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Spring 2024 Therapeutics 3 > Final Pain > Flashcards

Final Pain Flashcards

1
Q

What are the 3 brain circuits?

A

Peripheral pain Circuitry
Spinal Pain Circuitry
Brain Pain Circuitry

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2
Q

What are the 2 types of pain?

A

Acute
Chronic

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3
Q

What is considered “chronic” pain?

A

Pain lasting > 3 months

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4
Q

What are the 4 types of chronic pain?

A

Nociceptive
Neuropathic
Visceral
Mixed

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5
Q

What is nociceptive pain?

A

Related to inflammation/inflammatory condition

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6
Q

What is neuropathic pain?

A

Neuronal origin (neurogenic)

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7
Q

What is visceral pain?

A

Pain/pressure around internal organs

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8
Q

Diabetic neuropathy is an example of what type of pain?

A

Chronic -> Neuropathic -> Peripheral

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9
Q

What is the “fifth vital sign”?

A

Pain
-considered this

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10
Q

What are the 3 functions of pain?

A

-Warning system (avoid injury)

-Aid in repair (make area hypersensitive to avoid use of area so tissue can heal)

-Can be maladaptive (inflammation may lead to more damage)

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11
Q

How do we characterize pain?

A

Temporal features (onset, duration, course, pattern)

Intensity (average, least, worst)

Location

Quality

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12
Q

Pain from inflammation may have what qualities?

A

Throbbing
Pulsating

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13
Q

Neuropathic pain may have what qualities?

A

Stabbing
Shooting
Burning
Tingling

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14
Q

Visceral pain may have what quality?

A

Squeezing

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15
Q

What is opioid induced hyperalgesia?

A

Chronic opioid use makes pain worse and more pronounced

-This is an adaptive response by the body to opioid treatment

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16
Q

What is referred pain?

A

Pain that comes from another area of the body but the patient feels it in a different area

(ex: MI pain may extend down arm or in jaw)

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17
Q

What is the relation between pain and mood?

A

Pain is an EMOTION and impacts mood

*may make the Wong-Baker face rating scale less accurate if child is upset

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18
Q

What is the transmission pathway that pain takes in the periphery?

A

Periphery -> Spinal Cord -> Central Effect (brain) -> Back to Spinal Cord

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19
Q

The release of which inflammatory mediators at a site of trauma stimulates the afferent neuron to send signals to the spinal cord?

A

Prostaglandins
Bradykinin
Potassium

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20
Q

In the periphery, what is activated after trauma?

A

Peripheral Nervous System

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21
Q

What are the 3 groups of receptors in the periphery involved in pain signaling?

A

Temperature Sensitive
Acid Sensitive
Chemical Irritant Sensitive

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22
Q

What are the 3 temperature sensitive receptors?

A

Transient receptor potential cation channel (TRP)

TRPV (Vanniloid)

TRPM (Melastatin)

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23
Q

What is the role of the Transient receptor potential cation channel (TRP)?

A

Conducts Na, K, or Ca

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24
Q

What is sensed by the receptor TRPV (Vanniloid)?

A

Heat
(and spice/ capsaisan)

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25
Q

What is sensed by the receptor TRPM (Melastatin)

A

Cold
(also menthol)

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26
Q

What is the acid sensitive receptor in the periphery?

A

Acid sensing ion channel (ASIC)

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27
Q

What molecule activates the Acid sensing ion channel (ASIC)?

A

H+

28
Q

What molecule does the Acid sensing ion channel (ASIC) conduct?

A

Na+

29
Q

What are the chemical irritant sensitive receptors in the periphery?

A

Histamine

Bradykinin

30
Q

True or False: the reflex upon painful stimuli does not require CNS processing and does not need to go to the brain to occur

A

True

31
Q

What channels are important for action potential conduction?

A

Na+ and K+

(*specifically Na1.8)

32
Q

Which sodium channel is most important for action potential conductance?

A

Na 1.8

33
Q

What neurotransmitter is important in pain conduction?

A

Glutamate
-in spinal cord

34
Q

What are teh glutamate receptors?

A

AMPA (ion channel)
NMDAR (ion channel)
mGluR (metabotropic receptor)

35
Q

What are the 3 different pain fibers?

A

A beta fibers

A delta fibers

C-fibers

36
Q

What pain signals are transduced by A beta fibers?

A

Non-noxious (not pain producing)

ex: touch, pressure

37
Q

What pain signals are transduced by A delta fibers?

A

Pain, Cold

“First Pain” -reflex arc (sends initial feeling to brain)
-sharp, prickly

38
Q

What pain signals are transduced by C-fibers?

