Pain Management Flashcards
Increased sensitivity to pain =
algesia
pain producing =
algogenic
a normally non-harmful stimulus perceived as painful =
allodynia
the absence of pain in the presence of a normally painful stimulus =
analgesia
an unpleasant painful abnormal sensation, whether evoked or spontaneous =
dysesthesia
a heightened response to a normally painful stimulus =
hyperalgesia
pain in the distribution of peripheral nerve
neuralgia
an abnormal disturbance in the function of a nerve =
neuropathy
an abnormal sensation, whether spontaneous or evoked =
paresthesia
acute pain occurs in what time frame?
<1 month
acute pain is associated with ___ or ___ tissue damage
actual or potential
chronic pain occurs in what time frame?
> 3mo
chronic pain = persistent pain associated with a distinct period of ____ pain of __ months or more that includes negative ___ and ___ experience
uninterrupted, 3, sensory, emotional
nociceptive pain is ___ and ____ in nature
somatic and visceral
non-nociceptive pain is ___ and ___ in nature
neuropathic, inflammatory
what type of pain is identifiable to focus, stems from tissue damage, is well localized, sharp, hurts at area?
somatic
what type of pain is diffuse, referred, dull, cramping, squeezing.
visceral
what type of pain is associated with autonomic reflexes such as nausea, vomiting, diarrhea
visceral
what type of pain results from damage to peripheral or central neural structures, resulting in abnormal processing of painful stimuli?
neuropathic
remember this is also non-nociceptive
what type of pain stems from sensitization of the nociceptive pathway from multiple mediators
inflammatory pain
_____ is the transformation of noxious stimuli (chemical, mechanical, thermal) to an action potential
transduction
which nerve fibers are fast, sharp, pain(6-30m/s) (reflex alert)
A delta
which nerve fibers are slow (0.5-2 m/s) dull burning throbbing aching
C fibers
Substance P is associated with which nerve fibers?
c
Substance P causes vaso____, extravasation of plasma proteins, degranulation of ___ cells, sensitization of stimulated sensory nerve
vasodilation.
mast
glutamate is associated with ____, ____, ____
CNS, A-delta, C fibers
T/F Glutamate transduction has an instantaneous effect and is associated with fast, sharp pain.
TRUE
Bradykinin : ____-algesic
peptide.
has a direct stimulating effect on peripheral nociceptors via bradykinin receptors
____ is an amine released from mast cells, basophils, and platelets via Substance P, causing edema and vasodilation
histamine
___ is an amine stored and released from platelets after tissue injury
serotonin
what 3 substances are synthesized from cox1 and cox2, cause hyperalgesia
prostaglandins, leukotrienes, thromboxanes
PLT
what substance is released in response to tissue injury and causes an increased production of prostaglandins
cytokines
___ is a peptide released from afferent C fibers. causes local cutaneous vasodilation, plasma extravasation, and sensitization
Calcitonin gene-related peptide (CGRP)
___ is the process by which action potential is conducted from the periphery to the CNS
transmission
example is spinothalmic anterolateral tract
____ occurs once signal is recognized by various areas of brain
perception
____ refers to altering neural afferent activity along pathway
modulation
suppress = ____, enhance = ____
suppress = inhibatory, enhance = excitatory
SI-EE
suppression works on descending ___ pathways
efferent
___ inhibit COX, thereby stopping the conversion of arachidonic acid to prostaglandins
NSAIDs
30mg of IM Ketorlac is equivalent to ___mg IM morphine
12
dont administer toradol for >___ days
5
contraindications to Ketorlac include
coagulopathies, renal failure, active PUD, GI bleeding, hypersensitivity to NSAIDS, surgery with high potential for post op bleeding
MOA of toradol?
non-selective COX inhibitor
acetaminophen reduces ___ synthesis
prostaglandin
Opiods: CNS receptors are in the ____ horn, specifically ______
dorsal horn, specifically reed lamina II (substance gelatinosa)
opioids: peripherally ___ sensory nerve fibers in GI tract, lungs, joints
afferent
mu, delta, and kappa receptors: ___ channels are inhibited presynaptically, and ___ conductance is increased post-synaptically
ca, K
how do opiates affect adenylate cyclase activity?
decrease pre-synapptically - thereby inhibiting calcium channels, which causes a dec in excitatory neurotransmitters
what affect does increased potassium conduction postsynaptically on mu delta and kappa receptors have?
hyperpolarization, inhibits excitatory neurotransmission
T/F Ketamine is an NMDA agonist.
FALSE - NMDA antagonist
which receptor is associated with wind up?
NMDA
how do clonidine and precedex work at alpha 2 receptors?
- they inhibit adenyl cyclase and decrease cAMP
- activate postsynaptic K channels and inhibit presynaptic Ca channels which decrease neurotransmitter release
Should the patient continue their gabapentin, pregabalin, antidepressants, corticosteroids , methadones?
absolutely.
how do gapapentin and pregabalin (lyrica) work?
they are for neuropathic pain syndromes - inhibit neuronal excitation and stabilize nerve membranes.
how do antidepressants work?
they block the reuptake of serotonin and norepinephrine in the CNS, increasing availability
corticosteroids decrease ___ and ____ release
cytokine, prostaglandin
methadone has synthetic ____, ____ , and ____ receptor action
synthetic opiod, opiod, and NMDA
what are the 3 heuristic subdivisions of painful stimuli?
painful stimuli without tissue damage, tissue damage without nerve damage, and nerve damage
what are the 3 anatomic regions associated with pain
peripheral, spinal , cerebral
T/F Substance P and Substance P receptors are specifically associated with neuropathic and cancer pain.
FALSE. specifically associated with inflammatory pain, while diminished or absent in neuropathic and cancer pain
Chronic Pain: inflammatory pain produces capillary vasodilation, smooth muscle contraction. promotes ____ transmission of pain impulses to ____. via which 3 mediators?
promotes synaptic transmission of pain impulses to CNS.
histamine, bradykinin, substance P
neurpathic pain commonly leads to ____
allodynia
pain from stimuli that is normally not painful
T/F Neuropathic pain is persistent, allodynia, and not managed well with NSAIDs
true
____ is the cyclic response to pain that leads to abnormal pain response
windup
neuropathic pain is thought to include the dysfunction of both ___ and ____ fibers
A (fast) and C (slow)
NMDA receptors are stabilized by __
magnesium
In the periphery, abnormal (chronic pain): magnesium displaced, _____ activated, ____ ions enter cells. exaggerated release of ____ and _____
NMDA. calcium.
exaggerated release of substance P and excitatory amino acids
what is the low dose range of ketamine that has shown successful outcomes
0.25-.5mg/kg
T/F Cyclobenzaprine (flexeril) is useful for maintenance of long term chronic pain.
FALSE - it becomes ineffective in a few weeks, and is only for short term symptomatic reliefs.
what is the drawback of carisoprodol (Soma)?
it has the potential for dependence, tolerance, and mental impairment.
how does withdrawal from Baclofen present?
resp failure, hemodynamic changes, seizure, delirium
T/F Baclofen is NOT for use in chronic pain, rather it has specialized use for CP and MS.
TRUE
T/F Baclofen can be used for muscle spasms related to acute pain.
FALSE - baclofen should NEVER be used for muscle spasms related to acute or chronic pain. it was designed for extreme spasmodic conditions (CP, tetanus, MS) (per nagelhout)
