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445- Pain and Mental Health > Neuropathic Pain > Flashcards

Neuropathic Pain Flashcards

1
Q

neuropathic pain is
1. maladaptive and commonly persistent
2. adaptive and commonly persistent
3. maladaptive and temporary
4. adaptive and temporary

A

1

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2
Q

neuropathic pain is pain caused by a ________ of the _______ system

A

lesion or disease
of the somatosensory system

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3
Q

what are some peripheral causes of NeP

A

painful diabetic neuropathy, post herpetic neuralgia, carpal tunnel, trigeminal neuralgia

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4
Q

what are some central causes of NeP

A

post stroke, MS, spinal cord injury

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5
Q

what are some mixed causes of NeP

A

amyloidosis, vitamin def, chemical toxins

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6
Q

T or F: there are many predictors that may indicate if a patient will have neuropathic pain

A

F

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7
Q

characteristics of neuro pain

A

spontaneous or stimulus evoked
burning, tingling, sharp, stabbing pain
paresthesias/ dysesthesias, allodynia, hyperalgesia common

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8
Q

first line tx for general NeP

A

gabapentinoids, TCA, SNRIs

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9
Q

second line tx for general NeP

A

tramadol, opioid analgesics

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10
Q

3rd line tx for general NeP

A

cannabinoids

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11
Q

painful diabetic neuropathy is due to

A

damage of the nerves and blood vessels in arms/ legs

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12
Q

sx of painful diabetic neuropathy

A

Gradual onset of paresthesias and pain in legs/ feet (works its way up)
Allodynia and burning pain common + worse at night
Examination showing graded distal sensory loss (not graded if acute)

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13
Q

first line tx of painful diabetic neuropathy

A

SNRIs, TCAs, gabapentinoids

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14
Q

2nd line tx of painful diabetic neuropathy

A

tramadol, other opioids

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15
Q

which of the following has the most SEs
1. duloxetine
2. amitriptyline
3. pregabalin

A

2

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16
Q

is there a preference for SNRI, TCA, or gabapentinoid use in first line tx of diabetic neuropathy

A

no- all ~50% pain reduction

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17
Q

combinations of ___________ might reduce pain more than either alone for diabetic neuropathy

A

SNRI/TCA + gabapentinoids

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18
Q

a diabetic neuropathy patient is responsive to pregabalin, but needs more pain control. what should you do?

A

add duloxetine or amitriptyline

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19
Q

a diabetic neuropathy patient is not responsive to pregabalin needs more pain control. what should you do?
1. add duloxetine tp pregabalin
2. stop pregabalin and add duloxetine
3. continue pregabalin and add tramadol
4. continue pregabalin and add amitryptyline

A

2

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20
Q

where do cannabinoids show the most promise

A

chronic neuropathic pain conditions

21
Q

what are 4th line options in diabetic neuropathy

A

SSRIs, topicals, methadone

22
Q

what is postherpetic neuralgia

A

a long lasting complication of reactivation of the varicella zoster virus

23
Q

postherpetic neuralgia is pain ____ after rash duration

A

=>3mths

24
Q

T or F: postherpetic neuralgia can happen months to years after initial rash resolution
- what can it be caused by?

A

T- rare
may be precipitated by factors like surgery

25
Q

RFs for shingles

A

> 50yrs
immunocomp/ decreased

26
Q

sx of herpes zoster

A

severe stabbing pain/ dysesthesias followed by blistering skin eruptions

27
Q

shingles rash typically resolves in

A

2-4wks

28
Q

shingles rash pain can persist ______ after healing

A

> 4wks

29
Q

tx of shingles pain

A

mild- acet + NSAIDs
mod-severe: tramadol, strong opioids, topical lido (no capsacin), adjuvant with gaba or TCAs, prednisone if severe

30
Q

tx of shingles

A

7 day course of antivirals + analgesics

31
Q

post herpetic neuralgia RFs

A

age, more severe acute pain, larger rash SE, ophthalmic involvement, severe prodromal pain

32
Q

sx of postherpetic neuralgia

A

typically unilateral and dermatomal distribution- may be intermittent or constant
Aching, burning, itchy, sharp
Allodynia, hyperalgesia may be present

33
Q

average duration of PHN is

A

~12mths

34
Q

first line tx of PHN

A

gabapentinoids, TCAs
topical lido in older adults with CNS concerns

35
Q

second line tx of PHNs

A

topical lidocaine or capsacin
opioids

36
Q

what can result in lido systemic AEs

A

applying excessively, to cracked skin, occlusive covering

37
Q

capsacin AEs

A

local burning initially, stinging, erythema, topical burn

38
Q

how long does it take capsacin cream to reduce chronic NeP

A

=>6wks- poorly tolerated though
meh evidence

39
Q

what is trigeminal neuralgia

A

Condition that causes sudden, severe, sharp, unilateral electric shock like pain in lower face and jaw

40
Q

who is more likely to be affected by TGN

A

women, =>40yrs old

41
Q

potential causes of TGN

A

neurovascular compression, MS plaques, tumors, deformity, or may be idiopathic

42
Q

drug of choice for TGN

A

carbamazepine (or oxacarbazepine)

43
Q

alt besides carbamazepine for TGN

A

alt/ add ons include gabapentin, lamotrigine, baclofen, phenytoin- little evidence for nonconvulsants

44
Q

carbamazepine AEs

A

somnolence, drowsiness, dizziness, tremor, ataxia, hepatotoxicity, N/V (take with food), rash, SJS, blood dyscrasias (dose related)

45
Q

______________ (3) pain are generally less responsive to therapy

A

HIV neuropathies, radiculopathies, cancer chemo induced neuropathic

46
Q

how long is an adequate trial for NeP

A

4wks

47
Q

what Rx should be given with TCAs or opioisd

A

artificial saliva spray + bowel regimen

48
Q

when can you start to withdraw meds for NeP

A

after 1-3mths of relief

445- Pain and Mental Health (21 decks)

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