Pain

Question 1

what are 3 phases pain perception

Answer 1

Activation of noiceptors
Dorsal horn spinal cord
Brain response

Question 2

What are noiceptors

Answer 2

peripheral sensory neurons known as nociceptors alert us to potentially damaging stimuli at the skin by detecting extremes in temperature and pressure and injury-related chemicals, and transducing these stimuli into long-ranging electrical signals that are relayed to higher brain centers.

Question 3

What’s the dorsal horn do?

Answer 3

Recieves sensory information that enters the spinal
Cord via the dorsal routes and responds to noxious stimuli

SAME DAVE
Sensory = afferent
Motor = efferent
Dorsal = afferent
Ventral = efferent

Question 4

What are prostaglandins a group of?
Where are they made ?
What processes do they control?

Answer 4

The prostaglandins are a group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness. They control processes such as inflammation, blood flow, the formation of blood clots and the induction of labour.

Question 5

How are prostaglandins synthesised

Answer 5

The pathway for making prostaglandins is an extension of the fatty acid synthesis pathway (Figure 6.10. 1). Prostaglandins, molecules associated with localized pain, are synthesized in cells from arachidonic acid (see previous page) which has been cleaved from membrane lipids

Question 6

What are the pain descriptors for noiceptive pain

Question 7

What are the excitatory chemicals associated with pain?

Question 8

What are the inhibitory chemicals associated with pain?

Question 9

Describe 3 ways in which analgesics can work?

Answer 9

1. • Decrease excitability receptors
2. • Decrease the transmission of pain signals in the peripheral nervous system
3. • block transmission of pain signals centrally

Question 10

What are 7 properties of an ideal analgesic?

Answer 10

Easy to titrate to effective uses
Cost effective
No side effects
Reaches target quickly
Does not accumulate on repeated doses
Available in different formulations
Treats all types of pain

Question 11

Step one of analgesic ladder

Answer 11

Mild pain paracetamol
+|or NSAID

Question 12

Step 2 of analgesic ladder

Answer 12

Mild/moderate pain - weak opioid codiene +- nsaid

Question 13

Step
3 of analgesic ladder

Answer 13

Moderate /severe pain strong opioid +- nsaid

Question 14

5 examples of adjuvant meds

Answer 14

Biphosphonates - bone pain
Anticonvulsants -
Corticosteroids
Antispasmodic
Hot cold
Compress

Question 15

Analgesic ceiling

Answer 15

Dose beyond which there is no additional effect

Question 16

What is the MOA of paracetamol

Answer 16

Inhibits the cox enzyme in the CNS. This inhibits prostaglandin synthesis in the CNS. This reduces the pain

Question 17

What does the cox enzyme
Do?

Question 18

What does prostaglandin do?

Question 19

What is the MOA of NSAIDs

Answer 19

NSAIDs inhibit the enzyme cycloxynase (cox2). Which block the production of prostaglandins

Question 20

Why does the mode of action of NSAIDS cause GI disturbance

Question 21

Name the 3 categories of opioids

Answer 21

1. Pure full agonist - my
2. Partial agonist /mixed agonist - kappa
3. Pure antagonist - delta

Question 22

What are the 2 classes of opioids

Answer 22

1. Weak
2. Strong

Question 23

List 6 of the main side effects of opioids

Answer 23

Postural Hypotension
Sedation
Euphoria
Nausea and vomiting
Constipation
Respiratory depression

Question 24

Define tolerance

Question 25

Define dependency

Question 26

How do opioids act on the opioid receptor?

Answer 26

As an agonist

Question 27

What do opioids copy

Answer 27

The action of exogenous opioid
Such as endorphins

Question 28

What is the mechanism of
Action of opioids

Question 29

What’s nociplastic pain

Answer 29

symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia