Pain Correlates-Falkenberg TBL Flashcards
Where do we find nociceptors?
skin, muscle, joints and visceral tissues
How do you get neuropathic pain?
primary lesion or dysfunction in the nervous system,
i.e diabetic neuropathy
What is sympathetic pain or CRPS?
Pain signals from the sympathetic nervous system become constant and severe, even though there is no obvious cause of pain. The mechanism by which this happens is complex and not fully understood.
What kind of pain is this:
relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown.
idiopathic
What makes the nervous system plastic?
windup change of neurotransmitter change of phenotype sprouting glial cells hyperesthesia allodynia hyperlgesia
What are first line analgesic drugs?
acetaminophen
aspiring/NSAIDs
adjuvants
What are 2nd line or drugs to use when pain is out of control drugs?
opoids (sustained release or immediate release)
NSAIDs
adjuvants
What drugs do use for refractory pain (pain that persists longer than usual and isnt responding to the usual meds)?
spinal/epidural opoids (clonidine, local anesthetic) selective nerve blocks neuroablative procedures Ketamine total sedation
What are the major classes of analgesics?
NSAID’s
P-aminophenol
Opiates
Local anesthetics, lidocaine
What are examples of NSAIDS?
ibuprofen, naproxen, ketoprofen, COX-2 inhibitor
What is an example of an P-aminophenol?
tylenol
What are examples of opiates?
morphine, oxycodone, fentanyl
What is an excellent anesthetic?
lidocaine
What is a common calcium channel blocker?
ziconotide
what are these: Calcium channel blockers- ziconotide Anticonvulsants Selective serotonin reuptake inhibitors Alpha-agonists Multi-receptor drugs- Tapentadol (NE) TRPV-1- antagonists
analgesics
What drugs target the cortex for pain relief?
anxiolytics, hypnotics, opoids, psychostimulants, anticonvulsants
What drugs target the thalamus for pain relief?
SSRI’s, anticonvulsants
What drugs target the spinal cord?
Opoids, adrenergicagonists, SSRIs.
Where do you put a neural blockade?
spinal cord baby!
What can illicit pain relief at the pain receptors?
NSAIDs
Local Anesthetics
What does P.O stand for?
oral
What does P.R stand for?
rectal
What does Sub. Q stand for?
subcutaneous
How do you give someone a transmucosal administration of a drug?
via a sublingual lollipop
Why should you treat pain?
pulmonary function, CV function, mobility
The majority of drugs are (blank) rather than local. Why are local drugs so nice?
systemic
Because they have less systemic effects so less side effects
What is fentanyl?
100 X more potent than morphine (used in chronic pain patients)
What is preemptive analgesia?
prevent firing of pain nerves prior to surgery to increase recovery time and decrease risk of chronic pain.
(hit them with that multimodality, and do it before, during and after to prevent wind up)
What is additive and synergistic analgesia?
treating multiple types of receptors (multimodality) will have an additive affect and result in better pain relief
What is on-demand analgesia?
when the patient asks for it and you give it to them
What is patient controlled analgesia? What pnt population to you need to do special stuff for and why?
they have a button they can press for analgesia
children, keep parents out of room because the parents always mess with the button
What should you do for chronic pain?
comprehensive history and workup , and treat the, with a multidisciplinary approach and the goal is to increase their function rather than relieve the pain
What are adjuncts?
drugs that you can use on top of other drugs
What are some pharmacological adjuncts?
steroids TCAs muscle relaxants nerve blocks epidural injections spinal injections clonidine anti-epileptic drugs
If people are in pain will they get addicted to a drug?
no!!!! You can take a ton of it without getting addicted with pain BUT if you dont have pain and take a drug you can get addicted super fast
What are some fears of narcotics?
addiction, abuse, side effects, legal issues
How have drugs advanced so they cant be abused?
they have been made to be ineffective if crushed :)
In general it takes (blank) half-lives to get to a therapeutic level
5
How do you dose a drug based on weight?
mg/kg to the 3/4 power.
How can you get immediately to the therapeutic range?
loading dose!
If a drug gets approved by the FDA do you have to prescribe them for what the drug was intended for?
nope you can prescribe it for whatever you want
What is a TRPV-1 receptor activator? What do they do?
adlea (capsaicin)
they desensitize the nociceptors (think ben gay)
What does bicifadine do?
inhibits nor-epi and serotonin reuptake
What does RTX (reseniferatoxin?
TRPV-1 agonist
What works on glial cells?
CB2 (cannabinoid)
What are intrathecal pumps?
an implantable device in the spine that allows for meds to get directly pumped into it
What are dorsal column stimulators?
they are implantable devices in your spinal cord that will provide it with electrical stimulation to relieve pain
What are these: Ganglion blocks, neurotoxic Neurosurgical- ex. ganglionectomy, thalamotomy, nerve decompression, gamma knife Surgical- sympathectomy Radio-frequency treatments Whats the issue with these?
other procedures for analgesia
sometimes can cause windup and result in worse pain
