Pain Day

Question 1

How long does acute pain last? Chronic pain?

Answer 1

1 week or less; at least 6 months

Question 2

What is chronic regional pain syndrome?

Answer 2

Chronic condition characterized by severe pain, swelling, and changes in the skin

Question 3

Differentiate between the nociceptive Adelta and C fibers

Answer 3

Adelta fibers are the fast fibers that experience initial painful stimuli; C fibers contribute to the dull achy pain

Question 4

How does the descending pain system modulate pain perception?

Answer 4

Enkephalin interneurons can release endogenous opiates onto pre and post synaptic neuron terminals to modulate pain response within the dorsal horn

Question 5

What is nociception?

Answer 5

A process in peripheral or central nervous system that is associated with a noxious/highly unpleasant stimulus

Question 6

What is pain?

Answer 6

is the conscious experience associated with noxious stimuli

Question 7

Describe the theory of referred pain

Answer 7

Viscera experience nociception and sometimes there is “cross wiring”. Signals reach neurons in dorsal horn and can then ascend with anterolateral system

Question 8

What are the 5 functions of the medial pain system?

Answer 8

1. Limbic and Autonomic Activation
2. Learning and Anticipation
3. Nocifensive Behavior
4. Empathy
5. Inhibition

Question 9

Since 1996, opiate prescribing has increased in NYS. What has increased concurrently?

Answer 9

Deaths due to opiate overdose

Question 10

What is the general physiological result of opioid use? What system is primarily involved with pain?

Answer 10

Upregulation of the pain response - Hyperalgesia; Glutamate

Question 11

What are the social consequences of opioid use?

Answer 11

Loss of emotional affect

Question 12

What is the major strategy to kill seizures?

Answer 12

Kill the excessive neuronal firing!

Question 13

What are the three meds used to treat pain that block Na+ channels?

Answer 13

Carbamazepine, Lamotrigine, Topiramate

Question 14

What are the two drugs that block Ca2+ that are used to treat pain?

Answer 14

Gabapentin and Pregabalin

Question 15

What are the three bus stops of pain?

Answer 15

Cortex, Thalamus/Limbic, Spinal Reflex

Question 16

A patient experiences a minor painful stimulus. What channel is opened?

Answer 16

Sodium

Question 17

A patient experiences a full pain response. What channels are opened?

Answer 17

Sodium and Calcium

Question 18

A patient’s sensory system becomes glued together and begins to experience neuropathic pain. What channels are open?

Answer 18

Sodium, Calcium, Glutamate

Question 19

How can antidepressants modulate both psychological disorders AND pain disorders?

Answer 19

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!

Question 20

What are the three antidepressants used for pain?

Answer 20

Duloxetine and Milnacipran (SNRI) and Amitryptiline (TCA)

Question 21

In an emergency department, what patients receive more opioids?

Answer 21

Less educated, smokers, those who were abused

Question 22

What is an important thing to remember about pain perception?

Answer 22

People experience pain differently! One person’s 3 might be another person’s 5!

Question 23

Where is pain’s homebase in the brain? Where is depression’s homebase in the brain? What are their overlapping areas?

Answer 23

Amygdala, Contralateral Anterior Insula; Contralateral Anterior Insula, Anterior Cingulat Cortex and PFC; Contralateral Anterior Insula

Question 24

In brain studies, what are the similarities in activation betwixt major depressives and fibromyalgics?

Answer 24

The both activate similar deeper brain/limbic structures