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pharmacology 3 > neuropathic pain > Flashcards

neuropathic pain Flashcards

1
Q

neuropathic pain

A

pain caused by a lesion or disease of the somatosensory (SS) nervous system

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2
Q

peripheral neuropathic pain

A

initiated or caused by a primary lesion or disease in the peripheral SS system

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3
Q

central neuropathic pain

A

pain initiated or caused by a primary lesion or disease in the central SS system

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4
Q

peripheral neuropathic pain examples

A
  1. metabolic diabetic
  2. toxic - alcohol, chemotherapy
  3. post infectious - HIV, CMV
  4. post traumatic - post operative, neuroma/nerve entrapment, phantom limb pain
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5
Q

central neuropathic pain examples

A

spinal cord injury
post stroke pain
Multiple sclerosis

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6
Q

common types of neuropathic pain

A 
post hepatic neuralgia 
painful diabetic neuropathy 
low back nerve root pathology 
spinal cord injury 
Multiple sclerosis 
stroke
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7
Q

4 types of pain

A

noxious
inflammatory
neuropathic
nociplastic

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8
Q

nociceptive pain

A

noxious stimuli such ass heat, cold, intense mechanical force, chemical irritants
adaptive, high threshold pain
early warning system

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9
Q

inflammatory pain

A

peripheral inflammation positive symptoms
tenderness promotes repair
adaptive, low threshold pain

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10
Q

pathological pain

A

neuropathic pain

  • neural lesion, positive and negative symptoms
  • maladaptive, disease state of nerve symptoms
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11
Q

neuropathic pain

A
  • neural lesion, positive and negative symptoms

- maladaptive, disease state of nerve symptoms

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12
Q

dysfunctional pain

A
  • no lesion, no inflammation

- pain hypersensitivity, spontaneous pain

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13
Q

peripheral sensitisation

A

a damage nerve regrows and expresses different receptors
receptive field increases
stimuli that doesn’t normally cause pain start to be interpreted as pain - hyperalgesia

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14
Q

hyperalgesia

A

pain experiences is exaggerated

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15
Q

allodynia

A

non noxious stimuli causing extreme pain

due to peripheral and central sensitisation

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16
Q

taking a pain history

A

type, dustribution and location
character of pain
anatomical drawing
nerve territory
duration of complaints
average intensity of pain in the last week
extend of interference with daily activities
further history - exposure to toxins, pain meds, psychological disturbances

17
Q

positive sensory signs and symptoms of neuropathic pain

A

dysesthesias
parasthesias
spontaneous pain
stimulus evoked pain

18
Q

negative sensory signs and symptoms

A

loss/impairment of sensory quality

numbness and reduced sensation

19
Q

neuropathic pain diagnosis

A

diangnostic questionaire

20
Q

treatment of neuropathic pain

A

identify the cause
pharmacological
non-pharmacological
interventional

21
Q

pharmacological treatment for neuropathic pain

A
  • simple analgesics
  • NSAIDs
  • tramadol/tapentadol
  • strong opoids
  • adjuvant analgesics
  • antidepressants
  • anticonvulsants
  • local anaesthetics
  • NMDA antagonists
  • others
22
Q

concepts for treatment in neuropathic pain

A
  • dampen down peripheral sensitisation in the damaged axon (Na+ channel blockade)
  • dampen down central senstization (NMDA antagonists and calcum channel blockers)
  • enhancing descending inhibitory pathways (trycyclics/SNRIs and tramadol)
23
Q

first line treatment for neuropathic pain

A
  • gapabentin
  • gabapentin extended release or enacarbil
  • pregabalin
  • serotonin-noradrenaline reuptake inhibitors
  • duloxetine or venlafaxine
  • tricyclic antidepressants
24
Q

second line treatment for nueropathic pain

A

caopsaicin 8% pathces
lidocaine patches
tramadol

25
Q

thirrd line treatment for neuropathic pain

A

botulinum toxin A (subcutaneously - specialist use)

strong opiods

26
Q

interventions for neuropathic pain

A

epidural injections for herpes zoster
steroid injections for radiculopathy
SCS for FBSS
SCS for CRPS type 1

27
Q

non pharmacological aspects of neuropathic pain

A 
physiotherapy 
massage 
acupuncture 
hydrotherapy 
rehabilitation

pharmacology 3 (8 decks)

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