A

Pain, Temp, Touch, pressure, Itch
(polymodal) -involved with prolonged pain

“Second pain”
-dull, aching (nagging persistent pain)

39
Q

Does not having a myelin coating make a signal pathway faster or slower?

A

Slow

40
Q

Rank the 3 different pain fibers in order of Fastest to Slowest

A

F:
A beta- fibers (thick myelin coating)

A delta fibers (myelinated but not thick)

C-fibers (unmyelinated)
S:

41
Q

What is peripheral sensitization?

A

Repeated stimuli reduce firing threshold

-easier for pain conducting neurons to fire and conduct the painful stimuli
-more heightened pain response

42
Q

What substance is responsible for peripheral sensitization?

A

Substance P

(a neuropeptide released upon injury)

43
Q

What are the 4 functions of substance P?

A

Vasodilation

Degranulation of mast cells

Release of histamine

Inflammation and prostaglandin release

44
Q

How do the functions of Substance P contribute to peripheral sensitization?

A

Increase expression of pain receptors

45
Q

What leads to neuropathic pain sensitization in the spinal cord?

A

Change in neuropeptide release
-CGRP and Substance P released
-Chemical and biochemical changes occur on postsynaptic neurons in the spinal cord causing increased sensitivity

**Also increased AMPA and NMDA receptor expression which leads to more sensitivity
-these enhance the excitability of spinal neurons and pain conduction

*Also possibly enhanced sodium channel subtype expression leading to:
–Enhanced cellular excitability
–Generation of ectopic action potentials

46
Q

Where in the brain is there a high expression of opioid receptors?

A

In the brain stem along the descending pathway

*note: endogenous opioids stimulate descending inhibition

47
Q

What is the main opioid receptor expressed in the brain?

A

Mu opioid receptor

48
Q

What is the function of the descending pain pathway from the brain?

A

Modulates both the perception of pain and the signal coming up into the brain to allow you to perceive pain

49
Q

What is the main opioid receptor targeted by drugs?

A

Mu opioid receptor

(important in modulating pain pathways, also targeted by endogenous opioids)

50
Q

What are the actions of mu opioid receptors in the brain?

A

-Alter mood
-Produce sedation
-Reduce emotional reaction

51
Q

What are the actions of the mu opioid receptors in the brainstem?

A

Increase the activity of descending fibers

52
Q

What are the actions of the mu opioid receptors in the spinal cord?

A

Inhibit vesicle release

Hyperpolarize the post-synaptic membrane

53
Q

What are the actions of the mu opioid receptors in the periphery?

A

Reduce activation of primary afferent

Modulate immune activity

54
Q

What is the function of the somatosensory cortex (cortex) in processing pain?

A

Tells you where on the body the pain is coming from

55
Q

What is the function of the amygdala in processing pain?

A

Anticipates pain and reacts to perceived threats

56
Q

What is the role of the prefrontal cortex in processing pain?

A

Decision making, processes pain and plans actions to reduce the pain

57
Q

What is the function of the right lateral orbitofrontal cortex in processing pain?

A

Evaluates sensory stimuli, decides response

*Particularly used if fear is involved

58
Q

What is the function of the nucleus accumbens in processing pain?

A

Releases dopamine and serotonin

**this is the area associated with pleasure upon opioid use and addiction

59
Q

What questions would you want to ask to subjectively assess a patient’s pain?

A

PQRSTU

Precipitating factors (what makes better/worse)

Quality (stabbing, stinging, burning)

Region of pain location

Severity

Time-related nature (worse at certain time of day?)

U: impact of pain on yoU

60
Q

What objective information should we assess regarding pain?

A

Behavioral Changes

Physiological Changes
(sweating, pallor, tachycardia, dilated pupil, etc)

61
Q

What is acute pain?

A

Pain lasting < 3 months

62
Q

What is an example of acute pain?

A

Nociceptive pain
(tissue)

63
Q

What is an example of chronic pain?

A

Neuropathic pain
(nerve)

64
Q

What are the goals of therapy with pain treatment?

A

Correct underlying cause of pain

Minimize pain and symptoms (may not be able to be pain free, be realistic)

Improve QOL

Limit side effects

65
Q

What is the step-wise approach for treating nonmalignant pain created by the WHO?

A

Step 1: Non-opioid + or - Adjuvant analgesic

Step 2: Opioid for mild-moderate pain + Non-opioid + or - Adjuvant Analgesic

Step 3: Opioid for moderate-severe pain + Non-opioid + or - Adjuvant Analgesic

66
Q

When do we go to the next step in pain treatment?

A

If pain is persisting or increasing

67
Q

When do we step down in pain treatment?

A

If pain is resolving or toxicity occurs

Spring 2024 Therapeutics 3 (24 decks)

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