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Behaviour > Pain > Flashcards

Pain Flashcards

1
Q

which type of free nerve ending are important in initial sharp pain

A

A delta fibres

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2
Q

which type of free nerve ending are important in prolonged burning pain

A

C fibres (unmyelinated)

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3
Q

which extremes of temperature are interpreted as painful

A

below 15C and above 43C

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4
Q

which type of nociceptive fibre is polymodal

A

C fibres

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5
Q

In which part of the grey matter do A delta fibres terminate

A

lamina I, V and X, in the DORSAL HORN
they then excite second order neurones which project to the contralateral side via the anterior commissure and the anterolateral column of the spinothalamic tract

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6
Q

in which part of the grey matter do C fibres terminate

A

the SUBSTANTIA GELATINOSA (lamina II and III), axons pass through the anterior commissure to the contralateral side and rostrally up the spino-reticulo-thalamic tract

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7
Q

which membrane protein is activated by capsaicin

A

TRPV1

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8
Q

which membrane protein is activated by menthol

A

TRPM8

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9
Q

which part of the grey matter may be an important site of action for morphine like drugs as there is a lot of opioid peptides and receptors

A

the substantia gelatinosa

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10
Q

which fast neurotransmitters are released by nociceptive afferent neurones

A

glutamate

ATP

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11
Q

which glutamate receptor is important in “wind up” pain

A

NMDA

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12
Q

which glutamate receptor is responsible for fast synaptic transmission in the first synapse in the dorsal horn

A

AMPA

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13
Q

which type of sensory fibre inhibits nociceptive transmission

A

A beta fibres as they activate inhibitory interneurones

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14
Q

what is hyperalgesia

A

sensitisation of peripheral nociceptive nerve terminals and central facilitation of transmission at the level of the dorsal horn and the thalamus

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15
Q

how does neurogenic inflammation contribute to hyperalgaesia

A

primary afferent neurones release substance P and calcitonin gene-related peptide which promote inflammation by effecting blood vessels and inflammatory cells

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16
Q

what is allodynia

A

perception of pain when stimulus is present but is not normally nociceptive

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17
Q

what is parasthesia

A

perception of pain in the absence of any stimulus

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18
Q

what is the periaquaductal grey

A

area of the midbrain and grey area surrounding the central canal in the spinal cord. It is a descending pathway which controls impulse transmission in the dorsal horn.
It is thought to control the nociceptive gate

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19
Q

which two neurotransmitters are involved in the periaqueductal grey projection and how do they work

A

5HT
enkephalins
they act either directly or via interneurons to inhibit the discharge of spinothalamic neurones

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20
Q

what effects do opioid have on descending inhibitory pathways of pain

A

many effects

1) activated descending inhibitory pathways
2) inhibit transmission in the dorsal horn
3) inhibit excitation of peripheral nerves

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21
Q

how is GABA involved in modulation of pain

A

activation of interneurones in the dorsal horn causes GABA release which inhibits the primary afferent terminals

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22
Q

how is the noradrenergic pathway involved in the modulation of pain

A

noradrenergic pathway originated in the LOCUS COERULEUS and has an inhibitory effect on the dorsal horn.
It is thought that TCA work via the potentiation of this pathway

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23
Q

In the descending inhibitory pain pathway which receptors do the purinergic pathway act on?

A

they release adenosine on to the A1 receptors on the dorsal horn neurones

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24
Q

how can the sympathetic nervous system play a part in neuropathic pain

A

damaged sensory neurones can express alpha adrenoceptors and develop sensitivity to noradrenaline - sympathetic responses can produce severe pain

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25
Q

what are enkephalins

A

members of the endorphin family which are a group of endogenous opioid peptides

26
Q

why should opioids be avoided in asthmatic patients

A

opioids cause mast cells to release histamine which can potentially cause bronchospasm.

Other effects of this might be hypotension and urticaria

27
Q

why must morphine doses be lowered in patients with renal failure

A

Although morphine is inactivated by the liver, morphine-6-glucuronide is excreted in the urine

28
Q

why should morphine/morphine based analgesics be avoided at childbirth

A

It also should not be give to newborns.
neonates have a low conjugating capacity, therefore the liver in unable to metabolise all the morphine into morphine-6-glucuronide. Morphine therefore stays in the circulation and can cause respiratory depression.

