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Head, Neck and Neurology > Pain > Flashcards

Pain Flashcards

1
Q

What are the names of receptors which sense pain?

A

Nociceptor

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2
Q

What substances can sensitise nociceptors?

A 
Leukotrienes
Substance P
Noradrenaline
Neurokinin A
CRGP
Nitric oxide
Reactiev oxygen species
Cytokines
Prostaglandins
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3
Q

What types of fibres transmit painful stimuli?

A

A-delta and C fibres

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4
Q

Which ascending tract does painful stimuli follow to the brain?

A

Spinothalamic tract

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5
Q

Describe the gate control theory of pain

A

In the absence of input from C fibres, tonically active inhibitory interneurons suppress the pain pathway but with strong pain the C fibres can override this inhibitory neuron to allow a pain signal to be sent to the brain, however, pain can also be modulated by simultaneous somatosensory input

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6
Q

Describe the phenomenon of referred pain

A

The sensation of pain is experienced ay a site other than the injured or disease tissue. It occurs because both visceral and somatic afferents converge on the same neurons in the spinal cord. So input from the viscera may be ‘refer’ to the somatic source

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7
Q

What is hyperalgesia?

A

Increased sensitivity to painful simtuli

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8
Q

Describe the type of pain that occurs in non-specific low back pain

A

Characterised by tension, pain and stiffness particularly in the morning
usually short lived and self-limiting
usually varies with time and physical activity

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9
Q

How would non-specific low back pain, with no red flags, be managed?

A

Giving general information, education and advice
Analgesia - usually paracetamol and avoiding NSAIDs where possible
Patients advised to stay active and complete back exercises

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10
Q

What factors may contribute to the development and maintenance of chronic pain and disability (i.e. yellow flags)?

A 
Belief that pain is harmful and disabling
sickness behaviours i.e. extended rest
social withdrawal
problems at work
emotional problems
inappropriate expectations of treatment
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11
Q

Prolapse of the intervertebral disc involves the protrusion of the nucleus pulpous towards the intervertebral foramen. This is usually an anterior protrusion. T/F?

A

False- it is usually posterior

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12
Q

What red flag symptoms may indicate a more serious cause of back pain?

A

Systemic ailments (fever, night sweats)
history of malignancy or IV drug use
profound or progressive neurological deficit
sphincter disturbance (bladder or bowels)
trauma
pain refractory to medicines
Age <20 or >50
Prolonged corticosteroid drug use
Presence of contusion of abrasions over the spine

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13
Q

What more serious cause of back pain does IV drug use or immunocompromised states put you at risk of?

A

Osteomyelitis

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14
Q

If, in a patient presenting with back pain, you were concerned about the possibility of malignancy or infection what lab tests would you run?

A

FBC
Erythrocyte sedimentation rate
C-recative protein
Blood cultures

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15
Q

A patient should receive an X-Ray If symptoms of low back pain continue after how many weeks of conservative treatment?

A

6-8 weeks

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16
Q

How long is the spinal cord?

A

42-45cm

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17
Q

What is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

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18
Q

What catabolic stress responses are associated with pain?

A

Anxiety, depression, sleep impairment, increased blood pressure and heart rate, nausea, vomiting, ileum, urinary retention, uterine inhibition, restlessness, immobility, hyperventilation and cough inhibition

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19
Q

How does pain affect the hormones cortisone, glucagon and growth hormone?

A

Pain increases these hormones

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20
Q

How does pain affect the hormones insulin and testosterone?

A

Pain decreases these hormones

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21
Q

Through what type of fibres is physiological painful stimulation transmitted?

A

A-delta fibres

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22
Q

Through what type of fibres is pathological painful stimulation transmitted?

A

C fibres

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23
Q

C fibres transmit information faster than A-delta fibres. T/F?

A

False - the opposite is true

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24
Q

Physiological pain can be described as sharp, short and localised. How is pathological pain described?

A

Dull, diffuse, prolonged, produces spasm and guarding

25
Q

Pathological pain can be abolished by morphine. Can physiological pain be abolished by morphine?

A

No

26
Q

To which laminae of the spinal cord to the primary afferent transmit sensory painful stimuli?

A

Laminae 1+2

27
Q

What neurotransmitters are used by excitatory interneurons?

A

Glutamate

28
Q

What neurotransmitters are used by inhibitory interneurons?

A

GABA and glycine

29
Q

What is the name of the theory behind transcutaneous electrical nerve stimulation (TENS)?

A

Gate control theory of pain

30
Q

What is allodynia?

A

Pain from a stimulus which is not normally painful

31
Q

What substances can activate nociceptors?

