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Advanced Principles B (Summer '24) > Chronic Pain Management (Exam II) > Flashcards

Chronic Pain Management (Exam II) Flashcards

1
Q

What are the 4 steps of the pain process?

A

Transduction
Transmission
Modulation
Perception

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2
Q

_______ is a reduced threshold to painful stimulus.

A

Allodynia

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3
Q

______ is an increased response to painful stimulus.

A

Hyperalgesia

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4
Q

What are the excitatory neurotransmitters relevant to the process of pain transduction?

A
  • Glutamate
  • CGRP
  • NGF
  • Substance P
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5
Q

What is the “order” of the afferent pain transmission pathway?

A

1st order neuron → 2ⁿᵈ order neurons → 3ʳᵈ order neurons

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6
Q

What are first order neurons?

A

Periphery → dorsal horn (cell bodies to dorsal root ganglion)

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7
Q

What are 2ⁿᵈ order neurons?

A

Dorsal horn to thalamus

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8
Q

What are third order neurons?

A

Thalamus to cerebral cortex

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9
Q

What is the most important site of pain modulation?

A

Substantia Gelatinosa of the dorsal horn

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10
Q

What CNS structure modulates pain by acting on the substantia gelatinosa?

A

DIC (Descending Inhibitory Complex)

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11
Q

Where does the Descending Inhibitory Complex originate and end?

A

Periaqueductal gray matter & rostroventral medulla → substantia gelatinosa

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12
Q

Pain is inhibited when spinal neurons release _____ and ______.

A

GABA & glycine

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13
Q

Pain is inhibited when the descending inhibitory pain pathway releases….

A

NE, 5-HT, and endorphins

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14
Q

What are the three mechanisms behind facilitation (intensification) of painful stimuli?

A
  • Wind-up (sensitization) of 2ⁿᵈ order neurons
  • Reception field expansion
  • Hyperexcitability of reflexes
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15
Q

What drugs can be used to attenuate pain at the level of transduction?

A
  • NSAIDs
  • Opioids
  • LA’s
  • Antihistamines
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16
Q

What drugs can be used to attenuate pain at the level of transmission?

A
  • LA’s
  • Opioids
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17
Q

What drugs can be used to attenuate pain at the level of modulation?

A
  • Opioids
  • α2 agonists
  • NMDA Antagonists
18
Q

What drugs can be used to attenuate pain at the level of perception?

A
  • Opioids
  • α2 agonists
  • General Anesthetics
19
Q

What are the two types of acute nociceptive pain?

A

Somatic & Visceral

20
Q

What are the two types of somatic pain?

A

Superficial
- Well localized
- Input from skin, SQ, mucous membranes
Deep
- muscles, tendons, bones
- dull, aching, less localizable

21
Q

What is visceral pain?

A

From disease process or abnormal organ function from organ tissue or tissue covering the organ

22
Q

Visceral pain that can be better localized to the organ is known as ______ pain.

A

Parietal

23
Q

What are the two types of chronic pain?

A

Malignant (related to cancer)
Non-malignant (neuropathic, musculoskeletal, inflammatory)

24
Q

What is repeated stimuli reducing threshold of primary afferent nociceptors progressively?

A

Sensitizaiton

25
Q

What are risk factors for developing Complex Regional Pain Syndrome (CRPS)?

A
  • Previous trauma/surgery
  • Nerve Injury (Type II)
  • Work related injury
  • Female
26
Q

What are the two types of CRPS?

A
  • Type I (Reflex Sympathetic Dystrophy)
  • Type II (Causalgia)
27
Q

What is the difference between Type I & Type II CRPS?

A

Both the same except Type II has a documented prior nerve injury.

28
Q

What is CPSP?

A

Complex Post-Surgical Pain
- Difficult to control acute pain postoperatively
- Can be unresponsive to opioids

29
Q

Chronic Pain Chart

A
30
Q

What drug classes are the firstline therapy for treatment of chronic pain?

A

TCA’s
SNRI’s

31
Q

How do TCA’s work?

A
  • Inhibition of serotonin & NE reuptake
  • Blockade of histamine, catecholamines, ACh, and Na⁺ channesl
31
Q

What anticonvulsants are commonly prescribed for chronic pain?

A
  • Gabapentin
  • Pregabalin
  • Carbamazepine
32
Q

What is the max daily dose for gabapentin?

A

3600 mg

33
Q

What is the max day dose for pregabalin?

A

600mg

34
Q

What is a commonly used medication for post-herpetic neuralgia?

A

Lidocaine patches

35
Q

How do capsaicin patches treat nerve pain?

A

Long-term exposure causes overstimulation → depletion of substance P and desensitization of nerve

36
Q

What is generally considered a second line treatment in most guidelines?

A

Tramadol

Weak μ-opioid agonist & SNRI.

37
Q

What are third-line procedural therapies for chronic pain?

A
  • Interventional pain management (Somatic blocks, sympathetic blocks)
  • Implantable stimulators (spinal, deep brain)
  • Epidural (steroids, ablation)
38
Q

In addition to NMDA antagonism, what else is inhibited via ketamine?

A

Astrocyte activation

39
Q

Targeted drug delivery involves the delivery of medications directly to the…

A

dorsal horn

40
Q

What meds are typically used in pain pumps?

A

Morphine
Ziconitide

Advanced Principles B (Summer '24) (8 decks)

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