Test 1 Flashcards

Question

paradoxical thermal sensations-

Answer 1

hot perceived as cold and vice versa

Answer 2

Aftersensations- bang funny bone- have lingering pain

Answer 3

Normal pain response- increase stimulus intensity- start to feel pain, increase intesnsity even more to evoke a pain response When have an injury- normal pain response curve shifted to left- what was not painful is now painful- allodynia- As keep increasing intensity- evoke a pain response quicker Allpydina- wasn’t painful before but now is Hyperalgesia- was painful before but now the pain response is more intense In sunburn Allodynia- put tshirt on and hurts Hyperalgesia- slapping still hurts but hurts more, or temperature of shower- when sunburned pain response is more intense

Answer 4

Back pain most common What are they dying of?- stress/ immune deficiency making mopre likely to die of cancer and cardiovascular issues

Answer 5

sensory sensation activate perception- ex toucgh vs. pain- driven by nocioceptor Somatic- skin, muscle, joint, bone- know most about this pain, different than a migraine Visceral has own pain detecdtion system

Answer 6

anesthesia- local vs general- decrease all sensation vs. analgesia- reduction of pain on

Answer 7

pain vs. nociception(detection of danger cues when activate nocioceptor, different than perception of pain

Answer 8

Drilling hole in to skull to relieve pressure and mental illness Getting rid of the evil spirits

Answer 9

Potions Theriac- used for pain treatment, works cause has opium poppy- where opiods come from

Answer 10

Willow bark- chew on it or lick the tree, has salicylic acid- natural ingredient of aspirin Opium poppy- found in theriac and extract opium

Answer 11

Analgesia – state of reduced awareness to pain

Answer 12

Analgesics – substances that decrease pain sensation by increasing the threshold for painful stimuli. The do not affect somatosensation or consciousness. Analegsics- affect pain awarness but not somatosensation Non-opioids (NSAIDS, paracetamol, asprin) Analgesics Opioids (morphine, oxycodone)

Answer 13

Anesthesia – medications/drugs used to decrease all sensation (i.e., touch and pain). Local anethetics- reduce all somatosensation in local area General= put asleep

Answer 14

Co-analgesics/adjuvants – drugs not originally intended for pain relief but reduce pain either alone or in combination with opioids(analgesics). Ex- ssri, tricyclic antidepressants- help neuropathic pain

Answer 15

Opiates Class of drugs derived from the opium poppy/plant Opium poppy: used for the relief of pain for several thousand years

Answer 16

Opium The juice of the opium poppy Becomes brownish when it dries Chemical compounds extracted from opium (i.e., alkaloids) used to produce opioid drugs Opium or morphine- use as basis for building other opiates Take directly out of poppy plant unmodified= opiates, if take this chemical and start changing it, anything that is synthesized using opiates- opioid (0xycodon)

Answer 17

Illegal drugs (opium, heroin)- considered illegal because of spike of opium content, works extremely fast, very addicitive, quick onset that quickly fades, making more addictive Legal drugs (opioid medications; a.k.a. pain killers) Natural opioids (i.e., opiates)- morphine, codeine Semi synthetic opioids- oxycodone synthetic opioids- methadone, fentanyl

Answer 18

Fentanly- considered very strong, need very little amount to cause toxicity Get rid of withdrawal- keep constant stimulation at opiod centre When inject and ingest opiates- get rid of spike in blood stream Can use as transdermal patch- the skin slowly absorbs it, have no peaks and valleys- have steady state, but if remove it, can cause withdrawal- become physiologically dependent Cant just cut cold turkey opiates- there is a specific regimen when over many weeks, slowly decrease the opiod medication, so you don’t cause withdrawal

Answer 19

Designer Dry mouth Euphoria Sedation Itch Gastro Nausea Eyes Respiratory depression Addiction- consequence of opiod use, euphoria leads to the addiction

Answer 20

Opioids offer clinical benefits, but come with potential harms -misuse- ur medication- still using but using different using opiod as not prescribed, abuse-using opioid for things non intended for- ex high and addiction Contribution of both illegal and/or prescription opioids - opioid prescribing trends in Canada and USA- has steadly increased Since 2016 there have been 44,000 opioid related deaths in Canada In 2020 – 15 people died per day of opioid overdoses in Canada 94% of opioid-related deaths are accidental Young people aged 15 – 24 have been most affected- steal from their family= abuse Opiods= greatest tool against pain, especially chronic