A 
Potassium ions
5HT
Bradykinin
Hydrogen ions
Histamine
ATP
Adenosine
32
Q

Describe the process of peripheral sensitisation?

A

Substances such as bradykinin, cytokines, substance P and histamine act to lower the threshold at which nociceptors activate. This process of lowering painful stimuli threshold continues after the initial inflammatory stimulus has ended

33
Q

Describe the process of central sensitisation?

A

Mediated by the decreased release of GABA and glycine from interneurons and the decreased released fo NA and 5HT

34
Q

How long does general pain have to last for it to be considered chronic?

A

3 months

35
Q

What is the difference between nociceptive and neuropathic pain?

A

Nociceptive pain is due to tissue damage

Neuropathic pain is due to nerve damage

36
Q

Nociceptive pain from somatic sites is well localised dermatomal, shape, aching, gnawing and constant with no associations. How can nociceptive pain from visceral sites be described?

A 
Vague distribution
Diffuse to body surface
Dull
Cramp
Dragging
Often periodic
Often associated with nausea, sweating, tachycardia and hypertension
37
Q

How might a patient describe the sensation of neuropathic pain?

A 
Shooting
Electric-Shock like
burning
tingling
numbness
38
Q

Give examples of some causes of neuropathic pain

A 
Post-stroke
Lumbar radicular
diabetic peripheral neuropathy
post-hepatic neuralgia
chronic post-surgical pain
39
Q

Give examples of causes of low back pain

A 
Disc bulge or rupture
osteoarthritis
lumbar instability
joint degeneration
problems with surrounding muscles and ligaments
40
Q

Describe how a disc herniation could cause both neuropathic and nociceptive pain?

A

Leakage of substances from nucleus pulpous can active the peripheral nociceptors to cause nociceptive pain
compression and inflammation fo the nerve root can cause neuropathic pain

41
Q

Low back pain may cause radicular pain which travels into the lower limb along a narrow band. How is this pain provoked?

A

Straight leg raise

42
Q

What factors need to be assessed when covering a history of a patient presenting with pain?

A

Site, radiation, quality, severity, duration, frequency, relieving factors and associated phenomena
impact on quality of life
patient’s knowledge and expectations
relationship between pain and functional impairment

43
Q

This is an inter-relationship between pain, sleep and anxiety/depression. T/F?

A

True

44
Q

Patients with neuropathic pain commonly experience significant co-morbid symptoms, such as…?

A 
Poor apetitie
Anxiety
depression
difficulty concentrating
drowsiness
lack of energy
difficulty speaking
45
Q

What drugs are prescribed in step 1 of the WHO analgesic ladder?

A

Paracetamol and NSAIDs

46
Q

What drugs are prescribed in step 2 of the WHO analgesic ladder?

A

codeine

dihydrocodeine

47
Q

What drugs are prescribed in step 3 of the WHO analgesic ladder?

A 
morphine
oxycodone
dental
buprenorphine
methadone
diamorphine
pethidine
48
Q

What drug is prescribed between steps 2 and 3 of the WHO analgesic ladder?

A

tramadol

49
Q

10% of Caucasian do not have the required enzyme to metabolise codeine. What enzyme is this?

A

cytochrome p450 CYP 2D6

50
Q

Besides the drugs in the WHO analgesic ladder, what other neuropathic analgesics can be used?

A 
Amitriptyline
gabapentin
pregabalin
lidocaine
ketamine
capsaicin
clonidine
cannabinoids
51
Q

What physical therapies are used to treat low back pain?

A

Maintaining activity
physiotherapy
TENS

52
Q

How can acute pain be prevented from becoming chronic pain?

A

Early mobilisation
Limiting time of pain
Psychological input

53
Q

What psychological input is used in the management of low back pain?

A 
clinician explanation of pain
education classes
support groups
pain management programs
1:1 psychology
54
Q

In neuropathic pain, which additional type of fibre is used to transmit pain signals?

A

A-beta fibres

55
Q

Which substances stimulate pain following tissue damage?

A

Potassium ions

Prostaglandins

56
Q

Once pain has been stimulated, nerve fibres also back propagate to stimulate the release of CGRP and substance P. What is the action of these substances?

A

CGRP cause dilation of blood vessels

Substance P causes plasma extravasation, oedema and release of bradykinin

57
Q

In the spinothalamic tract, branches are given off in the spinal lemniscus which activate descending pathways to modulate nociceptive input. What substances are released in order to do this?

A

5-HT and noradrenaline

58
Q

In the gate control theory of pain, somatosensory input can override painful stimuli. The bifurcation of the afferent neuron in the dorsal column tract activates inhibitory neurons. T/F?

A

True

Head, Neck and Neurology (24 decks)

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