Pain Flashcards
What are “red” and “yellow” flags when it comes to pain
Red flag = sign of serious underlying organic etiology
Yellow flag= thoughts/behaviours that put a person at risk of developing chronic pain
Pain is considered chronic after…
3 months (sometimes 6?)
Broad categories of types of pain related to where in body the signals are coming from
Nociceptive: somatic, visceral
Neuropathic: central, peripheral
(often “mixed”)
shooting pain along the course of a nerve, often described as electrical or shocking in nature
Lancinating pain
Abnormal sensations, usually uncomfortable in a sensory field often described as “burning”
Dysesthesia
An abnormal sensation in the absence of a stimulus; often described in terms of “pins & Needles”
Parasthesia
When pain or discomfort is felt with a non noxious stimulus.
Allodynia
When a noxious or painful stimulus is experienced as pain more severe than would be ordinarily expected
Hyperalgesia
Main tract transporting pain signals afferently? When does it cross over?
Lateral spinothalamic tract
Decussates immediately
Name 4 different sensory nerve fibres from fastest/thickest to slowest/thinnest, & what kind of info they transport
A-alpha: proprioception
A-beta: touch
A-delta: pain (mechanical, temp)
C: pain (mechanical, thermal, chemical)
Define sensitization. Peripheral vs central?
Abnormal pain perception due to heightened neuronal sensitivity noxious and/or normal stimuli; happens in response to injury, inflamm, repetitive stim
Peripheral sensitization usually goes away when injury/inflamm resolves. If becomes chronic –> central (brain/dorsal SC; nonnocicieptive fibers recruited into nociceptive pathway)
3 tenets of the WHO analgesic ladder
“By the mouth” (preferably oral)
“By the clock” (preferably scheduled dosing)
“By the ladder” (symptom-oriented progression through steps)
Analgesics > ___ times per week –> MOH
3
3 steps of postop pain treatment
1) Nonopioid analgesic + local anesthetic infiltration
2) Step 1 + intermittent opioid doses
3) 1 + 2 + local anesthetic peripheral neural blockade + sustained release opioid analgesics
What opioid is not recommended in pts with epilepsy?
Tramadol (lowers seizure threshold)
Contraindications to oral opioid therapy
Asthma, resp depression
Head injury
Biliary colic (sphincter of oddi spasm)
Bowel obstruction
3 topical analgesics
Lidocaine
Capsaicin
Diclofenac
Name a “Selective” NSAID. What does that mean?
e.g. Celecoxib
Selective inhibition of COX-2 only (most inhibit COX-1 & COX-2)
COX-1 in constitutively expressed and involved in gastric mucosal integrity whereas COX-2 is induced during inflammation. So selective has less PUR disk
Name 6 non-selective NSAIDs
Aspirin Ibuprofen Diclofenac Naproxen Indomethacin Meloxicam
Out of naproxen, ibuprofen, and indomethacin, which non-selective NSAID is NOT preferred first line for pain?
Indomethacin (more side effects)
Why shouldn’t you give opioids to head injury pt?
Opioids may alter consciousness and pupillary responses, both of which are used to monitor head injury patients.
Consider ____ as an adjuvant drug in the management of postherpetic neuralgia
Gabapentin
Consider ___ as an adjuvant drug in the management of postherpetic neuralgia, diabetic neuropathy, spinal cord injury-induced neuropathy
Pregabalin (Lyrica)
Consider ____ for the management of trigeminal neuralgia
Carbamazepine
