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(3) Pharmacology > S2_L1: Pain Management > Flashcards

S2_L1: Pain Management Flashcards

1
Q

Determine the type of fibers.

  1. activated by noxious stimuli
  2. responsible for the Gate Control Theory
  3. unmyelinated, slow conduction
    velocity
  4. responsible for secondary pain
  5. large diameter

A. A-Beta fibers (Aβ)
B. A-Delta fibers (Aδ)
C. C-fibers
D. A & B
E. B & C

A
  1. E
  2. A
  3. C
  4. C
  5. A
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2
Q

Determine the type of fibers.

  1. Small diameter
  2. Medium diameter
  3. Myelinated
  4. activated by non-noxious mechanical stimuli
  5. fast conduction velocity

A. A-Beta fibers (Aβ)
B. A-Delta fibers (Aδ)
C. C-fibers
D. A & B
E. B & C

A
  1. C
  2. B
  3. D
  4. A
  5. A
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3
Q

Enumerate the 5 cardinal signs of inflammation.

A

● Heat (calor)
● Redness (rubor)
● Swelling (tumor)
● Pain (dolor)
● Loss of Function (functio laesa)

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4
Q

The pathophysiology of pain starts when a _______ is introduced

A

noxious stimuli

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5
Q

TRUE OR FALSE: Aβ and C fibers send neural transmission for you to feel the pain. Aδ fibers, which are responsible for touch and pressure, are able to stimulate the inhibitory neurons.

A. both statements are true
B. both statements are false
C. only the 1st statement is true
D. only the 2nd statement is true

A

B. both statements are false

a delta and a beta are interchanged

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6
Q

TRUE OR FALSE: Pain and nociception are different phenomena. Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.

A. both statements are true
B. both statements are false
C. only the 1st statement is true
D. only the 2nd statement is true

A

A. both statements are true

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7
Q

TRUE OR FALSE: Pain is a negative afferent impulse that has a constant emotional component. It is always associated with actual tissue damage.

A. both statements are true
B. both statements are false
C. only the 1st statement is true
D. only the 2nd statement is true

A

C. only the 1st statement is true

pain is associated with actual or potential tissue damage

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8
Q

Select the letter/s with the correct statement about the third order neuron.

A. First projection is found in the somatosensory cortex (BA 312), in the precentral gyrus
B. Second projection affects the autonomic nervous system
C. Third projection is responsible for the emotional component of pain

A

B & C

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9
Q

Select the letter/s with the correct statement.

A. Pain management decreases risk for pneumonia
B. Pain management decreases risk for thrombosis
C. Pain management decreases risk for depression and axiety

A

All

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10
Q

Select the letter/s with the correct statement.

A. Grimacing is always an expression of pain.
B. Crying is always an expression of pain.
C. Frowning is always an expression of pain.

A

A

Grimacing & frowning goes hand in hand. However, frowning alone does not imply pain. Crying is not always present for a person in pain.

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11
Q

Match the mechanisms of pain.

  1. Physiological pain
  2. Pathological pain
  3. Somatosensory pain
  4. Psychological pain
  5. Sharp pain

A. Nociceptive pain
B. Neuropathic pain
C. Both
D. None

A
  1. A
  2. B
  3. B
  4. D
  5. A
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12
Q

Match the mechanisms of pain.

  1. well localized
  2. stimulated during tissue injury
  3. Without obvious tissue injury
  4. damage to or abnormal function of nervous system
  5. pins and needles

A. Nociceptive pain
B. Neuropathic pain

A
  1. A
  2. A
  3. B
  4. B
  5. B
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13
Q

Match the mechanisms of pain.

  1. Protective
  2. No protective function
  3. radiating pain
  4. Shooting, burning pain
  5. throbbing, aching pain

A. Nociceptive pain
B. Neuropathic pain

A
  1. A
  2. B
  3. B
  4. B
  5. A
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14
Q

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage

A

Pain

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15
Q

TRUE OR FALSE: In nociception, there is no manifestation of pain

A

True

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16
Q

TRUE OR FALSE: In pain management, tissue damage is always present when there is pain.

