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SUM'20 - Regional > Pain > Flashcards

Pain Flashcards

1
Q

what sensations are associated with Epicritic sensations

A

light touch
pressure
proprioception
temperature discrimination

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2
Q

how are epicritic sensations characterized

what type of threshold receptors

and conducted by what nerve fibers

A

are characterized by low-threshold receptors and are generally conducted by large myelinated nerve fibers.

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3
Q

what receptors detect protopathic sensations

A

high threshold receptors

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4
Q

what nerve fibers conduct protopathic sensations

A

conducted by smaller, lightly myelinated (alpha-delta) and unmyelinated (C) nerve fibers.

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5
Q

where are third order neurons located

A

located in the thalamus

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6
Q

where do third order neurons send fibers

A

to somatosensory areas I and II in the post central gyrus of the parietal cortex and the superior wall of the sylvan fissure respectively

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7
Q

Spino-mesencephalic tract

A

may be important in activating anti-nociceptive, descending pathways because it has some projections to the peri-aqueductal gray

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8
Q

the cornea and tooth pulp are unique- as they are innervated by what fibers

A

Adelta

C fibers

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9
Q

how sensitive is visceral organ tissue

A

insensitive tissues

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10
Q

what type of nociceptors do visceral organs contain

A

silent nociceptors

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11
Q

most other organs (intestine ) are innervated by what type of nociceptors

A

polymodal nociceptors

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12
Q

what do polymodal nociceptors respond to

A

smooth muscle spasm, ischemia and inflammation

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13
Q

what do polymodal receptors not respond to

A

cutting, burning, or crushing that occurs during surgery

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14
Q

Primary hyperalgesia

A

exaggerated response to pain at the site of injury

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15
Q

Secondary hyperalgesia:

A

increased pain response evoked by stimuli outside the area of injury…Release of Substance P

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16
Q

Secondary hyperalgesia -skin presentation

A

has red flushing, local tissue edema, and sensitization to noxious stimuli. Does not have skin denervation.

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17
Q

peripheral sensitization in relation to primary hyperalgesia

A

of polymodal C fibers & high-threshold mechanoreceptors that leads to primary hyperalgesia

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18
Q

what is the Wong-baker FACES scale who is it best used for?

A

Designed for children >3yr, useful for those populations who have difficulty communicating

Various faces on the graph (smiling = no pain; to extremely unhappy = worst possible pain) describe the pain

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19
Q

Endocrine effects: Stress increases

A

catabolic hormones (catecholamines, cortisol, and glucagon

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20
Q

Endocrine effects: Stress decrease what hormones

A

anabolic hormones (insulin and testosterone)

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21
Q

Hematological effects: Stress mediated increases

A

platelet adhesiveness, reduced fibrinolysis, and hypercoagulability

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22
Q

define Entrapment syndromes

A

Are syndromes caused by neural compression wherever a nerve comes through an anatomically narrowed passage, and can involve sensory, motor, or mixed nerves

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23
Q

how is entrapment syndrome diagnosis confirmed

A

Diagnosis is confirmed by electromyography and nerve conduction studies

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24
Q

Myofascial pain

A

Syndromes characterized by aching muscle pain, spasms, stiffness, weakness, and occasionally autonomic dysfunction. Patients develop discrete “trigger points” of tenderness in one or more muscles or connective tissues. Roppy bands over trigger points

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25
Q

how is Fibromyalgia diagnosed

A

diagnosis is by rule out.

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26
Q

fibromyalgia- widespread pain index score?

symptoms severity scale score

A

7 or higher (or 3-6) with…

5 or higher (9 or higher)

  • at least 3 mos
  • another d/o not present to otherwise explain the pain
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27
Q

medications approved by FDA for fibromyalgia

A

pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella).

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28
Q

what medications are contraindicated in firbomyalgia (google)

A

Pure mu-opioid receptor agonists, such as codeine, fentanyl and oxycodone, are contraindicated

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29
Q

90% of disc herniations occur at what levels

A

L5-S1
or
L4-L5

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30
Q

what is Ankylosing spondylitis

A

a form of arthritis

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31
Q

what is ankylosing spondylitis associated with

A

familial disorder associated with histocomptability antigen HLA -B27

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32
Q

who is ankylosing spondylitis usually seen in

A

low back pain with early morning stiffness in YOUNG patients usually MALE.

