Pain Flashcards
What is pain?
An unpleasant sensory and emotional experience, associated with actual tissue damage
What is the pathway for pain?
1-Pain stimulus
2- a-delta and c-fibre
3-Synapse in spinal cord
4-Substance P and glutamate released
5-Goes to the thalamus and somatosensory cortex
6-However, travels there via amygdala which “alarms” your brain
All pain serves a protective function TRUE/FALSE
FALSE
acute pain serves a protective function
In chronic pain it no longer serves a useful purpose
What is nociceptive pain?
Appropriate physiological response to a painful stimulus via the intact nervous system
What is neuropathic pain?
Inappropriate response caused by a dysfunction in the nervous system
TRUE/FALSE
Chronic pain is associated with morphological changes in the CNS
TRUE
What are symptoms of neuropathic pain?
Shooting/burning sensations
Tingling/numbness
Allodynia
Hyperalgesia
What is allodynia?
Pain produced in response to a not normally painful stimulus e.g. light touch, cotton wool
What is 1st line to treat trigeminal neuralgia?
Carbamazepine
What are the 3 drugs that can be used for neuropathic pain?
Amitriptyline
Duloxetine
Gabapentin/pregabalin
What is complex regional pain?
Chronic condition, causes neuropathic pain, usually after surgery/minor injury, usually affecting arm/leg
Progressive disproportionate pain, swelling, skin changes and motor dysfunction (tremor or dystonia)
Management of complex regional pain
Physiotherapy and amitriptyline
Neuropathic pain occurs most commonly due to lesions where?
Thalamic
What does post stroke pain look like?
Mild, rapidly improving hemiplegia with initial paraesthesia
followed in weeks-months by allodynia
What type of pain do NSAIDs act on?
Nocioceptive
What are the classic NSAID S/E?
GI irritation/bleeding
Renal toxicity
Potential drug-drug
Cardiovascular S/E
What is the efficacy of non-opioid analgesia e.g. paracetamol?
Analgesic and antipyretic effects
Non inflammatory action
Name 2 weak and 2 strong opioids
Weak–> Tramadol and codeine
Strong–> Morphine and Oxycodone
What are opined analgesics mainly effective in?
Nociceptive pain
less effective in chronic states
How do opioids work?
Activate the endogenous analgesic system
What are side effects of chronic use of opiod analgesics?
Opiod induced hyperalgesia (can end up with more pain)
Libido issues
Immune modulatory issues
What are TCA’s effective in?
Neuropathic pain
Complex regional pain syndrome
Tension headaches
What are some classic S/E of TCAs?
Constipation Dry mouth Somnelence Abnormalities in HR and rhythm Insomnia Increased appetite
ARE THE RUMOURS TRUE?
SNRIs are better analgesics than SSRIs
GIRL THEY ARE TRUEEE
