pain

Question 1

acute pain

Answer 1

1 week or less

Question 2

chronic pain

Answer 2

at least 6 months. many consider an autonomous disorder.

Question 3

chronic regional pain syndrome

Answer 3

limb is cold, red, muscle wasting, nail changes.

Question 4

what is nociception

Answer 4

the sensation and transmittance of pain.

Question 5

first pain form which fibers?

Answer 5

A-delta fibers. fast. myelinated. reflexes. also think acute.

Question 6

second pain?

Answer 6

C-fibers. think chronic pain

Question 7

what transmits pain?

Answer 7

the vanniloid receptor. receives input from heat, acid, ionic…capsaicin

Question 8

hyperalgesia

Answer 8

spread of pain sensation to close regions associated with injury or pain.

Question 9

why hyperalgesia?

Answer 9

injury, trauma, etc released a number of inflammatory molecules that ultimately affect close regions.

Question 10

what is the descending pain system?

Answer 10

it is modulatory system. it can desensitize pain signals. it inhibits ascending pain through inhibition of substance P. it can also activate enkephalin interneurons that inhibit pain through activation of the descending pain system.

Question 11

what is nociception vs pain

Answer 11

nociception is sensation. pain is emotion.

Question 12

what are the five functions of the medial pain system?

Answer 12

limbic and autonomic activation, learning and anticipation, nocifensive behavior, empathy, inhibition.

Question 13

paleospinothalamic tract

Answer 13

synapses in the reticular formation and the medial intralaminar thalamic nucleus. projects to limbic structures and the anterior cingulate and insular cortex.

Question 14

spinoreticular tract

Answer 14

ascends bilaterally and terminates in two levels of the reticular formation.

Question 15

caudal reticular formation

Answer 15

sends recurrent signal to the interomediolateral cell columns as a method of activating the sympathetic system.

Question 16

rostral RF

Answer 16

projects to the locus ceruleus. innervates the parabrachial nucleus and the MITN

Question 17

spinomesencephalic tract

Answer 17

doral horn neurons innervate the periaqueductal gray. parabrachial, paraventricular nucleus, and the amgydala.q

Question 18

most important thing about the spinomesenchephalic tract?

Answer 18

it has cross-wiring from the visceral neurons and causes referred pain. this causes visceral pain to be perceived as cutaneous pain.

Question 19

neuroopathic pain treated how?

Answer 19

using anticonvulsants and tricyclics.

Question 20

inflammatory pain treated how?

Answer 20

NSAID

Question 21

whats does opioid treatment do?

Answer 21

it makes the patient less concerned about pain.

Question 22

where do non-noxious sensations transmit?

Answer 22

through the Abeta-fibers.

Question 23

full pain response achieved through what?

Answer 23

signif Na and Ca influx.

Question 24

what happens when the system goes awry?

Answer 24

inc Na Ca and glutamate.

Question 25

what are carbamezine, topiramate and lamotrigine?

Answer 25

they re all sodium channel blockers.

Question 26

what is gabapentin/pegabalin

Answer 26

they are calcium blockers.

Question 27

what are the SE of the anti epileptics?

Answer 27

cause sedation, psychomotor/cognitive impairment,

Question 28

antidepressants for treating pain?

Answer 28

yes. fibromyalgia, neuropathic.

Question 29

how do antidepressants work for pain?

Answer 29

depression and pain run together through NE. strengthen NE and pain and depression usually go away. remember the monoamines are all very similar and uptake pumps usually do all of them or cross-react. also remember the enkephalin systems AKA strengthens the descending pathway. it also activates GABAnergic neurons in the ascending to inhibit pain signals upward.

Question 30

duloxetine/milnacipran

Answer 30

SNRI antidepressants for pain. both have serotonin SE -HA, GI, insomnia, fatigue, sexaul and weight gain. NE SE -dry mouth, HTN.

Question 31

amitryptiline

Answer 31

TCA used for pain. serotonin and NE SE. Na channel blockade. also cholinergic symptoms such as dry mouth, constipation, blurred vision.

Question 32

reflexive pain occurs where? conscious pain?

Answer 32

spinal cord maybe thalamus, limbic and cortex.

Question 33

transference

Answer 33

patient assuming you can't or won't help and that you will be short and not listen and even rude.

Question 34

countertransference

Answer 34

you will likely be stressed, irritated, short and rude as these patients never follow the rules.

Question 35

when to give the opiate?

Answer 35

when the pain is severe.

Question 36

what type of pain is trauma?

Answer 36

inflammatory pain/

Question 37

burning in nature is what pain?

Answer 37

neuropathic

Question 38

what might explain neuropathic pain?

Answer 38

glutamate excess signaling

Question 39

what type of meds for neuropathic?

Answer 39

antiepileptic. NEVER NSAID. there is no inflammation