A

True

This is because nociception is present. And when there is nociception, there is (+) injury/ damage.

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17
Q

TRUE OR FALSE: A noxious stimuli may be transmitted with or without an action potential, as long as free nerve endings are intact.

A

False

It cannot be transmitted when there is no action potential. Conversion must first happen for transmission to occur

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18
Q

TRUE OR FALSE: Pain is modulated by the periaqueductal gray & posteromedial medulla

A

False

*ventromedial medulla

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19
Q

Which neuron in the pain pathway receives initial impulse from the Aδ and C fibers?

A. 1st order neuron
B. 2nd order neuron
C. 3rd order neuron

A

A. 1st order neuron

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20
Q

Which neuron is found in the pain pathway in the substantia gelatinosa

A. 1st order neuron
B. 2nd order neuron
C. 3rd order neuron

A

B. 2nd order neuron

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21
Q

Which neuron in the pain pathway allows for decussation?

A. 1st order neuron
B. 2nd order neuron
C. 3rd order neuron

A

B. 2nd order neuron

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22
Q

TRUE OR FALSE: The 1st order neuron is found on the dorsal root ganglion. The 2nd order neuron is found on the dorsal horn of the spinal cord.

A. both statements are true
B. both statements are false
C. only the 1st statement is true
D. only the 2nd statement is true

A

A. both statements are true

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23
Q

TRUE OR FALSE: Nociceptive pain is pain in response to a noxious stimulus at nociceptors that are located in different tissues. This system is a key physiologic function that prevents further tissue damage due to the body’s autonomic withdrawal reflex.

A. both statements are true
B. both statements are false
C. only the 1st statement is true
D. only the 2nd statement is true

A

A. both statements are true

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24
Q

indicated for tendon, meniscal, & ligamental tears

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

C. platelet rich plasma injection

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25
Q

Targets the spinal cord nerve roots by delivering local anesthetics in the epidural/subarachnoid space

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

B. central neural blockade

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26
Q

Done for post-op pain management

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

B. central neural blockade

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27
Q

Adjusted maximum number of dose every waking hours or increased pt activity

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

A. patient controlled analgesia

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28
Q

Used for delivery of opioids and morphine

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

B. central neural blockade

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29
Q

Match the medicines into their classification.

  1. NSAIDS
  2. morphine
  3. oxycodone
  4. tramadol
  5. codeine

A. simple analgesics
B. weak opioids
C. strong opioids

A
  1. A
  2. C
  3. C
  4. B
  5. B
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30
Q

Match the medicines into their classification.

  1. dihydrocodeine
  2. diamorphine
  3. aspirin
  4. paracetamol
  5. fentanyl

A. simple analgesics
B. weak opioids
C. strong opioids

A
  1. B
  2. C
  3. A
  4. A
  5. C
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31
Q

TRUE OR FALSE: When tramadol deems unhelpful in managing pain of the pt, Aspirin may be given instead

A

False

A stronger analgesic must be given

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32
Q

Justify the reason to use simple analgesics before utilizing weak opioids, then strong opioids.

A

The WHO pain ladder is used to treat pain, starting with simple analgesics first so as to give a small amount & concentration of drug that may be effective for pain management. When deemed ineffective, that is the time when stronger analgesics are prescribed. This is accordance to increasing drug tolerance after chronic intake or disease progression

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33
Q

TRUE OR FALSE: Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system, rather than stimulation of pain receptors. Patients tend to describe neuropathic pain with words like burning, tingling, numbness, shooting, stabbing, or
electric-like feelings.

A. both statements are true
B. both statements are false
C. only the 1st statement is true
D. only the 2nd statement is true

A

A. both statements are true

34
Q

TRUE OR FALSE: Chronic pain does not involve sympathetic hyperactivity.

A

True

Sympathetic activity is associated with acute pain. However, chronic pain may be associated with vegetative signs (eg. fatigue, loss of libido, loss of appetite) and depressed mood.

35
Q

_____ is the conversion of physical stimulus into
nerve impulses

A

Transduction

36
Q

What is/are the primary afferent receptors of the pain pathway?

