Pain Characterization Flashcards
Carbamezepine
Trigeminal neuralgia and anti-convulsant.
Gabapentin
Postherpetic neuralgia and anti-convulsant.
Pregabalin
Post-herpetic neuralgia
Diabetic neuropathy
Fibromyalgia
Spinal cord injury
Amitriptyline
Anti-depressant
Am I trippin’? No, you’re just depressed.
Duloxetine
Diabetic neuropathy
Fibromyalgia
SNRI
Lidocaine and Capsaicin
Post-herpetic neuralgia
This type of pain is caused by injury to body tissues.
Nociceptive pain
Most pain is _______.
Nociceptive
This pain is caused by damage to the nervous system.
Neuropathic
Pain receptors for tissue injury.
Nociceptors
Chronic pain is ___________ in nature.
Neuropathic
Most pain due to cancer us ____________.
Nociceptive
“To do harm” in Italian
Nuocere
Most chronic pain is neuropathic, except for these two things, which are nociceptive, but chronic in nature.
Osteoarthritis and Rheumatoid Arthritis
3 Types of nociceptors
Thermal
Mechanical
Chemical
Characteristic of dendrites on nociceptors.
NOT encapsulated
These drugs are used to treat nociceptive pain.
Acetaminophen (Tylenol)
NSAIDs
Opioids
This pain results from damage to the peripheral or central nervous system rather than stimulation of pain receptors.
Neuropathic pain
A painful response to a stimulus that’s not painful.
Allodynia
An exaggerated painful response to a painful stimulus.
Hyperalgesia
This pain results from damage to or dysfunction of the peripheral or central nervous system, rather than stimulation of pain receptors.
Neuropathic pain
Common causes of neuropathic pain: (these are all in blue).
Diabetic neuropathy Postherpetic neuralgia Facial nerve problems MS Chemotherapy Amputation HIV Spine surgery Alcoholism
Two most common forms of neuropathic pain.
1) Postherpetic neuralgia (shingles).
2) Diabetic peripheral neuropathy
Possible cause of trigeminal neuralgia.
Blood vessels compress CN V.
These do not help treat trigeminal neuralgia.
Analgesics and opioids.
First-line drug for Trigeminal Neuralgia
Anti-epileptic drugs
Like Carbamazepine
This drug is anti-epileptic and is used for partial pain relief for 80-90% of people with Trigeminal Neuralgia.
Carbamezepine
These 3 drugs are used to treat Chronic Neuropathic pain:
1) Anticonvulsant drugs
2) Anti-depressants
3) Topical lidocaine or Topical Capsaicin
Anticonvulsant drugs
Carbamezepine
Gabapentin
Pentagabalin
Antidepressants
Amitriptyline
Duloxetine
Topical lido and capsaicin are used for ________.
Neuropathy
Carbamezepine MOA
Inhibits Sodium channels on neurons, this reducing their excitability.
The main inhibitory neurotransmitter in the CNS.
GABA
What is Gabapentin used for?
Post-herpetic neuralgia and anti-convulsant.
MOA of gabapentin and pregabalin.
Inhibit Calcium receptors, preventing the exocytosis of neurotransmitters.
Used for the treatment of pain associated with diabetic neuropathy, postherpetic neuralgia, fibromyalgia, and neuropathic pain associated with spinal cord injury.
Pregabalin
Used off-label in the treatment of trigeminal neuralgia.
Pregabalin
Recommended by the Neuropathic Pain Group of the International Association for the Study of Pain (IASP) as first-line treatment for neuropathic pain.
Amitriptyline.
How does Amitriptyline work?
Inhibits the reuptake of Serotonin and NE from the presynaptic nerve.
Also blocks cholinergic, adrenergic, and histaminergic receptors and sodium channels.
Anticholinergic side effects (like dry mouth and eyes, urinary retention, excess sedation, orthostatic hypotension, constipation, and blurry vision) occur with these drugs.
Tricyclic antidepressants - Amitriptyline.
SNRI stands for:
Serotonin Norepinephrine reuptake inhibitor
A SNRI antidepressant used for diabetic neuropathy and fibromyalgia
(neuropathic pains).
Duloxetine
Topical Lido MOA
Blocks voltage-gated Na channels.
First line option to treat localized peripheral neuropathic pain.
Topical lido in a patch
Indicated for the management of neuropathic pain associated with postherpetic neuralgia.
Capsaicin (Topical)
Causes pain relief by reducing TRPV1-expressing nociceptive nerve endings, depleting the NT Substance P involved in sending pain signals to the brain.
The nerve endings are damaged and can’t recover for three months.
Capsaicin
A receptor that is expressed on nociceptive nerve fibers in the skin/
A nociceptive pain receptor in the skin.
TRP-V1
