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Physiology 2 > Pain > Flashcards

Pain Flashcards

1
Q

What are the main drugs that act to block pain?

A

local anaesthetics
NSAIDs
Opioids

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2
Q

What is pain?

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage - it is multifactorial

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3
Q

What affects pain?

A 
Culture
Gender
Age
Expectation
Hospitalisation
Stress
Anxiety
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4
Q

Positive effects of pain

A

Danger alert - withdrawal
Protection - rest injury
Prevention - learning

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5
Q

Negative effects of pain

A

Suffering
Impaired function - motor, respiratory and CVS
Relieving pain aims to alleviate these

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6
Q

Pain pathway

A

pain recognition - peripheral conduction - spinal processing - ascending transmission - relay to cortex
Goes through the thalamus
Lateral spinothalamic tract

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7
Q

Nociceptors

A

Free nerve endings
mostly in skin but some in deeper tissues - joint surfaces.
Some are dormant and become activated by injury

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8
Q

What stimuli do nociceptors respond to

A

mechanical
thermal
chemical

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9
Q

What inflammatory mediators are involved in sensitisation of pain?

A

Histamine
Bradykinis
Prostaglandins

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10
Q

What nerve fibres carry pain impulses?

A

A delta myelinated large fibres

C unmyelinated small fibres

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11
Q

What type of pain occurs in A delta myelinated large fibres?

A

Sharp, stabbing

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12
Q

What type of pain occurs in C unmyelinated small fibres

A

aching/ burning

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13
Q

What is visceral pain initiated by?

A

Distension
Inflammation
Ischaemia

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14
Q

Visceral pain pathways

A

generally by autonomic nerves, poorly localised and may be perceived int he relevant dermatome - referred pain

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15
Q

Where is cardiac pain felt?

A

Central chest/ arm - T1-4

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16
Q

Where is uterus pain felt?

A

Low central abdominal T10-12

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17
Q

What is neuropathic pain?

A

results from nerve damage
trauma and infection
often becomes chronic and is difficult to treat

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18
Q

Analgesic strategies

A

Amplification and inhibitory systems which target somewhere along the pathway between pain recognition and relay to the cortex

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19
Q

Local anaesthetics

A 
Target the pain pathway itself
they are bases - proton acceptors
aromatic ring = lipophilic 
amide or ester
link
amine group - hydrophilic
stops depolarisation
e.g. lidocaine
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20
Q

Action of local anaesthetics

A

administered extracellularly in ionised form
becomes unionised to cross the membrane
works intracellularly in its ionised form to prevent sodium channels opening

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21
Q

Problems and solutions with local anaesthetics

A

duration of action too short - add adrenaline and use catheter/ infusion
unwanted blockade - low concentrations
toxicity - less toxic forms given

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22
Q

Why is adrenaline given with local anaesthetic

A

Local anaesthetic causes vasodilation. Adrenaline causes vasoconstriction and so reduces blood flow and reduces absorption so the effect of the anaesthetic lasts longer

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23
Q

benefits of local anaesthetics

A

very effective
short term
for specific targets
drugs must be monitored

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24
Q

NSAIDs

A 
work at site of injury and in the cortex
COX inhibitors
prostaglandins targetted which are involved in peripheral pain sensation 
significant side effects
E.g. Diclofenac
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25
Diclofenac
reversible, highly potent and can cause ulcers and renal dysfunction
26
Prostaglandins
PGE2 PGF2 ALPHA PGI2 TXA2
27
PGE2
pain sensation
28
PGF2 alpha
bronchoconstriction and uterine contraction
29
PGI2
inhibition of platelet aggregation and vasodilation
30
TXA2
Activation of platelet aggregation and vasoconstriction
31
Examples of NSAIDs
``` aspirin ibuprofen naproxen diclofenac mefanamic acid paracetamol ```
32
Opioids
acts at spinal epidural and site of injury | GPCRs at brain, spinal cord, GI tract and peripherally
33
effects of opioids
``` analgesia constipation sedation respiratory depression mood alteration main unwanted effect = nausea and vomiting ```
34
What is given with IV opioids?
Anti-emetics as people who are not used to them will vomit
35
what are the different types of opioids?
synthetic semi-synthetic opiates - naturally occurring
36
Egs of synthetic opioids
Fentanyl, pethidine and tramadol
37
Egs of semi-synthetic opioids
diamorphine
38
Egs of opiates
morphine and codeine
39
how to treat an opiate overdose?
Naloxone
40
What are prodrugs?
Drugs that are converted into the active form once ingested so are not active when they enter the body. e.g. codeine and diamorphine are converted into morphine
41
What converts codeine into morphine?
Cytochrome P2D6
42
Genetic variability in CYP2D6
means codeine will not affect some people and can have dangerous effects on some due to rapid conversion to morphine by a highly active variant of CYP2D6
43
opioid mechanism
G alpha 1 receptor protein when morphine binds it activates G alpha 1 subunit and GTP is converted back to GDP so no adenylate cyclase and less cAMP so there is less calcium dependent neurotransmitter release and an efflux of potassium ions causing hyperpolarisation
44
benefits and risks of opioids
highly effective side effects considerable dose-response variability potential for abuse
45
Endogenous opioids
body's own analgesics endorphins/ enkephalins peptides produced in pituitary and hypothalamus released locally - CNS and systemically
46
analgesic ladder
paracetamol and NSAIDs Weak opioid Strong opioid
47
chronic/ constant pain treatment
morphine slow release MST and fentanyl patches
48
Actue/ variable pain treatment
flexible dosing and IV administration
49
PCA
Patient controlled analgesia allows patient to regulate dosing schedule - drowsiness prevents excessive dose administration . Dose size and lock out interval set to ensure time allowed for dose to work
50
View of pain
you can get little pain and lots of tissue damage or lots of pain and no tissue damage
51
Pain but little/ no tissue damage
``` phantom limb pain headaches period pain paper cut hungover ```
52
No pain but tissue damage
Some cancers battlefield injuries bruises
53
What affects the pain experience?
``` prior experience attention/ expectation mood - anxiety and depression neurochemical and structural changes genetics neural sensation beliefs meanings behaviour in relation to pain you are more likely to experience pain if you have previously done something that caused pain ```
54
why is pain important?
Threat signal | elicits support from others and acts as a social alarm
55
Pain cycle
people become inactive if in pain but that causes muscles to tense which further irritates the nerve
56
Emotional pain
holding in emotional pain causes muscle tension and physical pain
57
pain sensitisation
changes to synapses at dorsal horn causing increased sensitivity to incoming signals
58
What factors amplify pain?
``` temperature weather stress social isolation insomnia catastrophising anger depression pain focus pushing on inactivity nicotine chemical dependency diet some surgery extensive trauma ```
59
What factors dampen down pain?
``` temperature cognitive balance high self-efficacy goal setting sleep social support effective communication pacing exercise relaxation some medication diet some surgery ```
60
cold temperature
causes more pain
61
childhood trauma
causes more pain
62
why is social support important in pain psychology
endogenous opiates released when with someone you love so when isolated less released
63
emotions related to pain
``` anger frustration anxiety tension grief depression low self-esteem lack of confidence shame guilt injustice vulnerability PTSD and trauma symptoms ```
64
Pain and emotion
there is overlap in the areas of brain involved in pain perception and emotion perception
65
Alexithymia
unable to name emotions - persistent pain

Physiology 2 (20 decks)

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