Lecture 9 (1/3) Flashcards
what is a syndrome?
a collection of signs, symptoms, and medical problems that tend to occur together, but are not related to a specific, identifiable cause
- can turn into a disease or collection of disease
- you don’t know the cause
what is a disease?
a medical condition with a specific cause or causes and recognizable signs and symptoms
what is cancer?
whole bunch of individual diseases
what are the 3 types of clinical pain?
- acute pain
- cancer pain
- chronic non-cancer pain
difference between acute, sub-acute, and chronic pain
- acute: if back pain get resolved in 6-7 weeks
- Sub-acute: longer than that but less than 3 months
- Chronic: more than 12 weeks
why are there two phases of postsurgical pain?
there’s nociceptors activated at cut and from inflammation after you wake up
explain the role of analgesics after surgery
Analgesic wont reduce nociceptive output, but it might reduce inflammation post surgery
who is Scott Reuben?
published series of papers stating preemptive analgesia makes pain better, but he was a fraud (now no one believes preeemptive analgesia was a thing)
when does post-surgical pain become chronic post-surgical pain?
when it doesn’t go away after 3 months
in the USA, how many operations per year are there and how many develop CPSP?
23 million operations per year (5-85% develop CPSP)
what is causing CPSP?
Almost certainly that surgeon nicked the nerve (neuropathic pain)
Why doesn’t the risk of developing CPSP appear in surgical consent forms?
Not the surgeon’s problem (they don’t deal with pain)
explain the grey matter and CPSP study
- If you successfully treat pain, grey matter comes back
- No one knows what’s causing grey matter loss, nor which part of the brain is losing grey matter
what is primary cancer?
where it starts
what are the most likely and least likely types of cancer to be painful?
- least: leukemia
- most: oral/bone cancer
what is breakthrough pain?
spikes in pain level that last minutes to hours
- Need to have a second medication for this
- Dose of moderate opioid all the time thru IV
- When they complain of pain, shot of higher dose/more potent opioid is added
what is the problem w chemo therapeutics?
they produce neuropathy (that’s sometimes painful)
what % of people get CIPN (Chemotherapy-Induced Peripheral Neuropathy)?
30-40% of chemo recipients gets CIPN (~75% of this is painful neuropathy)
what causes cancer pain?
- Tumour presses on nerves
- Inflammation from immune system attacking tumour
- Tumour disrupting nearby tissue
- Algogens releasing
how many people have OA?
27 million
what are shock absorbers in joints?
cartilage and synovial fluid
what makes up a joint?
Cartilage, membrane, fluid, capsule
what are the 2 types of arthritis?
OA: Joint itself can degrade –> rubs together
– no inflammation
- Some people complain of pain, some don’t
Rheumatoid: happens to young people, autoimmune disease (immune system attacking tissues –> inflammation)
- Amount of inflammation is not necessarily indicative of how much pain someone is in
what are the two problems with arthritis?
pain and dysfunction
explain difference in treatment between RA and OA
very bad a treating OA, very good at treating RA
what is the mechanism of RA?
immune system attacks cartilage
explain RA treatment
- Macrophages release TNF alpha
- All drugs are TNF alpha blockers (so there’s less tissue damage)
- Affects symptoms AND disease
- Some of the best selling drugs in the world
- Have to be infused or injected because a physician needs to watch for side effects (first 20 min)
