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Anesthesia (SAB) > Lecture 17: Chronic Pain Management (Exam 3) > Flashcards

Lecture 17: Chronic Pain Management (Exam 3) Flashcards

1
Q

Slide 4

A
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2
Q

What does the NMDA receptor do

A

Slide 5

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3
Q

Slide 6

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4
Q

T/F: Genetics and past experience are involved in how we handle pain

A

True

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5
Q

What happens to the movement when there is pain in an area of the body

A
  • The kinesthetics of movement change
  • See compensation for painful or stiff regions leads to additional probs
  • ex. support limb OA, myofascial strain patterns, & Tendon & ligament injury
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6
Q

What is there a balance of in the body

A

Pro-inflammatory & anti-inflammatory mediators

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7
Q

What happens to the balance of pro & anti-inflammatory mediators if there is injury

A

Slide 8

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8
Q

What happens to inflammation as a px ages

A

It increases

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9
Q

What is fascia

A
  • White connective tissue
  • Directly under the skin
  • Deeper & broader bands of connecting muscles & tendons
  • The connection btw/ bones
  • The “interstitium” around organs & vessels
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10
Q

What is the clinical relevance of fascial tissue

A
  • Contractile elements of fascial enable modulating role in force generation & mechanosensory fine-tuning

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11
Q

What is the role of connective tissue in disease

A

Slide 12

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12
Q

Slide 13

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13
Q

How can we use myofascial to determine pain

A
  • By palpating
  • Hold alot of the pain
  • Doesn’t give the exact location of pain but an area where it is located
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14
Q

Slide 16

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15
Q

Slide 17

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16
Q

T/F: Opioids play a very important role in chronic pain management

A

False it is very questionable b/c of neuro-inflammatory, poor long-term efficacy, increasing doses req, & poor bioavailability

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17
Q

Slide 19

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18
Q

Describe Gabapentin

A
  • Most relevant anti-epileptic drug

slide 20

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19
Q
A
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20
Q

_______ leads to modifications in pain pathways that are more complex than acute pain.

A

chronic pain

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21
Q

rehabilitation

A

certification provides fundamental skills for pain management.

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22
Q

_____ can make pain feel more intense and should be managed alongside pain

A

stress

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23
Q

What is a key advantage of regional nerve blocks in chronic pain?

A

They can help reset pain pathways

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24
Q

_____________ can help reset the nervous system in chronic pain cases.

A

regional nerve blocks

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25
Q

What is a key benefit of strengthening exercises in hip dysplasia?

A

Strengthening gluteal muscles helps stabilize the hip

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26
Q

What is a key consideration when using laser therapy?

A

It has a biphasic dose response

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27
Q

What is a potential concern with using Gabapentin in elderly patients?

A

Ataxia and sedation

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28
Q

________ only needs to be dosed ______ daily, unlike gabapentin.

A

pregabalin; 2X

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29
Q

A receptor in the spinal cord that becomes activated during chronic pain, leading to pain amplification

A

NMDA receptor

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30
Q

Which physical therapy modality is most beneficial for weight loss in patients with mobility issues?

A

Underwater treadmill

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31
Q

What is a key benefit of non-steroidal anti-inflammatory drugs in chronic osteoarthritis?

A

They can prevent joint degeneration

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32
Q

_____________ includes treatments that don’t put drugs into the body, such as acupuncture and laser therapy.

A

physical medicine

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33
Q

________ is more beneficial than passive stretching, especially in cats.

A

active exercise

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34
Q

What is a key advantage of Pregabalin over Gabapentin?

A

Less ataxia and twice daily dosing

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35
Q

Critical factor in reducing chronic pain and inflammation

A

weight optiization

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36
Q

Which drug is most appropriate for blocking NMDA receptors orally?

A

Amantadine

37
Q

can be used to break the pain cycle in chronic cases.

38
Q

NSAIDS role

A

Anti-inflammatory medications that can provide disease-sparing effects when used long-term

39
Q

Myofascial Palpation

A

Gentle examination technique to detect fascial abnormalities and pain sources

40
Q

___________ is preferred over high-velocity adjustments in elderly patients.

A

joint mobilization

41
Q

Period of intensive pain control to reset central wind-up and improve chronic pain management

A

pain vacation

42
Q

Intrinsic immune imbalance that occurs in elderly patients

A

Inflemaging

43
Q

support limb changes

A

Overuse of diagonal leg when compensating for osteoarthritis in one limb

44
Q

What is the primary concern with underwater treadmill therapy in neurologic patients?

A

Risk of fatigue leading to loss of function

45
Q

What is the recommended monitoring frequency for long-term NSAID use?

A

Every 6 months

46
Q

What is a key advantage of Librela for osteoarthritis?

A

It targets nerve growth factor

47
Q

What is the role of fascia in chronic pain?

A

It carries body awareness and can become sticky with disuse

48
Q

What is the recommended approach for chronic pain in elderly patients?

A

Multimodal therapy including physical medicine

49
Q

which nerve is important as an analgesic factor in pain management.

50
Q

What is the recommended daily dosage of EPA and DHA for dogs?

A

5,200 mg per kg

51
Q

What is the primary concern with using opioids for chronic pain?

A

They are neuroinflammatory

52
Q

How often should blood work be checked initially when starting NSAIDs?

A

Within 3-4 weeks

53
Q

Products like Adequan and Dasequin that help protect joint health

A

joint supplements

54
Q

are important omega-3 fatty acids for pain management.