For this reason pethidine is the safer alternative to use

29
Q

what is diamorphine also known as

A

heroin

conversion to morphine is rapid in aqueous solution and in the brain hence the “buzz” when administered IV

30
Q

fentanyl, alfentannil, sufentanil and semifentanil are examples of what

A

highly potent pehylpiperdine derivatives with similar action to morphine.
Used mostly in anaesthetics but also used in severe chronic pain
Rapid onset of action

31
Q

what is naltrexone

A

a long acting opioid antagonist
used in the treatmetn of addiction as it reduces euphoria upon opioid administration
also used in reducing alcohol consumption

also effective in treating chronic pruritus

32
Q

why might paracetamol be combined with opioids?

A

it has an opioid sparing effect

33
Q

why is there an individual variability to morphine

A 
altered metabolism or sensitivity of receptors
eg
mutations of CYP450
P-glycoproteins 
glucuronyltransferase
mu receptors
34
Q

what are the non-opioid properties of tramadol

A

inhibits reuptake of NA and stimulates 5HT release

35
Q

name 2 weak opioids

A

codeine
dihydrocodeine
? tramadol

36
Q

why does methadone have less of a withdrawal effect

A

it has a long half life

37
Q

why is a short half life advantageous for remifentanyl

A

good as a sedative

38
Q

why must you be careful coprescribing tramadol and antidepressants

A

tramadol also stimulates serotonin release

39
Q

list four safety concerns with NSAIDS

A

GI damage
Damage to kidneys (renal perfusion)
Sodium and water retention (as a result of renal)
Worsening of asthma

40
Q

how might you assess nociceptive or neuropathic pain

A

Leeds assessment of neuropathic pain

41
Q

how do anti-epileptics aid analgesia

A

they reduce neuronal excitability

egs gabapentin and carbamazepine

42
Q

why should pregabalin be prescribed instead of gabapentin

A

it works the same but is cheaper!!

43
Q

how does amitriptyline work as an analgesic

A

proposed mechanisms:

  • sodium channels
  • better sleep
  • better mood
44
Q

what are the side effects of amitriptyline

A
  • drowsiness
  • arrhythmias
  • dry mouth
  • blurred vision
45
Q

how does ketamine work

A

it is an NMDA receptor antagonist which probably reduces wind-up phenomenon in the dorsal horn
has many psychotropic effects

46
Q

opioids activate the descending pathways that inhibit pain transmission by acting on neurones in the…

A

periaqueductal grey matter

47
Q

the vanilliod receptor activated by capsaicin is a…

A

ligand-gated cation channel

48
Q

the analgesic effect of morphin is mostly due to activation of

A

mu opioid receptors

49
Q

what effect does stimulation of opioid receptors have on adenylyl cyclase activity

A

it decreases it

50
Q

give an example of a partial mu receptor agonist

A

buprenorphine

51
Q

name a short acting opioid agonist used as a transdermal skin patch

A

fentanyl

52
Q

activation of kappa opioid receptors is responsible for causing …

A

dysphoria

53
Q

which finding typically occurs in opioid poisoning but not in central nervous system depression due to other causes

A

pinpoint pupils

54
Q

which transmitter is released at the first synapse in the dorsal horn ascending nociceptive pathway

A

glutamate

55
Q

what is the typical age of onset for trigeminal neuralgia

A

6th or 7th decade - usaully due to ectatic vascular loop pressing on the pons or nerve
in younger patients may be a sign of MS (esp if bilateral) or tumours (acoustiv schwannomas, meningiomas, epidermoids)

56
Q

how does trigeminal neuralgia present

A

knife/shock like pain down the distribution of the Vth nerve
tends to begin in V3 and then spread to V2
Stimuli to pain include washing, shaving, cold winds or chewing.
Spontaneous remission tends to last months/years

57
Q

how do you treat trigeminal neuralgia

A

carbamazepine or other anti-epileptics
Surgical options include percutaneous radiofrequency selective ablation or microvascular decompression of the nerve (90% success rate)

58
Q

what is postherpetic neuralgia

A

pain lasting for more than 4 months following shingles
develops in 10% of pts(esp elderly)
poor response to analgesic
gradual recovery takes around 2 years

59
Q

what it complex regional pain syndrome type II

A

causalgia is a chronic burning pain that occasionally follows nerve damage

60
Q

from the three groups of endogenous opioids, which receptors do they act on

A

endorphins - all three but strongest for mu
enkephalins - delta
dynorphins - kappa agonist

61
Q

what is the peak end rule of pain

A

different parts of pain experience carry greater weight (i.e. lower intensity at the end is better than ending on high intensity)
ending abruptly during high pain intensity leaves an unfavourable impression

62
Q

what causes post stroke pain

A

small thalamic infarcts
pt will present with hemiparesis and sensory loss
as weakness improves pt will have deep seated constant pain in paretic limbs

Behaviour (10 decks)

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