Pain Management - French

Question 1

What is somatic pain?

Answer 1

Pain originating from skin, muscle, bone, joint, or connective tissue. Often described as throbbing, and well localized.

Question 2

What is visceral pain?

Answer 2

Arising from the organs. Poorly localized or referred.

Question 3

With regard to neuropathic pain, what differentiates this from nocioceptive pain? What differentiates neuropathic pain from functional neuropathic pain?

Answer 3

Neuropathic pain arises without a noxious stimulus. It is defined as pain caused by damage to the nerves (diabetic neuropathy, postherptic neuralgia)

Functional pain arises from the malfunction of the nervous system (IBS, fibromyalgia)

Question 4

Describe the effect of activating Mu receptors in the PAG vs the spinal cord.

Answer 4

Both result in activation of the inhibitory descending pain pathway.

In the PAG, activation of Mu receptors blocks tonic GABA inhibition, resulting in PAG outflow (enkephalin and NE/5HT release).

In the spinal cord, enkephalins bind the Mu receptors and decrease both PRE (block of glutamate and substance P) and POST (hyperpolarizarion) mechanism, inhibiting the descending pathway–> analgesia.

[NE acts on a2 adrenergic receptors to attenuate the second-order neurons–> analgesia]

Question 5

Name the prototypical a2 receptor agonist. How is this drug used in pain management, and what is the mode of action?

Answer 5

(clonidine): block glutamate-substance P release from primary neuron–> attenuation of afferent-evoked excitation of 2nd order neuron–> decreased transmission of nociceptive stimuli

Question 6

At the level of the synapse, how does morphine work?

Answer 6

μ-opioid receptor agonists (morphine): block glutamate-substance P release from primary neuron plus hyperpolarize 2nd order neuron–> attenuation of afferent-evoked excitation of 2nd order neuron–>decreased transmission of nociceptive stimuli

Question 7

Of the mu opioid side effects (GI/Miosis/Euphoria/Analgesia/Respiratory depression/drowsiness), to which will tolerance not develop.

Answer 7

Tolerance develops to euphoria, analgesia, drowsiness, and respiratory depression.

GI and miosis will be seen regardless of chronicity of use.

Question 8

What reverses the respiratory depression of opioids?

Answer 8

Naloxone

Question 9

Why might scopolamine be given to a patient on opioid pain medication with nausea?

Answer 9

Scopolamine is a muscarinic antagonist often prescribed for nausea (motion sickness, postop nausea and vomiting).