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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
Q

What are some important neurotransmitters in hyperalgesia?

A

(1) Glutamate

(2) Substance P

(3) Nitric oxide

26
Q

What factor limits non-opioids?

A

Ceiling effect

Dose above which there is no further pharmacological action

27
Q

What is the mechanism of action of opiates?

A

Increase descending inhibitory pathways

Decrease neuropeptide release

28
Q

What is acetylsalicylic acid?

A

Aspirin

29
Q

Which analgesic is most appropriate for dysmenorrhoea?

A

Aspirin

30
Q

Give some examples of indoles.

A

(1) Diclofenac

(2) Indomethacin

31
Q

Give some examples of propionic acid derivatives.

A

(1) Ibuprofen

(2) Naproxen

(3) Ketoprofen

32
Q

What is etoricoxib licensed for?

A

(1) Ankylosing spondylitis

(2) Osteoarthritis

(3) Rheumatoid arthritis

(4) Acute gout

33
Q

What is celecoxib licensed for?

A

(1) Ankylosing spondylitis

(2) Osteoarthritis

(3) Rheumatoid arthritis

34
Q

Why were rofecoxib and valdecoxib withdrawn?

A

Cardiovascular side effects

35
Q

Why was lumiracoxib withdrawn?

A

Hepatotoxicity problems

36
Q

What is nefopam?

A

Non-opioid

For persistent pain if NSAIDs or opioids are not suitable

Causes little-no respiratory depression

Can have sympathomimetic + antimuscarinic side effects

pain (1 decks)

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