Pain Clinical Correlates Flashcards
Pain
Unpleasant sensory and emotional experience associated with actual or potentia l tissue damage
Acute pain
Hurt=harm…avoidance decreases damage
Clear path
Fixed end point, immobilization, meds
Chronic pain
Hurt does not = harm and fear avoidance cycel
Multifactorial
No end point, immobilization owrse, meds beware
Tx of actue and chronic
Acute - aggressive, coping skills secondary, intensive hospital, physio evolving
Chronic - step wise, coping skills important, outpatient only, physio established
Mech/noci pain
Sharp, dull, ache
Tissue destruction, inflammationan, somatic pain, visceral pain
Neuropathyuic pain
Bruning, stinging, pins and needles
Allodynia, dysethenia, hyperalgesia
Non painful sensation now painful
Abnormal sensation
Increases ensitivity to pain
Fibers types
Mecahno - Abeta - fast
Pain - adelta-fast
C - slow
Pain pathway
Can be excitatory or inhibitory
Anexiety and depression
Lateral pathway - helps ID location, type intensity
Medial - helps drive attnetion and salience to the pain
Gate control theroy
Can only handle so much stimulus so if you stimulate Abeta fibers, less capacity to send pain
TENS
Transcutaneous electricla nerve stimuloation
Based on Gate theory
For Chronic MSK pain normally
Opioid indication
Acute, traumatic, post op, cancer, palliative
What should especially not be prescribed with opioids
Benzos
Opioid receptors
Mu - most analgesia and bad things
Kappa - some analgesia, dysphoric effects
Delta - no analgesia
Fentanyl onset of action
2-5 minutes
Better than morphine or hydromorphone
Naloxone with SE
Shorter half life than opioid
Confusion, dizzy, N/V
Arrythmias
Seizures
Negative pressure pulooanry edema
Complex regional pain syndrome
Hyperaesthesia or allodynia
Temperatuee or skin color asymmetry
Sweating, swelling or atrophy
2 types of CRPS
RSD - absence of definable injury…noxoius event iwht sponatneous pain and hyperalgesia
Casalgia - Similar course with burning and allodynia…need specific nerve injury
Tx of CRPS
All physical therapy related
Sympathetic blockade success
Horner syndrome
Temp increase
Increased blood flow
Trigeminal nerualgia and causes
Sudden stabbing pain or more constant buring pain that is severe to soft touch
Myelin destruction (BV or MS) Compression from tumor or AVM
Main drug for TN and stuff about it
Carbamazepine (Na channel blocker)
Diagnositc for TN
Also for tonic-clonic seizures and bipolar disorder
Stabilizes inactivsated V gated channel
Side effects of SJS, toxic epidermal necrolysis, bone marrow suppression
Diabetic peripheral neuroapthy
Diagnose with PE, NOT EMG
Pregablin
Alpha 2 delta subunit calcium channel blocker
More potent and quikcer onset than gabapentin
For diabetic and fibromyalgia
Dizziness, sleepiness, swelling
Gabapentin
Less potent and longer titration period than pregablin
Fibromyalgia and tx
Physical, mental, and social components
More in women
Widespread pain/abnormal pain processing
Duloxetine/milnacripran/pregablin
Duloxetine
SNRI serotinin-NE reuptake inhibitor
Favors serotnin over NE
Suicidal thoughts a risk when initating tx in adolescents
TCAs
Inhibit serotinin and NE as well as partial Na channel blockade
Acute Mechanical LBP
Most gets better
Ice, rest, heat
NSAIDs,
PT
Mechanical back pian tx.
Duloxetine or injections
Thalamic pain syndrome
Dejerine-Roussy syndrome
After thalamic stroke
Try everything
Intrathecal drugs
Morphine and baclofen (for spasticity)
Ziconotide (Ca hcnanel blocker)
