Principles of Pain Management

Question 1

T/F: Pain has sensory, as well as affective and cognitive consequences

Answer 1

True

Question 2

What does noxious mean, nocicpetors

Answer 2

Harmful or unplesant, specialezed recptors that detect noxious stimuli causing pain

Question 3

What are the pain fibers and what type of pain is associated with them

Answer 3

A delta fibers: fast, sharp pain or pressure at a precise location
C fibers: slow poorly localized sensations (aching, burning cramping)

Question 4

What happens during transduction, agents released

Answer 4

Nociceptors convert noxious stimulus into action potential that can be recognized by the central nervous system (pain impulse)/ histamine, serotonin, bradykinin, prostaglandins, substance P

Question 5

What happens during transduction, agents released

Answer 5

Nociceptors convert noxious stimulus into action potential that can be recognized by the central nervous system (pain impulse)/ histamine, serotonin, bradykinin, prostaglandins, substance P

Question 6

What happens during transmission

Answer 6

Pain fibers transmit electrical signals (pain impulses) from the site of injury along sensory tracts through the spinal cord then up to the brain

Question 7

What happens during perception

Answer 7

Pain impulse travels along the ascending pathway into the brain, starts at the thalamus where interpretation occurs, pain impulse moves to the frontal cortex and limbic system giving the emotional response to pain

Question 8

What happens during modulation

Answer 8

Along the descending pathway there is release of endorphins and dynorphins to blunt the incoming peripheral signals and lessen the ascending transmission

Question 9

What is peripheral sensitization

Answer 9

Release of inflammatory mediators to reduce the nociceptor threshold and activate normally “silent nociceptors

Question 10

What is allodynia and hperalgesia

Answer 10

never endings responding to weark and normally nonpainful stimuli, stronger stimuli provoke exaggerated pain

Question 11

What is central sensitization

Answer 11

Changes in central nervous structures involved in pain perception, can be irreversible and manifest with continous pain WITHOUT any present stimuli

Question 12

What are the classifications of pain and what are the associated categories

Answer 12

Pathogenesis: Nociceptive and neuropathic
Duration: Acute and chronic

Question 13

What is nociceptive pain, somatic and visceral locations

Answer 13

Pain that arises from tissue injury, pretective and warns of damage, somatic: localized to skin, muscles, joints, bones (A delta fibers), visceral: internal organs (C fibers)

Question 14

What is neuropathic pain, causes

Answer 14

Result of abnormal function of the nervous system that takes days-months to develop/ diabetes, herpes zoster, HIV, surgery, radiation, metastasis

Question 15

T/F: Numbness along with allodynia and hyperalgesia is associated with nociceptive pain

Answer 15

False: Numbness along with ALLODYNIA and HYPERPLASIA is associated with NEUROPATHIc pain

Question 16

What is the difference between acute and chronic pain

Answer 16

Acute pain usually has identifiable causes that resolve as healing occurs (usually nociceptive), while chronic pain persists beyond the duration of healing with no identifiable cause ALONG WITH a PSYCHOLOGIC component

Question 17

What is the way to scale pain for adults, children or people with language bariers

Answer 17

Visual analog scale, Wong-Baker FACES apin rating scale

Question 18

T/F:Pain scales are one dimensional and measure pain intensity only

Answer 18

True

Question 19

What are nonphamcacolic treatments of pain

Answer 19

Rehab, acupuncture, massage, stress management, cognitive behavioral therapy

Question 20

What is RICE

Answer 20

Rest, Ice, Compress, Elevate

Question 21

What are options to aid in acute pain

Answer 21

Cold pack wrap, NSAIDS and/or acetaminophen

Question 22

What are options for chronic pain

Answer 22

Gabapentin, backlofen, tramadol, massage, physical therapy, support group, attention to emotional health

Question 23

What is WHO 3 step pain ladder

Answer 23

Step 1 mild pain: ibuproffen or acetaminophen
Step 2: Mild-moderate pain: tramadol, codeine, Hydrocodne plus acetaminophen, IR oxycodone plus acetaminophen
Step 3: Morphine, hydropmorphone, ER oxycodone, methadone, fentanyl

Question 24

What should WHO 3 be used fore

Answer 24

Applicable to nociceptive pain but NOT helpful for pure neuropathic pain or chronic pain

Question 25

What is the dual MOA of tramadol

Answer 25

Parent drug:Inhibition of nopepinephrine and serotonin reuptake involved in the descending hibitory pathway
M1 metabolite: weak mu receptor agonist that resutls in inhibition of ascending pain pathways

Question 26

What is the indication for tramadol

Answer 26

Moderate or moderately severe pain NOT SEVERE PAIN (nociceptive not neuropathic)

Question 27

What are the metabolizers of tramadol

Answer 27

CYP3A4: inactive metabolite, CPD2D6: active metabolite, mu agonist

Question 28

What are the CYP2D6 phenotypes that effect tramadol

Answer 28

Ultrarapid metabolizer: Reduce dose by 30% and be alert for adverse effects or use an alternate drug (NOT CODEINE or OXYCODONE)
Intermediate metabolizer: be alert for insufficient pain relief and consider dose increase
Poor metabolizer: Use an alternative drug (NOT CODEINE) or be alert for insufficient pain relief

Question 29

What patients should avoid tramadol

Answer 29

Seizure-prone patients

Question 30

What are side effects of tramadol

Answer 30

Nausea, vomitting, fatigue, drwosiness, headache, dry mouth

Question 31

T/F: Paitients taking antidepressant should not take tramadol due to possible serotonin syndrome

Answer 31

True