A

EPA and DHA

55
Q

What is a key consideration when using herbal medicines?

A

Natural doesn’t mean safer

56
Q

can be particularly helpful for joint-specific pain.

A

shockwave therapy

57
Q

know this

58
Q

Kinesthetics of Movement

A

Compensation for
painful or stiff regions
leads to additional
problems

59
Q

what other problems can occur from kinesthetic compensation

A

Support limb OA
* Myofascial strain
patterns
* Tendon and ligament
injury
* Altered body awareness
and increased tendency
toward additional injury

60
Q

physical medicine examples

A

ouch/massage
* Acupuncture
* Laser or Photobiomodulation
* Therapeutic exercise
* Joint mobilization
* Heat/cold
* Exercise/motion
* Fascial Release

61
Q

Emerging Evidence (Lascelles) that longer
durations of treatment with _________ (6 months)
are associated with less progression of arthritis
and pain in dogs with OA

62
Q

N-Methyl D-Aspartate

A

–Become activated by recurrent depolarization- loss of
Mg plug
–When activated- massively amplify calcium release
and thus nerve transmission
–Massive contributor to neuro-inflammation
–Excellent drug targets (receptors not constitutively
active)

63
Q

N-Methyl D-Aspartate drug targets

A

Ketamine
* Amantadine
* Methadone
* +/- Tramadol (minor)

64
Q

drugs of this classification antagonize central sensitization, glial activation, and decrease opioid tolerance, making a number of drugs more
effective

A

NMDA antangonists: amantadine and memantine

65
Q

t/f: you should exercise caution when prescribing amantadine to a dog who has a pre-existing seizure condition

A

true, can cause more seizures

66
Q

________ metabolized by the liver and cleared by the kidneys, so reducing the dose with liver or
kidney disease is recommended. Amantadine is available in tablets, capsules and a liquid solution
that is safe in animals. However,

A

amantadine

67
Q

Fat is ____________
Reduction in weight is ___________

A

pro-inflammatory; Analgesic

68
Q

Polysulfonated Glycosamino-Glycans

A

FDA approved (dogs) injectable drug
* For Non-infectious arthritis
* Decrease catabolic enzymes
* Enhance anabolic enzymes

69
Q

Intra-Articular
Treatments for OA

A

Corticosteroids
* Hyaluronic acid
* Local anesthetics
* Platelet-rich plasma (PRP)
* Interleukin-1 receptor antagonist (IL-1ra,
IRAP, ACS)
* Mesenchymal or Bone Marrow stem cells
(MSC or BMAC)
* Botulinum A neurotoxin
* TRPV1 agonists (capsaicin)
* Radiation Therapy (Synovetin)

70
Q

Corticosteroids

A

Reduction in pain from 1-4 weeks
* Not considered a long-term therapy alone
-three doses four weeks apart

71
Q

regenerative therapy that augments natural healing process:

A

Platelet-Rich Plasma (PRP/ACP)
* Interleukin-1 Receptor Antagonists (IRAP)
* Mesenchymal Stem Cells
* Bone-marrow derived stem cells (BMAC

72
Q

synovetin OA

A

breaks the vicious cycle of inflammation and chronic pain

73
Q

Mechano-transduction from interaction with fascia networks

A

How fascia are associated with disease
* Modalities that interact with fascia for tissue deformation

74
Q

neuomodulation can be

A

central
spinal
peripheral
visceral

75
Q

tissue deformation is a powerful modulator of intrinsic healing in which soft tissues

A

skin, muscle
* ligaments, tendons
* fascia, cartilage
* periosteum

76
Q

When the connective tissue complex
is deformed

A

growth factors and a variety of
proteins and neurotransmitters are released

77
Q

Fibroblasts in loose connective
tissue respond to stretch

A

within minutes
* increasing ATP
* enhancing cytoskeletal relationships with neighboring cells

78
Q

Therapeutic laser

A

Photons of light energy penetrate tissue and stimulate chromophores in the mitochondria

79
Q

direct healing effects of electricity

A

-enhance bone and nerve repair mechanisms (nerves grow toward the cathode) at low intensity, but are destructive at high intensity
* PEMF- pulsed electrical magnetic field therapy (Assisi Loops, etc)

80
Q

chemical healing effects of electricity

A

Receptor mediated effects (CGRP, NGF, Substance P)

81
Q

mechanical healing effects of electricity

A

Mechanotransduction

82
Q

thermal healing effects of electricity

A

increase local blood flow

83
Q

which locations can you used electricity for healing

A

Cellular, Tissue, Segmental and Systemic

84
Q

Important Promoters of De-Amplifying
Neuromodulation

A

Acupuncture
* Motion, Physiotherapy, Rehabilitation
* Vagal nerve stimulation
* System Modifying Pharmacology
Epi-genetic changes in humans

85
Q

system modifying pharmacology (form of de-amplifying neuromodulation)

A
  • Anti-inflammatories
  • Gabapentin/Pregablin
  • Cannabinoids (analgesia and inflammation)
  • NMDA antagonists
  • Pain Vacations
86
Q

Epi-genetic changes in humans 9form of de-amplifying neuromodulation)

A
  • Meditation
  • Diet, supplements
  • Medical interventions, in general
87
Q

forms of Fascial
Modula,on

A
  • Acupuncture
  • Stretching
  • Massage/touch
  • Pressure waves
    —–Tapping
    ——ibration
    ——Shock wave therapy

Anesthesia (SAB) (17 decks)

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