Exam #01h - Neuropathic and other difficult Pain

Question 1

Which pain type is defined as pain arising as a consequence of a lesion or disease affecting the somatosensory system with indefinable damage to neurons?

Answer 1

Neuropathic pain

Question 2

Give an example of neuropathic pain?

Answer 2

phantom limb pain

Question 3

True or False - Regarding neuropathic pain, the pain signal is maintained ectopically by dysfunction in the activity of tissue nociceptors and/or by abnormal pain signaling in the CNS?

Answer 3

True - pain can persist even after stimulus is gone

Question 4

With regards to peripheral sensitization, increases in excitability of peripheral nociceptors DECREASES OR AMPLIFIES pain signals to the CNS?

Answer 4

amplifies

Question 5

With regards to central sensitization, increases in the excitability of pain-transmitting neurons within the CNS result in normal inputs producing MUTED/EXAGGERATED responses?

Answer 5

exaggerated

Question 6

Name (7) different difficult pains to treat?

Answer 6

1. neuropathic
2. burns
3. bone
4. migraines
5. sickle cell
6. phantom limb
7. fibromyalgia

Question 7

What are the first line agents to treat difficult pain. If neither of these 2 agents work, what is tried next?

Answer 7

first line are NSAIDs or APAP

if those don’t work, try opioids

Question 8

List the (4) extreme sensations that characterize neuropathic pain?

Answer 8

1. burning (like a blow torch)
2. electricity
3. extreme cold
4. numbness and tingling

Question 9

Which nerve fiber, that responds to light touch/pressure, is particular to neuropathic pain?

Answer 9

A-beta nerve fiber

Question 10

How would A-beta fiber that responds to light touch/pressure be involved in neuropathic pain?

Answer 10

A-beta fibers are in close proximity to C-fibers (the afferent neurons that transmit slow pain to CNS) and, after damage, A-beta fibers could synapse with C-fibers so the lightest touch on your body could be perceived as painful

Question 11

What was the first FDA approved drug for Tx of fibromyalgia (brand and generic)

Answer 11

Pregabalin (Lyrica)

Question 12

Explain the MOA of Gabapentin and Pregabalin?

Answer 12

They bind to subunits of voltage-gated Ca2+ channels and inhibit excitatory NT release

Question 13

What are (7) common AE associated with Gabapentin and Pregabalin?

Answer 13

1. dizziness
2. sleepiness
3. dry mouth
4. edema
5. blurred vision
6. weight gain
7. difficulty concentrating

Question 14

What non-opioid, non-NSAID analgesic is administered intrathecally to treat the most severe intractable pains for refractory cases (brand and generic)?

Answer 14

Ziconotide (Prialt)