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DSouza 2015 > Pain > Flashcards

Pain Flashcards

1
Q

Tourniquet pain mediated by …

A

C fibers

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2
Q

2 medications found to be useful in treating tourniquet pain?

A

Clonidine + ketamine

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3
Q

Spinal stenosis is intermittent claudication, is worse with … and relieved with …

A

Ambulation

Rest and siting

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4
Q

DDx of back pain?

A

No rediculopathy and axial pain -> Discogenic pain

Axial pain + rediculopathy -> Disc herniation

Lateral pain + precipitation with lateral rotation -> facet joint pain

Worst with ambulation -> spinal stenosis

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5
Q

Drug tolerance definition?

A

Exposure to a drug results in diminution of an effect or the need for higher dose to maintain an effect.

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6
Q

Drug dependence definition?

A

Drug is administered to prevent withdrawal symptoms or in which it is associated with tolerance or both.

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7
Q

Addiction definition?

A

A state of heavy physical or emotional dependence on a drug (compulsive or pathological use), this term is often synonymously used with drug dependence

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8
Q

Examples of neuropathic pain?

A

Postherptic neuralgia

Phantom limb pain

Trigeminal neurolgia

Complex regional pain syndrome

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9
Q

First line ttx of trigaminal neuralgia pain?

A

Carbamazepine (others: oxycarbamazepine which is less SE, and phenytoin)

Caused by vascular compression of trigaminal nerve root.

It’s unilateral, episodic and stabbing pain

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10
Q

Type of sympathetic blockade for Face and upper extremity?

A

Stellate ganglion block

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11
Q

Type of sympathetic blockade for Lowe extremity ?

A

Lumber symptomatic block

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12
Q

Type of sympathetic blockade for Upper abdomen?

A

Celiac plexus block

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13
Q

Type of sympathetic blockade for Pelvis?

A

Hypogastric plexus block

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14
Q

Indications for lumber sympathetic block?

A

CRPS (primarily)

Vascular insufficiency
Phantom limb pain

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15
Q

Stellate ganglion ?

A

It’s formed by fusion of inferior cervical and first thoracic ganglion and it is anterior to C7 vertebral body.

SE’s: Horner’s syndrome, hoarseness (involvement of recurrent laryngeal nerve).

Complications: pneumothorax, phernic nerve palsy, intrathecal, intravascular injection.

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16
Q

Myofacial pain?

A

Muscle pin with specific trigger points

Not neuropathic nor has dermatomal distirbution

17
Q

Treatment of phantom limb pain?

A

Gabapentin/amitriptyline

Opioids maybe useful

TENS

Spinal cord stimulation

Intrathecal opioid pump

Stump revision if stump triggers the pain

18
Q

Gabapentin acts on …

A

Ca channels

19
Q

Phenol vs alcohol in baricity ?

A

Alcohol is hypobaric

Phenol is hyperbaric

20
Q

Postherpetic neruralgia;

Common site

RFs

Treatment

A

Thoracic dermatologist followed by trigaminal distribution

> 60, sever pain or abnormalities during acute phase.

Acyclovir or corticosteroid not effective during acute phase

TCA, gaba, topical capsaicin

21
Q

Allodynia definition

A

Painful response to a usually non-painful stimulus

22
Q

Hyperalgesia definition

A

Increased response to a stimulus that is normally painful

23
Q

Hyperpathia definition

A

A painful syndrome, characterized by increased rxn to stimulus , especially a repetitive stimulus, as well as an increased threshold. It may occur with hyperesthesia, hyperalgesia, or dysethesia.

24
Q

CRPS 1 vs CRPS 2?

A

Both are sympathetic mediated however type 2 associated with nerve injury

25
Q

The comments SE of morphine is

A

Constipation

26
Q

Muscle rigidity from opiates treated with

A

Po Baclofen, or muscle relaxation

27
Q

How long fentanyl patch works after removal?

A

12-16 hours

It’s prolonged action due to dermal deposits

Indication: opioid dependent chronic pain ptn

28
Q 
SE of major non opioids 
Gaba
Carbamazepine 
Amitriptyline
Tylenol
A

Dizziness, sedation, weight gain, peripheral edema

Dizziness, sedation, elevated liver enzymes, leuopenia, leukocytosis, thrombocytopenia, agranulocytosis, aplastic anemia.

Dry mouth, sedation, seizures

Hepatotoxic

29
Q

Baclofen Toxicity

A

GABA b agonist, decreases excitatory neuro transmission.

Drowsiness, dizziness, GI upset.

Higher doses; seizures, delirium, tachycardia, bradycardia, hypotension.

Ttx: supportive. Charcoal or hemodialysis

30
Q

Indication for spinal cord stimulation?

A

Failed back surgery syndrome
Refractory angina pectoris
Peripheral vascular disease
CRPS type 1

31
Q

TENS machine principle?

A

Gate control theory of pain and conduction block theory

Gate control theory -> afferent input from large fibers decreases the transmission from small fibers (pain).

Conduction block theory -> high rate of stimulation decreases the ability of small fibers to transmit the signal.

DSouza 2015 (21 decks)

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