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33
Q

how is ankylosing spondylitis diagnosed

A

radiographic evidence of sacroiliitis present- progression develops bamboo like radiographic appearance.

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34
Q

Diabetic neuropathy

A

• MOST COMMON neuropathic pain in practice and is a major cause of morbidity

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35
Q

• MOST common syndrome is peripheral polyneuropathy

A

symmetric numbness (“stocking and glove”)

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36
Q

Tension headache:

A

Described as tight bandlike pain or discomfort that is often associated with tightness in the neck muscles

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37
Q

where is tension headache usually located on the head

is it bilateral or unilateral

A

May be frontal, temporal, or occipital

more often bilateral than unilateral

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38
Q

Cluster headaches are classically found where

A

unilateral and periorbital.

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39
Q

what is the pattern of occurrence for cluster headaches

A

1-3 attacks/day in a 4-8week period.

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40
Q

how long do cluster headache episodes last

A

30-120 min

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41
Q

how are cluster headaches pain described

A

Burning or drilling sensation that may awaken the patient from sleep

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42
Q

trigeminal neuralgia is known as

A

tic douloureux

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43
Q

nociceptive pain

A

cause by activation or sensitization of peripheral nociceptors that transduce noxious sitmuli

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44
Q

neuropathic pain

A

is a resul of injury or acquired abnormalities of peripheral or central neural structures

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45
Q

Acute pain

A

is caused by noxious stimulation due to injury, a disease process or abnormal function of a muscle or viscera. It is usually nociceptive, which serves to detect, local and limit tissue damage.

46
Q

Somatic Pain

superficial

how is it characterized?

A
  • Superficial somatic pain is due to nociceptive input arising from skin, subcutaneous tissue, and mucous membranes
  • (characterized well localize, sharp, pricking, throbbing, or burning sensation);
47
Q

Chronic pain

A

is pain that persists beyond the usual course of an acute disease or after a reasonable time for healing to occur. This healing can vary from 1 to 6 months. Chronic pain may be nociceptive, neuropathic or mixed

48
Q

the distinguishing factor of chronic pain-

A

A distinguishing factor of chronic pain is that psychological mechanisms or environmental factors frequently play a major role

49
Q

first order neurons

A

majority of neurons send the proximal end of their axons into the spinal cord via the dorsal spinal root at each cervical thoracic lumbar and sacral level

50
Q

second order neurons

A

may ascend or descend one to three spinal segments in lissauer tract before synapsing with second order neurons

they snaps with second order neurons in the grey matter of the ipsilateral dorsal horn.

51
Q

the spinothalamic tract

A

classically considered the major pain pathway.

52
Q

what is Classically considered the major pain pathway

A

The spinothalamic tract

53
Q

The spinothalamic tract- where is it

A

It lies anterolaterally in the white matter of the spinal cord.

it is an ascending tract

54
Q

Acute pain

A

Acute pain is typically associated with a neuroendocrine stress response that is proportional to
pain intensity

55
Q

CV effects:

A

hypertension,
tachycardia,
enhanced myocardial irritability,
increased systemic vascular resistance.

Cardiac output increases in most normal patients but may decrease in patients with compromised ventricular function. Because of the increase in myocardial oxygen demand, pain can worsen or precipitate myocardial ischemia

56
Q

Respiratory effects:

A 
increase 02 consumption
increase c02 production
increase minute ventilation
increase WOB
reduced tidal volume
atelectasis
shunting
reduced vital capacity
reduced coughing
57
Q

Facet syndrome

A

they “SERVE THE NERVE ROOT”

injury to the facet joint can compress the spinal nerve the exits the respective intervertebral foramen - causing pain and muscle spasm along the associated dermatome

(apex)

58
Q

Spinal stenosis- is a disease seen with what age group

A

advancing age

59
Q

spondylolisthesis

A

displacement anteriorly of one vertebral body on the next d/t disruption of the posterior elements, usually the pars interarticularis

60
Q

spondyloptosis

A

Subluxation of one vertebral body on another resulting in one body in front of the next.

