Principles of Pain Management Flashcards
T/F: Pain has sensory, as well as affective and cognitive consequences
True
What does noxious mean, nocicpetors
Harmful or unplesant, specialezed recptors that detect noxious stimuli causing pain
What are the pain fibers and what type of pain is associated with them
A delta fibers: fast, sharp pain or pressure at a precise location
C fibers: slow poorly localized sensations (aching, burning cramping)
What happens during transduction, agents released
Nociceptors convert noxious stimulus into action potential that can be recognized by the central nervous system (pain impulse)/ histamine, serotonin, bradykinin, prostaglandins, substance P
What happens during transduction, agents released
Nociceptors convert noxious stimulus into action potential that can be recognized by the central nervous system (pain impulse)/ histamine, serotonin, bradykinin, prostaglandins, substance P
What happens during transmission
Pain fibers transmit electrical signals (pain impulses) from the site of injury along sensory tracts through the spinal cord then up to the brain
What happens during perception
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
What happens during modulation
Along the descending pathway there is release of endorphins and dynorphins to blunt the incoming peripheral signals and lessen the ascending transmission
What is peripheral sensitization
Release of inflammatory mediators to reduce the nociceptor threshold and activate normally “silent nociceptors
What is allodynia and hperalgesia
never endings responding to weark and normally nonpainful stimuli, stronger stimuli provoke exaggerated pain
What is central sensitization
Changes in central nervous structures involved in pain perception, can be irreversible and manifest with continous pain WITHOUT any present stimuli
What are the classifications of pain and what are the associated categories
Pathogenesis: Nociceptive and neuropathic
Duration: Acute and chronic
What is nociceptive pain, somatic and visceral locations
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)
What is neuropathic pain, causes
Result of abnormal function of the nervous system that takes days-months to develop/ diabetes, herpes zoster, HIV, surgery, radiation, metastasis
T/F: Numbness along with allodynia and hyperalgesia is associated with nociceptive pain
False: Numbness along with ALLODYNIA and HYPERPLASIA is associated with NEUROPATHIc pain
What is the difference between acute and chronic pain
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
What is the way to scale pain for adults, children or people with language bariers
Visual analog scale, Wong-Baker FACES apin rating scale
T/F:Pain scales are one dimensional and measure pain intensity only
True
What are nonphamcacolic treatments of pain
Rehab, acupuncture, massage, stress management, cognitive behavioral therapy
What is RICE
Rest, Ice, Compress, Elevate
What are options to aid in acute pain
Cold pack wrap, NSAIDS and/or acetaminophen
What are options for chronic pain
Gabapentin, backlofen, tramadol, massage, physical therapy, support group, attention to emotional health
What is WHO 3 step pain ladder
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
What should WHO 3 be used fore
Applicable to nociceptive pain but NOT helpful for pure neuropathic pain or chronic pain
What is the dual MOA of tramadol
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
What is the indication for tramadol
Moderate or moderately severe pain NOT SEVERE PAIN (nociceptive not neuropathic)
What are the metabolizers of tramadol
CYP3A4: inactive metabolite, CPD2D6: active metabolite, mu agonist
What are the CYP2D6 phenotypes that effect tramadol
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
What patients should avoid tramadol
Seizure-prone patients
What are side effects of tramadol
Nausea, vomitting, fatigue, drwosiness, headache, dry mouth
T/F: Paitients taking antidepressant should not take tramadol due to possible serotonin syndrome
True
