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Year 4 - Neurology and Special Senses > Neurology - Pain > Flashcards

Neurology - Pain Flashcards

1
Q

What is pain?

A

Unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

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2
Q

What are the two categories of pain?

A

Acute
New onset of pain

Chronic
Pain for 3 months or more

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3
Q

What are the two aspects to the experience of pain?

A

Sensory
Sensory signal transmitted from pain receptor (sharp sensation e.g. needle)

Affective
Unpleasant emotional reaction to the pain (extremely painful, cant bear it)

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4
Q

What does it mean that pain is subjective?

A

Differs between people

If someone indicates they’re in pain, we need to accept it even when there is no apparent cause

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5
Q

What is pain threshold?

A

Point at which sensory input is reported as painful

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6
Q

What is Allodynia?

A

When pain is experienced with sensory inputs that do not normally cause pain e.g. light touch

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7
Q

What is pain tolerance?

A

How much pain a person can accept and continue as normal

Varies drastically between people

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8
Q

What are the two groups of fibres which transmit pain?

A

C fibres
Unmyelinated and small diameter

Transmit signals slowly and produce dull and diffuse pain

A-delta fibres
Myelinated and large diameter

Transmit signals fast and produce sharp and localised pain sensations

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9
Q

Where are pain signals interpreted?

A

Thalamus
Cortex

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10
Q

What are the main sensory inputs that generate pain?

A

Mechanical (pressure)
Heat
Chemical (prostaglandins)

Pain can be experienced without activity in primary afferent nociceptors
Activity in primary afferent nociceptors can be detected without patient experiencing pain

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11
Q

What is referred pain?

A

Pain experienced in a location away from site of tissue damage

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12
Q

What causes referred pain?

A
  • Nerves can share innervation of multiple body parts
  • Pain in one area amplified sensitivity in spinal cord to signals from other areas
  • Activation of sympathetic NS in response to pain causes pain in other areas
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13
Q

What is neuropathic pain?

A

Abnormal functioning or damage of sensory nerves causing pain being transmitted to the brain

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14
Q

How can pain be measured?

A

No objective way of experiencing pain

Visual analogue scale
Ask patient to rate pain along horizontal line

Numerical rating scale
0-10

Graphical rating can be used for kids, happy and sad faces

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15
Q

What are the three sets of the WHO analgesic ladder?

A

Step 1
Non-opioids e.g. paracetamol and NSAIDs

Step 2
Weak opioids e.g. codeine and tramadol

Step 3
Strong opioids e.g. morphine and fentanyl

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16
Q

What mechanisms of action does tramadol have?

A

SNRI
Opioid agonist

17
Q

How is chronic pain separated?

A

Chronic primary pain - no underlying condition

Chronic secondary pain - underlying condition can explain pain e.g. arthritis

18
Q

What factors can cotnribute to pain persistence and severity?

A

Biological
Psychological
Social

19
Q

What physical factors can lead to chronic pain?

A

Sensitisation of primary afferent nociceptors by frequent stimulation

Increased activity of sympathetic NS

Increased muscle contraction in response to pain

20
Q

What are the options for managing chronic primary pain?

A
  • Supervised group exercise programs
  • Acceptance and commitment therapy (ACT)
  • CBT
  • Antidepressants

Patients should not be started on :
- Paracetamol
- NSAIDs
- Opioids
- Anti-epileptics

21
Q

What are the typical features of neuropathic pain?

A

Numbness
Burning
Tingling
Paraesthesia
Electric shock sensation

22
Q

What are some common causes of neuropathic pain?

A

Post-herpetic neuralgia (shingles distribution in dermatome)
Nerve damage from surgery
MS
Diabetic neuralgia
Trigeminal neuralgia
Complex regional pain syndrome

23
Q

What questionnaire is used to assess pain characteristics and likelihood of neuropathic pain?

A

DN4 questionnaire

4/10 or more indicates neuropathic pain

24
Q

What treatments are used for neuropathic pain?

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

Only one used at a time

Tramadol can be used for short-term as PRN

25
Q

What is used for trigeminal neuralgia?

A

Carbamazepine

26
Q

What is complex regional pain syndrome?

A

Abnormal nerve functioning causing neuropathic pain, abnormal sensations and skin changes

Triggered by injury, can occur months after

Treatment guided by a pain specialist

27
Q

What can happen to an area in complex regional pain syndrome?

A

Allodynia
Intermitten swelling
Colour changes
Temperature changes
Skin flushing
Abnormal sweating

Year 4 - Neurology and Special Senses (41 decks)

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