Management of CHRONIC PAIN Flashcards
What causes PAIN after injury?
- Peripheral Sensitization
2. Central Sensitization
What is peripheral sensitization?
- a REDUCTION in the threshold of PERIPHERAL AFFERENT nociceptors
What is CENTRAL sensitisation?
- incr. excitability of SPINAL neurones
- REWIRING of the spinal cord
- changes in the BRAIN
How does chronic regional pain syndrome present as?
- ALLODYNIA
- hyperalgesia
- swelling
- blue, white, red
- hair and NAIL changes
- OSTEOPENIA
What is ALLODYNIA?
- a usually, non-painful stimulus triggers pain
Name the 4 diff. types of pain.
- Nociceptive pain (pain from INJURY RELAYED through a NORMAL nervous system)
- neuropathic pain (pain generated WITHIN the NS)
- Others: INFLAMMATORY
- Mixed
What is hyperalgesia?
- more pain than expected from a PAINFUL stimulus (pin-prick)
What are the causes from neuropathic pain ?
SHINGLES, post- herpetic neuralgia
- trauma/ surgery/ DIABETIC neuropathy/ amputation
Describe neuropathic pain.
- burning/ shooting/ tingling/ sensitivity
Main 2 classes of drugs for management of neuropathic pain?
- TCAs (amitriptyline)
- ANTICONVULSANTS (GABAPENTIN)
Name other drug classes than can be used to treat neuropathic pain.
- opioids (MORPHINE)
- NMDA antagonist (KETAMINE)
- CAPSAICIN
- gaba AGONIST (baclofen)
What drugs are given to children with chronic pain?
- Topical Levomenthol
- Total Capsaicin
- Lidocaine
- TCAs (Amotriptyline)
- Gabapentin and Pregabalin
What causes pain in a cancer pt?
- Post-surgical pain
- Chemo-induced painful PERIPHERAL neuropathies
- chronic GRAFT vs HOST disease
- Radiation induced pain SYNDROME
- Hormonal therapy and arthralgias
apart from medical interventions what can be done with chronic pain?
- Physiotherapy
- occupational therapy
- psychology
- pain association scotland
- pain MANAGEMENT programme
What procedural work can be done to rx chronic pain?
- TENS
- Acupuncture
- Nerve Blocks
- intrathecal drug delivery systems
- spinal cod stimulation
What percent is chronic pain suggestive to inherited?
- 40-50%
What genes are involved in the manifestation of chronic pain?
presence of ABNORMAL SCN9A = INCR. pain
====if ABSENT= no pain
Can acute pain transition to CP?
- YES
- related to child ANXIETY, parental catastrophing, depression and sleep quality
Can an ankle sprain develop into CP?
- neurodegeneration
- axonal dropout in PERIPHERAL nerve
- FEAR of pain
- cytokine changes
What is erthromalalgia?
Burning hands and left
What channelopathies are a.w pain?
- SODIUM channelopathies
What are side efx of CP?
HORMONAL (adrenal/libido)
Immunomodulation
Hyperalgesia (OIH)
How and why does “phantom pain” arise?
- occurs d.t remapping of cortically representations (LOWER FACE)
- to the missing hands