A

A-delta & C fibers

37
Q

What is the generic name of aspirin?

A

acetylsalicylic acid

38
Q

A 11-point scale ranges from ‘0’ representing one pain extreme (e.g. “no pain”) to ‘10’ representing the other pain extreme.

What is being described?

A

Numeric Pain Scale

39
Q

This consists of a straight line with the endpoints defining extreme limits such as ‘no pain at all’ and ‘pain as bad as it could be. The patient is asked to mark his pain level on the line between the two endpoints.

What is being described?

A

Visual Analogue Scale (VAS)

40
Q

TRUE OR FALSE: Acute pain is usually nociceptive, although it can be neuropathic.

A

True

41
Q

What is the analgesic ceiling effect?

A

The analgesic ceiling effect of a drug refers to the dose beyond which there is no additional analgesic effect. Higher doses do not provide any additional pain relief but may increase the likelihood of side effects

42
Q

What route of administration is best for long-term use of analgesics?

A

Oral or transdermal

43
Q

A quadriplegic patient takes an opioid analgesic to control the pain related to his condition. The patient’s pain would be considered as ____ pain.

A

Neuropathic pain

NOTE: this is also considered as a chronic pain

44
Q

Which neuron in the pain pathway stores memory of pain and gives a person their future behaviors to future pain experience

A. 1st order neuron
B. 2nd order neuron
C. 3rd order neuron

A

C. 3rd order neuron

This is seen in the 4th projection (prefrontal cortex)

45
Q

Which neuron in the pain pathway allows pain modulation

A. 1st order neuron
B. 2nd order neuron
C. 3rd order neuron

A

B. 2nd order neuron

NOTE: The second projection of the 3rd order neuron may also be responsible for pain modulation.

46
Q

Which neuron in the pain pathway is the reason why cognitive behavior and placebo effect is effective

A. 1st order neuron
B. 2nd order neuron
C. 3rd order neuron

A

C. 3rd order neuron

47
Q

Which neuron in the pain pathway is found in the thalamus

A. 1st order neuron
B. 2nd order neuron
C. 3rd order neuron

A

C. 3rd order neuron

48
Q

TRUE OR FALSE: When there is tissue damage, there is pain.

A

False

Nociception is present, but emotional components must come into play for pain to be present.

49
Q

TRUE OR FALSE: The second order neuron ascends via the lateral spinothalamic tract contralaterally. The second order neuron comprises the gateway to the cortex.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

C. Only the 1st statement is true

3rd* order neuron = found in the thalamus = gateway to cortex

50
Q

TRUE OR FALSE: The 3rd order neuron has 4 projections. Thalamocortical projections head towards the brainstem

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

51
Q

TRUE OR FALSE: The third projection of the pain pathway is found in the limbic system. This is the seat of emotions.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

52
Q

TRUE OR FALSE: Noxious stimuli are received by the free nerve endings. These are efferent nociceptors.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

C. Only the 1st statement is true

53
Q

This is the neural process of encoding a noxious stimuli

A

Nociception

54
Q

TRUE OR FALSE: The periaqueductal gray & ventromedial medulla use serotonin
or norepinephrine to modulate pain

A

True

It contains high concentrations of opioid substances. The descending pathways uses the following proteins mentioned in the question.

55
Q

Modulation of pain happens by (1)____ excitatory
or (2)____ inhibitory mechanisms

A
  1. increasing
  2. increasing

Modulation increases or decreases sensation of pain. In pain management, we want inhibitory mechanisms to happen. But in diseased states, the excitatory mechanisms happen.

