Review Flashcards
Acute Nociceptive Pain
Mild- non opioids
Moderate
Severe- opioid, +/- multimodal analgesia, non opioids
Non opioid treatments for mild pain
NSAIDs (1/2)
Aspirin (1/2)
Acetaminophen (CNS 2)
Celecoxib (2)
Classification of Pain by Severity-Intensity
Behavior
Cognitive
Social
Cultural
Multimodal Analgesia
Local anesthesia
Ketamine
Clonidine
Severe pain
Local anesthesia target
Voltage sensitive Na channels
Ketamine target
NMDA receptor block
first synapse
Clonidine target
a2
Clonidine
Treats high blood pressure. A lower blood pressure can reduce the risk of strokes and heart attacks. Also treats attention deficit hyperactivity disorder (ADHD). Belongs to a class of drugs called antihypertensives.
Chronic Neuropathic Pain
mild- mod: non opioid
–Adjuvants: block central sensitization (NMDA). perf sens (PG), and ↑ descending inhibition (u)
Severe: Tramadol
Buprenorphine
Opioid
Central Sensitization
NMDA mediated
Peripheral Sensitization
PG
Tramadol
↑ u, ↓ NE
Buprenorphine
Treats moderate to severe chronic pain. This medicine is a narcotic analgesic.
Partial u
Acute pain is primarily ____________ - somatic more common than visceral
nociceptive
Classification of Pain by Duration
Chronic Pain
persisting beyond the normal healing time (neuropathic)
no identifiable organic cause (e.g., fibromyalgia, irritable bowel syndrome)
Pain related to a chronic disease (e.g., osteoarthritis)
Pain, chronic and acute, associated with cancer
Severe pain, Crying out scale
7-8
Stressed, tense, expression, Least pain
1-2
Moaning, restless, Moderate pain
5-6
Classification of Pain by Origin
Nociceptive Pain
“Normal” pain resulting from activation of nociceptive nerve fibers
Somatic pain - arising from skin, bone, joint, connective tissue, or muscle due to:
Musculoskeletal conditions, Inflammation, Mechanical/compressive problems
Described as throbbing and well-localized
Visceral pain (arising from internal organs) can manifest as arising from other structures (referred) or be well-localized
Neuropathic Pain
Distinct from nociceptive pain - persists and has become disengaged from noxious stimuli or the healing process
Result of nerve damage. Syndromes include: diabetic neuropathy, postherpetic neuralgia
Abnormal operation of the nervous system. Syndromes include: fibromyalgia, irritable bowel syndrome, tension type headache
Described as burning, tingling, shock-like or shooting
Opioids in chronic pain?
YES for Cancer!
Inhibitors of monoamine reuptake (TCADs-SNRIs) are NOT effective for
ACUTE pain
result of nerve damage
Neuropathic
Receptor Targets at Projection Neuron
u-k opioid
α2-adrenergic
NMDA-Glu
[5HT3 (chronic pain)]
[5HT1D (migraine)]
Receptor Targets at Projection Neuron (PN)
α2-adrenergic
u-k opioid
NMDA-Glu
[5HT3 (chronic pain)]
[5HT1D (migraine)]
____________ are NOT effective for ACUTE pain
Inhibitors of monoamine reuptake (TCADs-SNRIs)
