Pain Flashcards

1
Q

Pain definition

A

Subjective sensation of nociceptive stimulus

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2
Q

TRP acronym

A

Transient Receptor Protein

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3
Q

TRP types

A

TRP v1
TRP M (‘M’ = menthol)

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4
Q

TRP v1

A

Chilli pain receptors

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5
Q

TRP M

A

Cold

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6
Q

Pain nerve fibre classification

A

C fibres
A delta

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7
Q

C nerve fibre qualities

A

Non-myelinated
Slower longer onset of pain

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8
Q

A delta nerve fibre qualities

A

Myelinated -
Quicker shorter onset of pain

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9
Q

Common pain nerve fibres in viscera

A

C

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10
Q

Common pain nerve fibres in skin

A

A delta

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11
Q

Pathway of pain signal - Pain cascade

A

Nerve ending impulse ->

Dorsal root ganglion (glutamate in synapse) ->

Decussates at level of spinal cord ->

Spinothalamic tract ->

Thalamus ->

Signal splits to multiple parts of the brain:
- Cortex
- Periaqueductal grey
- Nucleus Raphe Magnus
- Locus Coeruleus

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12
Q

Excitatory synaptic neurotransmitter

A

Glutamate

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13
Q

Inhibitory synaptic neurotransmitter

A

GABA

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14
Q

Gate control theory of pain site

A

Substantia gelatinosa

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15
Q

Nerve input to substantia gelatinosa

A

A delta pain fibre
A beta motor fibre
Periaqueductal grey via Nucleus Raphe Magnus
Locus coeruleus

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16
Q

Location of periaqueductal grey

A

Around 3rd ventricle to base of brain stem

17
Q

Neurotransmitter for Nucleus Raphe Magnus

18
Q

Neurotransmitter for Locus Coeruleus

A

Noradrenaline

19
Q

Receptor present in substantia gelatinosa

20
Q

NMDA receptor qualities

A

Ionotropic receptor (not g protein coupled)
Glutamatergic
Particularly permeable to Calcium ions (and Sodium)

21
Q

How does Magnesium inhibit NMDA receptor

A

Magnesium and 2+ charge (same as Calcium) but is larger in size so does not pass Magnesium

Electrochemical gradient attracts Magnesium but blocks receptor

Competes with calcium but does not permeate

Use dependant blockade of NMDA receptors

22
Q

Action of intravenous Lidocaine at non cardiotoxic doses

A

NMDA receptor antagonist

23
Q

Ketamine mode of action

A

NMDA receptor antagonist

24
Q

Methods to reduce pain in peripheral nerve tissue

A

Regional block
Reduce size of incisions
Anti-inflammatories (NSAIDs, Dexamethasone)

25
Drugs
26
Types of opioid receptors
Mu opioid receptor Kappa opioid receptor Delta opioid receptor
27
Opioid receptor qualities and action
Pre-synaptic G coupled metabotropic receptor Gi (inhibitory) Reduces cyclic AMP action Reduces voltage gated calcium channel action
28
Location of action of opioid receptors
Spinal level - receptors in substantia gelatinosa Further in pain cascade - inhibitory action on locus coeruleus
29
Mode of action of clonidine
Alpha 2 receptor agonist
30
Effects of clonidine
Anxiolytic - reduced sympathetic drive Analgesia - not 100% know but possible reduced noradrenaline action (eg from locus coeruleus
31
Analgesia option which effects Nucleus Raphe Magnus and Locus coeruleus
Tricyclic antidepressants - Amitriptyline Duloxetine Mixed SNRI effects
32
Plane block definition
Anaesthetise 'plane' / area rather than specific nerve More conducive to catheter insertion as less risk than when placed directly to nerve
33
Approach to regional block pain calls
Check block area with ethyl chloride spray Does level of block need to increase (more volume, lower concentration) Does level of analgesia need to increase (less volume, higher concentration)