PAIN AND ADDICTION

Question 1

what are the four parts of pain communication?

Answer 1

transduction
transmission
perception
modulation

Question 2

On what types of sensory neurone have nociceptive function?

Answer 2

a delta fibres

c fibres

Question 3

Which sensory neurone has the fastest conduction speed?

Answer 3

a alpha fibres

Question 4

what is the function of a alpha fibres?

Answer 4

proprioception

sensory relay from golgi tendon organ

Question 5

what is the function of a delta fibres?

Answer 5

NOCICEPTION (mechano and thermal)

Question 6

what is the function of a beta fibres?

Answer 6

touch

Question 7

what is the function of C fibres?

Answer 7

NOCICEPTION (mechano, thermal and chemical)

Question 8

which is the only fibre type to sense chemical stimuli?

Answer 8

C fibres

Question 9

which sensory fibre has the slowest rate of conduction?

Answer 9

C fibres

Question 10

which sensory fibre is non-myelinated?

Answer 10

C fibres

Question 11

what receptors on axons of 1st order sensory neurones are activated in response to heat?

Answer 11

TRPV1 receptor

Question 12

what is acute nociceptive pain?

Answer 12

high threshold, stimulus dependent pain

designed to warn away from painful stimuli

Question 13

what is inflammatory pain? is it reversible?

Answer 13

sensitisation of acute nociceptive pain due to innocuous stimuli being processed as noxious

e.g. touching the site of a burn

YES it is reversible

Question 14

what is neuropathic pain?

Answer 14

pain caused by a lesion or disease in somatosensory nervous system, whereby neurones are sensitised even in the absence of any stimulus

Question 15

what is stimulus evoked neuropathic pain?

Answer 15

problems with noxious stimulus amplification (hyperalgesia) or pain caused by a normal stimulus (allodynia)

Question 16

what is hyperalgesia?

Answer 16

increased sensitivity to pain

Question 17

what is allodynia?

Answer 17

pain induced from non-noxious stimuli

Question 18

What is spontaneous neuropathic pain?

Answer 18

burning or tightness associated with paraesthesia, tingling, shooting or stabbing

Question 19

what are the 4 mechanisms of neuropathic pain?

Answer 19

inflammatory mediation
altered nociceptor activity
altered spinal processing
pain processing in the brain

Question 20

How do neuropeptides contribute to neuropathic pain?

Answer 20

released by 1st order neurones following nociceptor activation

they cause increase in local inflammation

Question 21

what is the role of altered nociceptor activity in neuropathic pain?

Answer 21

inflammatory mediators modulate Na+ on nociceptive neurones, meaning lower threshold for AP conduction

Question 22

what is unique about nociceptor nerve endings

Answer 22

nerve endings are free in local environment

Question 23

in which rexed laminae to sensory nociceptive 1st order neurones terminate?

Answer 23

I to V

Question 24

according to the gate control theory, which fibres ‘override’ noxious stimuli transmission in the dorsal column?

Answer 24

a beta fibres

Question 25

what factors influence pain response?

Answer 25

cognition
mood
depression
genetics
context

Question 26

In addition to glutamate, what other excitatory neurotransmitter is found at the synapse between the first and second order nociceptive neurones?

Answer 26

Substance P

Question 27

through which two mechanisms does TENS produce its analgesic effects?

Answer 27

Closing the gate (gate control theory)

Endogenous opioid release (a delta fibres)

Question 28

How should you manage acute pain? (4 concepts)

Answer 28

enhanced recovery
expectation management
multimodal analgesia
opioid sparing

Question 29

what is meant by ‘multimodal pain management’ when treating acute pain?

Answer 29

use of pharmacological and non-pharmacological pain relievers to target all of the different facets of pain communication
e.g. local anaesthetics - transmission
NSAIDS - transduction
psychological interventions - pain modulation (via spinoreticulothalamic pathway)

Question 30

what is the definition of chronic pain?

Answer 30

pain that extends beyond the the period of healing, often with no pathology, occuring for 3 or more months

Question 31

what is the difference between primary and secondary chronic pain?

Answer 31

primary - pain is the disease itself

secondary - pain is the symptom of something else

Question 32

what is physical drug dependence?

Answer 32

when an individual depends on a drug for normal physiological functioning

Question 33

what is psychological drug dependence?

Answer 33

when drug use is a strong motivator of behaviour

Question 34

define drug addiction

Answer 34

Lay term used to emphasise psychological dependency

NOT A CLINICAL DIAGNOSIS

Question 35

define the term drug abuse

Answer 35

drug use that doesn’t conform to social norms. One can absue drugs without being dependent

Question 36

how is addiction diagnosed?

how is severity of addiction measured?

Answer 36

when a patient identifies as having several physical/behavioural traits that relate to addiction e.g. tolerance, withdrawal

by the number of traits one displays

Question 37

which region of the brain is responsible for the pathophysiology of addiction?

Answer 37

Nucleus accumbens

Question 38

what are the three stages of withdrawal?

Answer 38

severe (days 1-3)
moderate (days 3-10)
mild (10-30)

Question 39

explain the two different pathways to addiction

Answer 39

sensation seeking - those that use drugs in order to feel good
self medication - those that use drugs to cope with dysphoria in their life (often the quicker way to dependence)

Question 40

what are the three stages of opioid dependency treatment?

Answer 40

detoxification
relapse prevention
lifestyle and behaviour change

combination of pharmacotherapy, psychological therapy and family/social support should be used to treat addiction

Question 41

what receptors are found to be reduced in cocaine, alcohol and opiate addiction?

Answer 41

Dopamine D2 receptors