Pain: Pathophysiology and Management

Question 1

Normal Body response in times of stress

Answer 1

▪️increased blood pressure
▪️increased heart rate
▪️increased pupil diameter
▪️increased plasma cortisol

Question 2

Type of Primary Sensory Afferent nerve that responds maximally to light touch, and/ or moving stimuli

Answer 2

Alpha-beta

Question 3

Type of Primary Sensory Afferent nerve that does not usually produce pain

Answer 3

Alpha-beta

Question 4

Type of Primary Sensory Afferent nerve that responds only to painful stimuli

Answer 4

PRIMARY AFFERENT NOCICEPTORS
▪️Myelinated Alpha-Delta
▪️Unmyelinated C axons

Question 5

What is Sensitization

Answer 5

A process that happens when intense, repeated or prolonged stimuli are applied to damaged or inflamed tissues.

The threshold for activating the primary afferent nociceptors is lowered and the frequency of firing is higher, and all stimulus intensifies.

Question 6

Factors that affects Sensitization

Answer 6

▪️low pH
▪️prostaglandins
▪️leukotrienes
▪️bradykinin, etc

Question 7

Normal innocuous stimuli can produce pain

Answer 7

Allodynia

Question 8

Increased pain intensity to the same stimuli

Answer 8

Hyperalgesia

Question 9

What is the major neurotransmitter released from the terminals of primary afferents to excite the spinal cord neurons

Answer 9

Glutamate

Question 10

What is referred pain?

Answer 10

Spatial displacement of pain sensation from the site of injury

Question 11

Injury to Spinothalamic tract

Answer 11

Produces permanent deficits in pain and temperature discrimination

Question 12

How does injury to frontal lobe affect affect pain perception?

Answer 12

This diminishes emotional impact of pain while largely preserving the individual’s ability to recognize noxious stimuli as painful

Question 13

Constellation of spontaneous pain and signs of sympathetic dysfunction without obvious nerve injury

Answer 13

Complex Regional Pain Syndrome Type I (Reflex sympathetic Dystrophy)

Question 14

Constellation of spontaneous pain and signs of sympathetic dysfunction with obvious nerve injury

Answer 14

Complex Regional Pain Syndrome Type II (Post-traumatic Neuralgia/Causalgia)

Question 15

Offers significant benefit in management of Acute Post-operative pain because it does not affect coagulation

Answer 15

Cox-2 selective drugs

Question 16

Pain drug most commonly associated with severe GI bleed but without Cardiovascular risk

Answer 16

Aspirin

Question 17

Most potent pain-relieving drug

Answer 17

Opioids

Question 18

Opioid overdose antidote

Answer 18

Naloxone

Question 19

MOA of Opiods

Answer 19

Acts on Mu receptor

Question 20

Painful conditions that responds to Tricyclic Antidepressants

Answer 20

Post-herpetic neuralgia
Diabetic neuropathy
Fibromyalgia
Tension headache
Migraine headache
Rheumatoid arthritis
Chronic low back pain
Cancer
Post-stroke pain

Question 21

Anticonvulsants helpful in Trigeminal neuralgia

Answer 21

Phenytoin

Carbamazepine

Question 22

Anticonvulsants helpful in neuropathic pain

Answer 22

Gabapentin

Pregabalin