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Neurology > Management of Chronic Pain > Flashcards

Management of Chronic Pain Flashcards

1
Q

What is pain?

A

An unpleasant sensory and emotional experience, associated with actual tissue damage or described in terms of such damage

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2
Q

What kind of experience is pain?

A

Unique and conscious

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3
Q

What are the 3 main variables in pain?

A
  • Sociocultural
  • Biological
  • Psychological
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4
Q

What is obvious in acute pain?

A

Tissue damage

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5
Q

What type of function may acute pain have?

A

Protective

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6
Q

There is INCREASED nervous system activity in acute pain

A

TRUE

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7
Q

When does pain in acute pain resolve?

A

Upon healing

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8
Q

What is chronic pain?

A

Pain beyond expected period of healing

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9
Q

Describe chronic pain.

A
  • Pain no longer serves a useful purpose
  • Changes in pain signalling and detection
  • Degrades health and function
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10
Q

What should you always use when taking a measurement of pain?

A

Verbal scale rating

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11
Q

What should you always look for in examination?

A

To see if the person is in pain

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12
Q

What kind of behavioural observations might you see in someone who is in pain?

A
  • Grimacing
  • Rigid body posture
  • Limping
  • Frowning
  • Crying
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13
Q

What are some physiological responses to pain?

A
  • Increased HR

* Increased BP

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14
Q

RULE 1

A

Listen to the patient

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15
Q

RULE 2

A

The pain is what they say it is

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16
Q

RULE 3

A

They can be in pain even if they don’t look like it

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17
Q

Name the 2 main types of pain.

A
  • Nociceptive

* Neuropathic

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18
Q

Describe nociceptive pain.

A

An appropriate physiologic response to painful stimuli via an intact nervous system

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19
Q

Describe neuropathic pain.

A

An inappropriate response caused by a dysfunction in the nervous system

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20
Q

How is a diagnosis of neuropathic pain achieved?

A

History + Exam

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21
Q

How do patient usually describe neuropathic pain?

A
  • Burning
  • Shooting
  • Tingling
  • Sensitivity
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22
Q

On examination of a patient with neuropathic pain, what sensory changes are observed?

A
  • Allodynia

* Hyperalgesia

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23
Q

What is allodynia?

A

Pain from a stimulus that isn’t normally painful

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24
Q

What is hyperalgesia?

A

More pain than expected from a painful stimulus ie. pin prick

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25
Q

Suggest some causes of neuropathic pain.

A
  • Shingles, post-herpetic neuralgia.
  • Surgery.
  • Trauma.
  • Diabetic neuropathy.
  • Amputation.
  • Many of unknown origin
26
Q

What is neuroplasticity?

A

The ability of the nervous system to form and recognise synapses

27
Q

What does a lower degree of chronicity relate to?

A

A better therapy result

28
Q

Chronic pain is associated with MORPHOLOGICAL CHANGES IN THE CNS

A

TRUE

29
Q

Once pain is present, it is often persistent and seldom totally resolves, even with treatment

A

TRUE

30
Q

Give examples of non-opioid analgesics.

A

NSAID’s

Paracetamol

31
Q

Give examples of opioid analgesics.

A

Tramadol.
Codeine.
Morphine.
Oxycodone.

32
Q

Give examples of 2 antidepressants.

A

Amytriptyline

Duloxetine

33
Q

Give examples of 2 anticonvulsants.

A

Gabapentin

Pregabalin

34
Q

Give examples of 2 topical analgesics.

A

Capsaicin

Lidocaine 5% plaster

35
Q

Topical analgesics reduce pain impulses transmitted by what?

A
  • A delta fibres

* C fibres

36
Q

What are the main side effects of topical analgesics?

A
  • Rash
  • Pruritus
  • Erythema
37
Q

List the main side effects of opioids.

A
  • N+V
  • Constipation
  • Dizziness
  • Vertigo
  • Somnolence
  • Dry skin
  • Pruritus
38
Q

List the main side effects of NSAID’s.

A
  • GI irritation/bleeding
  • Renal toxicity
  • Drug-drug interactions
  • CVS side effects
39
Q

List the main side effects of anti-convulsants.

A
  • Sedation
  • Dizziness
  • Ataxia
  • Peripheral oedema
  • Nausea
  • Weight gain
40
Q

List the main side effects of SNRI’s.

A
  • N+V
  • Constipation
  • Somnolence
  • Dry mouth
  • Increased sweating
  • Loss of appetite
41
Q

Severe chronic pain is ________

A

MULTIFACTORIAL

42
Q

What kind of pain do NSAID’s work on?

A

Nociceptive

43
Q

What is the mod of action of NSAID’s?

A
  • Inhibition of cyclooxygenase

* Prosatglandin synthesis decreases

44
Q

Name some NSAID’s.

A
  • Ibuprofen

* Aspirin

45
Q

What is paracetamol a derivative of?

A

Analine derivative ie. Panadol

46
Q

What is the efficacy of paracetamol?

A
  • Analgesic

* Antipyretic

47
Q

What is the mode of action of paracetamol?

A
  • Inhibition of central prostaglandin synthesis
48
Q

Give 2 examples of week opioids.

A
  • Tramadol

* Codeine

49
Q

Give 2 examples of strong opioids.

A
  • Morphine

* Oxycodone

50
Q

Describe the efficacy of opioids.

A
  • For nociceptive pain
  • Less effective in chronic states
  • Only partially effective in neuropathic pain
51
Q

Describe the mode of action of opioids.

A
  • Activates the endogenous analgesic system
  • Stimulate receptors in the limbic system to eliminate
    the subjective feeling pain
  • Affect descending pathways that modulate pain perception
  • Reduce ascending pain signal transmission in the spinal cord
52
Q

Give 2 examples of antidepressants.

A
  • Amitriptyline

* Imipramine

53
Q

Describe the efficacy of antidepressants.

A
  • Neuropathic pain
  • Complex regional pain syndrome
  • Tension headache
54
Q

Describe the mode of action of antidepressants.

A

Inhibition of neuronal re-uptake of noradrenaline and/or serotonin (5-HT)

55
Q

Give 2 examples of Selective Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs +SNRIs).

A
  • Duloxetine.

* Venlafaxine.

56
Q

Under what category do Selective Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs +SNRIs) come?

A

Antidepressants

57
Q

Describe the efficacy of SSRI’s and SNRI’s.

A
  • Neuropathic pain
58
Q

SSRI’s are better than SRNI’s

A

FALSE - SNRI’s are better

59
Q

Describe the mode of action of SSRI’s and SRNI’s.

A
  • Selectively inhibit reuptake of noradrenaline +/- serotonin
  • Provide analgesia by intensifying descending inhibition
60
Q

Give 3 examples of anticonvulsants.

A
  • Carbamazepine.
  • Gabapentin.
  • Pregabalin.
61
Q

Describe the efficacy of anticonvulsants.

A
  • Neuropathic pain
62
Q

Describe the mode of action of anticonvulsants.

A

Different modes of action:
• Gabapentin: binds to presynaptic voltage-dependent calcium channels1
• Pregabalin: interacts with special N-type calcium channels1
• Carbamazepine: blocks Na+1 and Ca2+ channels

Neurology (42 decks)

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