Inhibition of neuronal reuptake of noradrenaline and serotonin (5 HT)
SSRI and SNRI same except selective inhibition
S/E of TCAs?
Constipation
Dry mouth
Somnolence
Mode of action of gabapentin?
Binds to presynaptic voltage dependant calcium channels
Mode of action of pregabalin?
Interacts with special N-type calcium channels
Mode of action of carbamazepine?
Blocks Na and Ca channels
S/E of anticonvulsants?
Sedation
Dizzy
Ataxia
Periph oedema