56
Q

Fill in the blanks:

Pain perception depends on:
1. _____
2. _____ factors
3. _____ expectations
4. Other _____
5. _____ strategies
6. _____ factors
7. _____ factors

A
  1. Beliefs
  2. Psychological
  3. Cultural
  4. illnesses
  5. Coping
  6. Social
  7. Spiritual
57
Q

Nerve damage may be caused by the following, EXCEPT:

A. Amputation
B. Trauma
C. DM
D. Htn
E. Cancer

A

D. Htn

58
Q
  1. acute but may become chronic
  2. chronic
  3. progressive
  4. nerve compression
  5. no obvious cause

A. Cancer pain
B. Non-cancer pain

A
  1. B
  2. A
  3. A
  4. B
  5. B
59
Q
  1. 90 days
  2. 2 months
  3. 100 days
  4. painful despite healed tissue
  5. persistent

A. acute pain
B. chronic pain

A
  1. A
  2. A
  3. B
  4. B
  5. B
60
Q

This condition pertains to being oversensitized even in simple touch

A

Hyperalgesia

61
Q

The following are conditions causing neuropathic pain, EXCEPT:

A. Peripheral and entrapment neuropathy
B. Arachnoiditis
C. Trigeminal neuralgia
D. Brachial plexus avulsion pain
E. None

A

E. None

62
Q

The following are conditions causing neuropathic pain, EXCEPT:

A. Phantom limb pain
B. Post-stroke pain
C. Spinal cord injury pain
D. Cancer
E. None

A

D. Cancer

63
Q

Mechanisms of Neuropathic Pain.

  1. Increased in number of pain receptors
  2. Changes in chemical signaling
  3. Damage to descending pathway
  4. Abnormal firing of pain fibers
  5. “Rewiring” of neurons

A. Peripheral nervous system
B. Central nervous system

A
  1. A
  2. B
  3. B
  4. A
  5. B
64
Q

This is a condition wherein non-noxious stimulus creates a noxious sensation and will be reported as pain by a pt

A

Allodynia

65
Q

Mechanisms of Neuropathic Pain.

  1. sharp
  2. throbbing
  3. burning
  4. pins and needles
  5. aching

A. Nociceptive
B. Neuropathic

A
  1. A
  2. A
  3. B
  4. B
  5. A
66
Q

This is a component of pain assessment that focuses on strategies that a pt does to alleviate pain

What is being described?

A

palliating factors

67
Q

This is a component of pain assessment that focuses on activities done by the pt that induces or increases pain sensations.

What is being described?

A

precipitating factors

68
Q

This is a component of pain assessment that focuses on how pain affects a person’s ADLs

What is being described?

A

psychosocial factors

69
Q

This scale is used for children who cannot read.

A

face pain rating scale

70
Q

Enumerate the 5 non pharmacological treatment of pain under the “physical” category

A

● RICE (rest, ice, compression, elevation)
● Surgery
● Nursing care
● Acupuncture
● physiotherapy

71
Q

Enumerate the 3 non pharmacological treatment of pain under the “psychological” category

A

● Explanation
● Assurance
● Support group

72
Q

This is the association for training or fellowship needed for pain management

A

International Association for the Study of Pain (IASP)

73
Q

TRUE OR FALSE: Scoliosis is a chronic condition. It has a nociceptive pain.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

C. Only the 1st statement is true

Scoliosis may have both nociceptive and neuropathic pain

74
Q

TRUE OR FALSE: Verbal description is the only way to express pain; No communication negates no pain

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are false

NOTE: Verbal description is only one of the several
behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman/animal experiences pain

75
Q

Indicated for chronic severe OA

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

C. platelet rich plasma injection

76
Q

allows a mixture of drug analgesics to be administered to the patient

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

A. patient controlled analgesia

77
Q

Indicated for cancer patients; uses a catheter

A. patient controlled analgesia
B. central neural blockade
C. platelet rich plasma injection

A

B. central neural blockade

78
Q

Name 2 importance of asking or obtaining a pain scale.

A
  1. baseline for therapy
  2. basis for improvement
79
Q

TRUE OR FALSE: Pain has an adaptive role.

A

True

80
Q

TRUE OR FALSE: Pain is inferred from the activity of sensory neurons

A

False

81
Q

Cognitive Behavioral therapy targets what area of the brain?

A

prefrontal cortex

82
Q

What imaging is used to identify structures prior to MSK injections?

A

MSK US

(3) Pharmacology (12 decks)

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