61
Q

what is the preferred corticosteroid for injection. in procedures involving relatively vascular areas, such as head and neck region.

A

dexamethasone

62
Q

Neuralgia

A

Pain in the distribution of a nerve or a group of nerves -

Sciatic, neuropathy, diabetes, chicken pox (shingles in adults)

63
Q

Radiculopathy

A

Functional abnormality of one or more nerve roots

64
Q

Transduction

A

The event whereby noxious thermal, chemical, or mechanical stimuli are converted into action potential

65
Q

Anesthesia

A

ABSENCE OF ALL PAIN SENSATION

66
Q

Allodynia

A

Perception of an ordinarily non-noxious stimulus as pain

-Something that causes pain that wouldn’t normally cause pain!

67
Q

does the brain have nociceptors

A

lack nociceptors totally

68
Q

does the brain meningeal coverings have nociceptors

A

Yes

69
Q

visceral afferent fibers travel and enter the spinal cord between

A

T1 and L2

70
Q

nociceptive C fibers from the trachea, larynx, and esophagus travel with ____nerve to enter the nucleus solarium in the brain stem .

A

vagus

71
Q

excitatory amino acids

A

glutamate and asparate

72
Q

excitatory neuropeptides

A

substance P and calcitonin gene related peptide.

73
Q

inhibitory amino acids

A

glycine and GABA

74
Q

coccydynia

A

result from trauma to coccyx or surrounding ligaments

75
Q

Piriformis syndrome –

A

pain in buttock, numbness and tingling in sciatic nerve

76
Q

Degenerative Disc Disease

A

 Nucleus pulposus (gelatinous material) degenerates and becomes fibrotic
 Most commonly affects lumbar spine – subjected to greatest motion

77
Q

degenerative disc disease is most commonly associated with what two things

A

overweight

smoking

78
Q

treatment of degenerative disc disease

A

o Steroid injections
o Ablation
o Surgical fusion

79
Q

-pain fibers from head are carried by

A

trigeminal (V),
acial (VII),
glossopharyngeal (IX) and
vagal (x)

“1975”

80
Q

spondylolysis,

A

disruption of the pars interarticularis

81
Q

Total spinal anesthesia can occur following attempted epidural or caudal anesthesia if there is accidental intrathecal injection. Onset is usually rapid, because the amount of anesthetic required for epidural and caudal anesthesia is

A

5 to 10 times that required for spinal anesthesia.

82
Q

urinary retention may result of neuraxial block due to LA blocking

A

s2-s4 root fibers (decreases urinary tone & inhibits the voiding reflex)

  • Epidural opioids also interfere with normal voiding
  • Use urinary catheter
83
Q

Accidental intravascular injection intervention/tx:

A

Lipid emulsion, 20% 1.5 mL/kg bolus OVER 1 MINUTE, should be given followed by a 0.25-mL/kg infusion.

Incremental 1 mcg/kg doses of epinephrine should be administered rather than larger 10 mcg/kg doses.

Should cardiac function not be restored additional lipid emulsion can be administered up to 10 mL/kg.

84
Q

The rank order of local anesthetic potency at producing seizures and cardiac toxicity is the same as the rank order for potency at nerve blocks. how do they rank?

A

-LOW: Chloroprocaine has relatively low potency and also is metabolized very rapidly;

MOD: lidocaine and mepivacaine are intermediate in potency and toxicity;

!!! HIGH: levobupivacaine, ropivacaine, bupivacaine, and tetracaine are most potent and toxic.

85
Q

A subdural injection of epidural doses of local anesthetic produces a clinical presentation similar to that of high spinal anesthesia, with the exception that the onset

A

may be delayed for 15 to 30 min and the block may be “patchy.”

