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845 > Neuropathic Pain > Flashcards

Neuropathic Pain Flashcards

1
Q

Diagnosing Neuropathic Pain

A
  • Imaging
  • Physical Examination
  • Mental Assessment
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2
Q

Acute Pain

A

Requires temporal pain management

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3
Q

Chronic Pain

A
  • Pain continues beyond the expected time of tissue healing

- Requires long-term pain management

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4
Q

Nociceptive Pain

A
  • Somatic, visceral, or inflammatory pain

- Peripheral stimuli (temperature, mechanical, or chemical)

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5
Q

Non-nociceptive Pain

A
  • Neuropathic pain

- Functional pain

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6
Q

Inflammatory Pain

A

Tissue damage or inflammatory reactions

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7
Q

Neuropathic Pain

A

Central and peripheral nerve damage

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8
Q

Functional Pain

A

Normal nerve function but abnormal conduction

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9
Q

Central Neuropathic Pain Syndrome

A

Nerve damage on CNS (brain or spine)

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10
Q

Peripheral Neuropathic Pain Syndrome

A

Nerve damage on peripheral nervous system

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11
Q

Ascending Pathway + Pain

A
  • Helps send the signal of pain

- Facilitates substance P, glutamate, and nerve growth factor

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12
Q

Descending Pathway + Pain

A
  • Helps with the suppression of pain sensation

- Inhibits via NE, 5HT, DA, and opioids

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13
Q

1st Line Treatment + Neuropathic Pain

A
  • TCAs
  • SNRIs
  • Ca++ channel ligands
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14
Q

If patient is well controlled and has no/minimal ADRs…

A

Continue on current regimen or consider dose adjustment

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15
Q

If patient has partial improvement but needs more…

A

Add an additional first-line agent or adjust the dosage

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16
Q

If patient has no improvements or significant ADRs…

A

Try a different first line agent or adjust the dosing

17
Q

When to move onto 2nd line therapy…

A

-If ALL first line agents and their combinations have failed
OR
-All first line agents are CI

18
Q

2nd Line Treatment + Neuropathic Pain

A
  • Capsaicin topical
  • Lidocaine topical
  • Tramadol
  • *Can combine these with third-line agents**
19
Q

3rd Line Treatment + Neuropathic Pain

A
  • Antidepressants (SSRIs)
  • Anticonvulsants (CBZ, OXC, LAC, LTG, TPM, etc.)
  • Topical agents (ketamine)
  • Botulism toxin A
20
Q

Ca++ Channel Ligand Examples/Dosing

A
  • Gabapentin: 400-1200 mg TID
  • Gabapentin ER: 600-1800 mg BID (postherpetic neuralgia in adults)
  • Pregabalin 150-300 mg BID
21
Q

SNRI Examples/Dosing

A
  • Duloxetine: 60-120 mg QD

- Venlafaxine: 150-225 mg QD

22
Q

TCA Examples/Dosing

A
  • Amitriptyline, nortriptyline, imipramine, clomipramine
  • All 12-150 mg/day, QD or BID dosing
  • NOT recommended at dose of >75 mg
  • NOT recommended for elderly, anticholinergic ADRs
23
Q

Ca++ Channel Ligand MoA/ADR

A
  • Block nerve impulse by binding to Ca++ channels
  • Decrease Ca++ influx, which decreases excitatory neurotransmitters, which reduces pain nerve firing
  • ADRs: sedation, peripheral edema
24
Q

SNRI MoA/ADRs

A
  • Block reuptake of NE and 5HT
  • Overall well-tolerated and safer than TCAs
  • ADRs: sedation, GI upset, insomnia, headaches
25
Q

TCAs MoA/ADRs

A
  • Effective to treat continuous burning pain
  • Blocks voltage-gated Na channels
  • Antagonize NMDA receptors and block alpha adrenergic receptor
  • ADRs: sedation, orthostatic hypotension, weight gain, cardiotoxicity, ANTICHOLINERGIC effects
26
Q

Nonpharm Options

A
  • Exercise
  • Physical therapy
  • Oriental medicine: acupuncture, tai chi, traditional Chinese medicine
  • Massage therapy
  • Chiropractic
  • Biofeedback
  • Cognitive behavioral therapy
  • Mindfulness based stress reduction
  • Herbal medicine
  • TENS unit
  • Surgery
27
Q

Drugs + Obese Patients

A

AVOID

  • Valproic acid
  • Gabapentin
  • Pregabalin

POSSIBLE BENEFIT
-Topiramate

28
Q

Drugs + Epileptics

A

AVOID
-Bupropion (decreases seizure threshold)

POSSIBLE BENEFIT
-Antiepileptic drugs

29
Q

Drugs + Migraines

A

POSSIBLE BENEFIT

-Topiramate

30
Q

Drugs + Anxiety

A

POSSIBLE BENEFIT

  • Gabapentin
  • Pregabalin
31
Q

Drugs + Depression

A

POSSIBLE BENEFIT

-SNRIs

32
Q

Drugs + Sleep Issues

A

POSSIBLE BENEFIT

  • Gabapentin
  • Pregabalin
  • TCAs
33
Q

Drugs + Geriatrics

A

AVOID

-TCAs

845 (24 decks)

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