Exam #01c - Pain

Question 1

True or False - sensation of acute pain should not be eliminated, while sensation of chronic pain should be eliminated?

Answer 1

True - chronic pain is deleterious to quality of life (QoL)

Question 2

The optimal therapy for pain involves matching what with what?

Answer 2

The analgesic MOA with the type(s) of pain

Question 3

Pain pathways involve pain signals traveling to the spinal cord via what (2) nerve fibers? What type of pain does each carry?

Answer 3

1. A-delta - sharp pain

2. C fibers - dull, burning pain

Question 4

Which pain pathway nerve fiber carries the pain signal to the spinal cord faster than the other? Why?

Answer 4

A-delta fibers carry sharp, specific pain to the spinal cord faster b/c they are thicker and thinly sheathed in a insulating material (myelin) compared to the unmyelinated C-fibers

Question 5

Where do A-delta and C fibers synapse on second order neurons in the spinal cord (after entering the dorsal root ganglion)?

Answer 5

Substantia gelatinosa

Question 6

What part of the brain allows us to located where pain is coming from?

Answer 6

Somatosensory cortex

Question 7

Which type of pain is due to a stimulus that does not normally provoke pain (i.e. a non-noxious stimulus)?

Answer 7

Allodynia - no nociceptor activation

Question 8

Which type of pain has matching presynaptic and postsynaptic activity?

Answer 8

Normal pain

Question 9

Which type of pain is an inappropriate excess response to a pain stimulus?

Answer 9

Hyperalgesia

Question 10

Which type of pain involves the pain getting amplified when you allow pain to persist?

Answer 10

Sensitization

Question 11

Which pain is easy to diagnose, but difficult to treat b/c of a huge psychological component often correlating to physical or mental abuse?

Answer 11

Fibromyalgia

Question 12

Compare the SOA for NSAIDs, LA’s, and opioids?

Answer 12

NSAIDs work at site of injury in the periphery
LA’s work at the primary afferent neuron
Opioids work in the CNS

Question 13

What are the (5) types of analgesics used to treat nociceptive pain?

Answer 13

1. NSAIDs
2. Opioids
3. Tramadol
4. APAP
5. Combinations

Question 14

NSAIDs have which of the following properties:

A) rapid onset
B) anti-inflammatory
C) inhibits COX-1
D) lacks CNS effects of opioids
E) analgesic

Answer 14

NSAIDs have all of those properties

Question 15

What (2) ways can you develop APAP hepatoxicity when taking APAP?

Answer 15

1. OD

2. excess alcohol

Question 16

Which receptor type do opioids primarily work through to deliver analgesia?

Answer 16

mu GPCR’s (inhibitory, Gi)

Question 17

True or False - Tramadol is a centrally acting analgesic with NO peripheral effect?

Answer 17

True

Question 18

Why is it said that Tramadol is multi-modal with a dual MOA?

Answer 18

Tramadol has (2) enantiomers which activate mu opioid receptors (from metabolite, mu agonist) and nonopioid receptors (inhibiting reuptake of NE and 5-HT)

Question 19

True or False - Tramadol and Tapentadol are considered NSAIDs?

Answer 19

False

Question 20

Tapentadol also has a dual MOA like Tramadol. How is Tapentadol’s MOA different?

Answer 20

Tapentadol still inhibits the afferent pain signal by being a mu opioid agonist, but different than Tramadol in that it is only a NE reuptake inhibitor (and not 5-HT as well)

Question 21

True or False - Patients tend to dose themselves with less opioid when using PCA (patient controlled analgesia) rather than healthcare professionals controlling it?

Answer 21

True

Question 22

True or False - the WHO analgesic ladder is a guide to the proper dose of analgesic?

Answer 22

False - it says nothing about dose. Start with 1st step drugs and if pain persists, move up the ladder