Management of CHRONIC PAIN Flashcards

1
Q

What causes PAIN after injury?

A
  1. Peripheral Sensitization

2. Central Sensitization

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2
Q

What is peripheral sensitization?

A
  • a REDUCTION in the threshold of PERIPHERAL AFFERENT nociceptors
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3
Q

What is CENTRAL sensitisation?

A
  • incr. excitability of SPINAL neurones
  • REWIRING of the spinal cord
  • changes in the BRAIN
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4
Q

How does chronic regional pain syndrome present as?

A
  • ALLODYNIA
  • hyperalgesia
  • swelling
  • blue, white, red
  • hair and NAIL changes
  • OSTEOPENIA
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5
Q

What is ALLODYNIA?

A
  • a usually, non-painful stimulus triggers pain
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6
Q

Name the 4 diff. types of pain.

A
  1. Nociceptive pain (pain from INJURY RELAYED through a NORMAL nervous system)
  2. neuropathic pain (pain generated WITHIN the NS)
  3. Others: INFLAMMATORY
  4. Mixed
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7
Q

What is hyperalgesia?

A
  • more pain than expected from a PAINFUL stimulus (pin-prick)
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8
Q

What are the causes from neuropathic pain ?

A

SHINGLES, post- herpetic neuralgia

- trauma/ surgery/ DIABETIC neuropathy/ amputation

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9
Q

Describe neuropathic pain.

A
  • burning/ shooting/ tingling/ sensitivity
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10
Q

Main 2 classes of drugs for management of neuropathic pain?

A
  • TCAs (amitriptyline)

- ANTICONVULSANTS (GABAPENTIN)

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11
Q

Name other drug classes than can be used to treat neuropathic pain.

A
  • opioids (MORPHINE)
  • NMDA antagonist (KETAMINE)
  • CAPSAICIN
  • gaba AGONIST (baclofen)
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12
Q

What drugs are given to children with chronic pain?

A
  1. Topical Levomenthol
    - Total Capsaicin
    - Lidocaine
    - TCAs (Amotriptyline)
    - Gabapentin and Pregabalin
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13
Q

What causes pain in a cancer pt?

A
  1. Post-surgical pain
  2. Chemo-induced painful PERIPHERAL neuropathies
  3. chronic GRAFT vs HOST disease
  4. Radiation induced pain SYNDROME
  5. Hormonal therapy and arthralgias
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14
Q

apart from medical interventions what can be done with chronic pain?

A
  • Physiotherapy
  • occupational therapy
  • psychology
  • pain association scotland
  • pain MANAGEMENT programme
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15
Q

What procedural work can be done to rx chronic pain?

A
  • TENS
  • Acupuncture
  • Nerve Blocks
  • intrathecal drug delivery systems
  • spinal cod stimulation
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16
Q

What percent is chronic pain suggestive to inherited?

A
  • 40-50%
17
Q

What genes are involved in the manifestation of chronic pain?

A

presence of ABNORMAL SCN9A = INCR. pain

====if ABSENT= no pain

18
Q

Can acute pain transition to CP?

A
  • YES

- related to child ANXIETY, parental catastrophing, depression and sleep quality

19
Q

Can an ankle sprain develop into CP?

A
  • neurodegeneration
  • axonal dropout in PERIPHERAL nerve
  • FEAR of pain
  • cytokine changes
20
Q

What is erthromalalgia?

A

Burning hands and left

21
Q

What channelopathies are a.w pain?

A
  • SODIUM channelopathies
22
Q

What are side efx of CP?

A

HORMONAL (adrenal/libido)

Immunomodulation

Hyperalgesia (OIH)

23
Q

How and why does “phantom pain” arise?

A
  • occurs d.t remapping of cortically representations (LOWER FACE)
  • to the missing hands