pain 1 Flashcards

1
Q

What is the purpose of acute pain?

A

Protective mechanism

e.g. thermal burns

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2
Q

What are the types of pain?

A

(1) Nociceptive pain

(2) Neuropathic pain

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3
Q

What type of pain is caused by a tissue injury?

A

Nociceptive pain

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4
Q

How long does acute nociceptive pain last?

A

<3-6 months

Desirable

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5
Q

How long does chronic nociceptive pain last?

A

> 6 months

Undesirable

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6
Q

What is allodynia?

A

Pain after stimulation

Not normally painful

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7
Q

What is hyperalgesia?

A

Increased pain from a stimulus that normally causes pain

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8
Q

What is neuropathic pain?

A

Nerve injury

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9
Q

What are some conditions that are associated with neuropathic pain?

A

(1) Diabetic neuropathy

(2) Phantom limb pain

(3) Cancer pain

(4) Chemotherapy-induced peripheral neuropathy

(5) Postherapeutic neuralgia

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10
Q

How may neuropathic pain be described?

A

(1) Severe

(2) Sharp

(3) Burning

(4) Cold

(5) Numb

(6) Tingling

(7) Weakness

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11
Q

What is the pain pathway?

A

(1) Detection of pain in the periphery

(2) Transmission of pain signals from periphery to spinal cord

(3) Reception of signal by higher central brain centres

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12
Q

Describe the role of local neuronal circuits and descending inhibitory pathways from higher brain centres on signals

A

Signals are amplified or inhibited

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13
Q

Describe the myelination state of non-nociceptive Aß.

A

Myelinated

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14
Q

Describe the myelination state of nociceptive C.

A

Unmyelinated

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15
Q

What sensation do non-nociceptive Aß fibres produce? large

A

Touch + pressure

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16
Q

What sensation do nociceptive C fibres produce?

A

Dull + burning pain

17
Q

What sensation do nociceptive A-delta produce?

A

Sharp pain

18
Q

What are some inflammatory mediators of peripheral pain?

A

(1) Bradykinin

(2) Substance P

(3) ATP

(4) Protons

(5) Prostaglandins
- particularly PGE2 + PGF2

19
Q

What is the role of bradykinin as an inflammatory mediator of peripheral pain?

A

Activates B2 receptors in nociceptive neurons + B1 receptors via a metabolite

20
Q

What is the role of substance P as an inflammatory mediator of peripheral pain?

A

Activates NKA (neurokinin) receptors in nociceptive neurones

21
Q

What is the role of ATP as an inflammatory mediator of peripheral pain?

A

Activates P2X3 receptors

22
Q

What is the role of protons (H+) as an inflammatory mediator of peripheral pain?

A

Activate acid-sensing ion channels (ASICs)

23
Q

What is the role of prostaglandins as an inflammatory mediator of peripheral pain?

A

PGE2 + PGF2

Greatly increase responses to bradykinin and 5-HT

Increase sensitisation

24
Q

What are prostanoids?

A

Prostaglandins + thromboxane

Produced from precursors in cell membrane

25
What are some important neurotransmitters in hyperalgesia?
(1) Glutamate (2) Substance P (3) Nitric oxide
26
What factor limits non-opioids?
Ceiling effect Dose above which there is no further pharmacological action
27
What is the mechanism of action of opiates?
Increase descending inhibitory pathways Decrease neuropeptide release
28
What is acetylsalicylic acid?
Aspirin
29
Which analgesic is most appropriate for dysmenorrhoea?
Aspirin
30
Give some examples of indoles.
(1) Diclofenac (2) Indomethacin
31
Give some examples of propionic acid derivatives.
(1) Ibuprofen (2) Naproxen (3) Ketoprofen
32
What is etoricoxib licensed for?
(1) Ankylosing spondylitis (2) Osteoarthritis (3) Rheumatoid arthritis (4) Acute gout
33
What is celecoxib licensed for?
(1) Ankylosing spondylitis (2) Osteoarthritis (3) Rheumatoid arthritis
34
Why were rofecoxib and valdecoxib withdrawn?
Cardiovascular side effects
35
Why was lumiracoxib withdrawn?
Hepatotoxicity problems
36
What is nefopam?
Non-opioid For persistent pain if NSAIDs or opioids are not suitable Causes little-no respiratory depression Can have sympathomimetic + antimuscarinic side effects