Pain Day Flashcards
How long does acute pain last? Chronic pain?
1 week or less; at least 6 months
What is chronic regional pain syndrome?
Chronic condition characterized by severe pain, swelling, and changes in the skin
Differentiate between the nociceptive Adelta and C fibers
Adelta fibers are the fast fibers that experience initial painful stimuli; C fibers contribute to the dull achy pain
How does the descending pain system modulate pain perception?
Enkephalin interneurons can release endogenous opiates onto pre and post synaptic neuron terminals to modulate pain response within the dorsal horn
What is nociception?
A process in peripheral or central nervous system that is associated with a noxious/highly unpleasant stimulus
What is pain?
is the conscious experience associated with noxious stimuli
Describe the theory of referred pain
Viscera experience nociception and sometimes there is “cross wiring”. Signals reach neurons in dorsal horn and can then ascend with anterolateral system
What are the 5 functions of the medial pain system?
- Limbic and Autonomic Activation
- Learning and Anticipation
- Nocifensive Behavior
- Empathy
- Inhibition
Since 1996, opiate prescribing has increased in NYS. What has increased concurrently?
Deaths due to opiate overdose
What is the general physiological result of opioid use? What system is primarily involved with pain?
Upregulation of the pain response - Hyperalgesia; Glutamate
What are the social consequences of opioid use?
Loss of emotional affect
What is the major strategy to kill seizures?
Kill the excessive neuronal firing!
What are the three meds used to treat pain that block Na+ channels?
Carbamazepine, Lamotrigine, Topiramate
What are the two drugs that block Ca2+ that are used to treat pain?
Gabapentin and Pregabalin
What are the three bus stops of pain?
Cortex, Thalamus/Limbic, Spinal Reflex
A patient experiences a minor painful stimulus. What channel is opened?
Sodium
A patient experiences a full pain response. What channels are opened?
Sodium and Calcium
A patient’s sensory system becomes glued together and begins to experience neuropathic pain. What channels are open?
Sodium, Calcium, Glutamate
How can antidepressants modulate both psychological disorders AND pain disorders?
By increasing NE, you can treat the ascending pathways and treat conditions such as depression, anxiety, and ADHD and increase descending NE to increase GABA interneurons activity and decrease pain signals!
What are the three antidepressants used for pain?
Duloxetine and Milnacipran (SNRI) and Amitryptiline (TCA)
In an emergency department, what patients receive more opioids?
Less educated, smokers, those who were abused
What is an important thing to remember about pain perception?
People experience pain differently! One person’s 3 might be another person’s 5!
Where is pain’s homebase in the brain? Where is depression’s homebase in the brain? What are their overlapping areas?
Amygdala, Contralateral Anterior Insula; Contralateral Anterior Insula, Anterior Cingulat Cortex and PFC; Contralateral Anterior Insula
In brain studies, what are the similarities in activation betwixt major depressives and fibromyalgics?
The both activate similar deeper brain/limbic structures
