Pain management

Question 1

What is the gate theory

Answer 1

A combo of neurons in the dorsal horn regulates the transmission of pain signals to the brain

Question 2

Transmission of the pain signal is then regulated by what

Answer 2

Larger mechanofibers. If fibers are stimulated (non painful), the original perception of pain is diminished closing the pain gateway. Meaning a non painful input closes the gate to the painful stimuli

Question 3

When the gate is closed

Answer 3

Pain sensation is blocked

Question 4

When gate is open

Answer 4

Pain sensation reaches the brain

Question 5

What are the 3 opiod receptors

Answer 5

Mu, kappa, delta

Question 6

What receptor does morphine have a high affinity towards

Answer 6

Mu

Question 7

What is the effect of Mu receptors

Answer 7

Analgesic effect but also induces respiratory depression, euphoria, and mydriasis (pupil dilation).

Question 8

What is the effect of the Kappa receptor

Answer 8

Analgesic effects, but can have dysphoric and hallucinatory effects. No respiratory depression.

Question 9

Where are mu receptors found

Answer 9

Presynaptic neurons and dorsal horn of spinal cord

Question 10

Where are kappa receptors found

Answer 10

Widespread in the brain, pspinal cord and neurons

Question 11

Where are delta receptors found

Answer 11

Bind to enkephalins which are peptides that regulate nociception in the body.

Question 12

What is the effect of the delta receptors

Answer 12

So analgesic effect, but much more limited.

Question 13

Anesthesia

Answer 13

Absence of all sensation, especially to pain.

Question 14

Analgesia

Answer 14

Decreased or absent sensation of pain

Question 15

Hyperalgesia

Answer 15

Extreme sensitivity to pain

Question 16

Hyperesthesia

Answer 16

Extreme sensitivity to one of the body’s sense organs, such as pain or touch receptors in the skin

Question 17

Allodynia

Answer 17

Pain due to a stimulus that is not usually pain provoking. Like light touch or stroking.

Question 18

Dysesthesia

Answer 18

Abnormal reaction to touch. Occurs when a part of the body is touched and it causes some sort of unpleasant sensation like pain, burning, tingling. Caused by lesions in the nervous system

Question 19

Hyperpathia

Answer 19

Condition of hypersensitivity to sensory stimuli (includes hyperesthesia, hyperalgesia)

Question 20

Neuropathic pain

Answer 20

Pain caused from damage or disease to the somatic nervous system. Damage is usually to small non-myelinated fibers in the nerve which results in painful stimuli

Question 21

Nociceptive pain

Answer 21

Usually caused by damage to body tissue and is usually described as sharp, aching, or throbbing. Can be visceral or somatic

Question 22

Idiopathic pain

Answer 22

Unknown origin. Can by psychological in origin but may also involve both the cerebral and peripheral physiological mechanisms.

Question 23

Psychogenic pain

Answer 23

Pain that is caused, increased or prolonged by mental or emotional factors. (i.e. back pain, stomach pain)

Question 24

What is neuropathic pain characterized by

Answer 24

1. Allodynia, hyperalgesia.

2. Stabbing, burning and tingling

Question 25

Examples of neuropathic pain

Answer 25

1. Herpes 2. Neuralgia 3. Post stroke pain 3. Post amputation pain 4. Radiculopathic pain

Question 26

Types of nociceptive pain

Answer 26

1. tissue damage 2. arthropathies (arthritis) 3. myalgia 4. visceral pain (tumors)

Question 27

Acute pain

Answer 27

Rapid onset of organic or traumatic cause that induces immunologic and physiologic responses (usually short duration).

Question 28

Chronic pain

Answer 28

Pain that lasts longer than 3-6 months. after acute cause or lingers longer than expected duration

Question 29

Difference in treatment of acute vs chronic pain

Answer 29

``` Acute = get rid of the pain, do not progress to chronic Chronic = manage to a level that allows the pt to live a decent life style ```

Question 30

Physical dependence

Answer 30

Results from chronic use that has produced a tolerance and creates negative physical symptoms of withdrawal when the drug is stopped.

Question 31

Tolerance

Answer 31

Body is becoming unresponsive to a given level of the drug. Increase in the dose is required to provide the same amount of analgesia. Rotate opioids if this occurs

Question 32

Addiction

Answer 32

Drug seeking behaviors that occur when patients with sever pain cannot obtain tolerable relief (look at chart on objectives list)

Question 33

What are some red flags with addicted patients

Answer 33

1. out of control with meds 2. decrease quality of life 3. wants to continue meds despite side effects 4. does not follow treatment plan