86
Q

diplopia is most often a symptom of what cranial nerve dysfunction? (from PDPH)

A

CN 6 - abuducens

87
Q

volume of blood injected for an epidural blood patch:

A

15-20mL

88
Q

differential diagnosis that should be considered as source of headache when evaluating for PDPH:

A

migraine,
caffeine withdrawal,
meningeal infection, and
subarachnoid hemorrhage,

89
Q

abrupt discontinuation of this medication has been associated with fever, altered mental status, pronounced muscle spasticity or rigidity, rhabdomyolysis, and death

A

baclofen

*GABA-b agonist, is particularly effective in the treatment of muscle spasm associated with multiple sclerosis or spinal cord injury when administered by continuous intrathecal drug infusion

90
Q

Excess glucocorticoid activity can produce:

A

HTN, hyperglycemia, increased susceptibility to infection, peptic ulcers, osteoporosis, aseptic necrosis of the femoral head, proximal myopathy, cataracts, and rarely psychosis

91
Q

the preferred corticosteroid for injection procedures involving relatively vascular areas, such as the head and neck region

A

dexamethasone

92
Q

Transient neurological symptoms (TNS) are most commonly associated with the use of what LA?

A

hyperbaric lidocaine (up to 12%)

93
Q

Cauda equina syndrome (CES) is associated with the use of what LA?

A

5% Lidocaine

hyperbaric lidocaine

94
Q

Cauda equina syndrome (CES) symptoms:

A
  • bowel and bladder dysfunction
  • paresis of legs (motor and/or sensory)
  • diminished sensory in perineal region
  • “patchy” sensory loss
  • pain may be similar to nerve root compromise
95
Q

TNS is most common among who? (3)

A
  1. outpatients
  2. males
  3. lithotomy position
96
Q

LA associated with the worst outcomes with intravascular injection?

A

bupivacaine

*cardio toxic

97
Q

arachnoiditis

A
  • may be infections/noninfectious
  • reaction from chemicals neurotoxicity of chg
  • marked by pain
  • on XR seen as “clumping of nerve roots”
98
Q

meningitis and arachnoiditis result from

A

contamination of equipment or injected solutions

99
Q

the sympathetic nervous system (SNS) appears to play a major role in some patients with

A

chronic pain

100
Q

o A distinguishing factor of chronic pain is that what two mechanisms/factors frequently play a major role:

A

psychological mechanisms or environmental factors

101
Q

• The first order neurons synapse with second order neurons in the

A

dorsal horn

102
Q

• First order neurons synapse with second order neurons in the gray matter of the ipsilateral dorsal horn (communicate through interneurons) and carry on to the

A

thalamus

103
Q

• Axons of second order neurons cross midline to the contralateral side of the spinal cord before they terminate in the spinothalamic tract and send their fibers to the thalamus, reticular formation, nucleus raphe magnus, and

A

periaqueductal gray

104
Q

• Located in the thalamus & send fibers to somatosensory areas I & II in the postcentral gyrus of the parietal cortex & the superior wall of the sylvian fissure, respectively.

A

third order neurons

105
Q

• Perception & discrete localization of pain take place in these cortical areas.

A

somatosensory cortex

106
Q

o Neuroendocrine stress response is attenuated or absent in most patients with

A

chronic pain.

107
Q

o Antidepressants are most useful for patients with

A

neuropathic pain.

108
Q

o Antidepressants potentiate the action of

A

opioids

frequently help normalize sleep patterns.

109
Q

Long-term side effects of neuroleptic medications include akathisia (extreme restlessness) and tardive dyskinesia (involuntary choreoathetoid movements of the tongue, lip smacking, and truncal instability).

examples of neuroleptics :

A

haloperidol
chlorpromazine
perphenazine
fluphenazine

110
Q

o Tizanidine (Zanaflex) is a centrally acting α 2-adrenergic agonist used in the treatment of muscle spasm in conditions such as .

A

multiple sclerosis, low back pain, and spastic diplegia

111
Q

o Cyclobenzaprine (Flexeril) also may be effective for (MS, low back pain, spastic diplegia). Its precise mechanism of action is .

A

unknown

SUM'20 - Regional (17 decks)

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