Answer 21

Late 1990s, opioid marketing by pharma industry was aggressive Specific types of opioids were marketed as less addictive than other medications Opioid sales have quadrupled between 1990 & 2010 Mislead the public & prescribing physicians Claimed that Oxycontin was less addictive than other pain medications In 2023, Sackler family(owned perdue pharmacy) ordered to pay 6 Billion over a decade to compensate families. Protected from civil lawsuits. Any family affected by this couldn’t sue this pharmacy company any further Oxycontin- promoted as safe alternative Before 90s- were hesitant Perdue pharma made oxycontin- slow release oxycodone(strong opioid with lots of peaks and valleys) oxycodone- wrapped in contin(protective) and slow down the oxycodone if crush it up- gets rid of that confirmation, making it act like a drug(get high)

Answer 22

Purdue taught its sales force that there were fewer “peaks and valleys” in oxycodone levels among patients taking OxyContin. Fewer highs and lows meant less euphoria and fewer “comedowns.” The chart showed the drug’s release over 12 hours as a smooth line, with few ups and downs Short acting- sharp rise and then comes down critical zone= pain relief- above= eurphoria, below = pain Long lasting- rises slowly and doesn’t reach euphoria, was supposed to last 12 hours Purdue used a LogRhythm scale to make it seem like this curve was ”flat”

Answer 23

Antagonist of Opiates Medication designed to reverse opioid overdose Routes of administration: Intranasal or Intramuscular Naloxone- counteracts opioid overdose, it blocks all recpetors kicking the opioid out and reversing its effects

Answer 24

Willow bark (salicylic acid) *mentioned in Dioscorides’ collection of cures – 80 A.D. Bayer company Aspirin= alsylic acid- asa- derived from salicylic acid

Answer 25

COX-1 and COX-2 Both are involved in increasing PGE2 activity, causing increased inflammation COX-1 maintains protective layer of stomach NSAIDs are dual inhibitors of COX- 1 and COX-2 NSAID inhibition of COX-1 contributes to stomach lining and ulcers NSAIDS- non strodial anti-inflammatory drugs- inhibit cox-1 and cox2 enzymes Main side effect= stomach issues, can cause ulcers because inhibit cox1( forms protective layer for stomach) More interested in their ability to reduce cox2- arises when hurt ourselves, causing inflammation Pge2- important for inflammation, associated with pain Non selective- ihibit both

Answer 26

Derived from NSAIDs Selective inhibitors of COX-2 thought to have less gastrointestinal issues than NSAIDs Discovered that COX-2 was involved in the synthesis of the prostaglandins that produce inflammation and pain Controversy: Increased incidence of heart attack, stroke by up to 40%. Most removed from the market (Vioxx Step function= Kaplan myer graph

Answer 27

NSAIDS, opioids analgesics, paracetamol Paracetamol- doesn’t decrease inflamatiion

Answer 28

If pain occurs, there should be prompt oral administration of drugs in the following order: non- opioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs – “adjuvants” – should be used. To maintain freedom from pain, drugs should be given “by the clock”, that is every 3-6 hours, rather than “on demand”. This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective. Surgical intervention on appropriate nerves may provide further pain relief if drugs are not wholly effective. Step approach- start with least drastic then move up if not eorkinh Ketamine= horse anetshetic

Answer 29

Phase 0 animal trials, start with 5-20 compounds Phase 1 small human trials, 2-5 compounds Phase 2 larger human trial, 2 compounds Phase 3- 1 compounds, larger human trial FDA approved and market introduction

Answer 30

Parallel- start with participants, randomized them and analyze Crossover- both groups go through each condition, one at a time- carryover affect Enriched design- screen patients, wield out those who have adverse effects or no effect, ramdomise from the ones that work

Answer 31

Relative risk= risk relative to all events- prob of event occurring compared to all events Odds that something worked over odds that something didn’t Looking at odds that something happened to odds that something that didn’t happen Relative Risk Relative Risk Odds Ratio Probability of Getting Disease if exposed Probability of Getting disease if not exposed Probability of Outcome if on drug Probability of Outcome if on placebo Odds that the diseased were exposed Odds the controls were exposed Create 2 by 2 contingency table Cases vs control Exposed vs unexposed

Answer 32

Odds Ratio = Odds of pain reduction with Botox- include those no effect Odds of pain reduction with placebo- include no effect =85/32 21/93 = 85 X 93 21 X 32 = 7,905 672 = 11.76 Botox has an odds of pain reduction that is 12-fold greater than placebo Note: these are not real data, and the numbers are used just to illustrate calculating the odds ratio Ratio of 1= no difference, treatment didn’t work Greater than one- treatment works by that amount Less than one- treatment is less likely to work than placebo When dividing 2 frcations- flip the numerator and denominator Know how to set up table

Answer 33

How many ppl you need to treat before one person benefits above and beyond placebo How to calculate- 1/ portion benefeting from treatment- portion benefiting from control Lower NNT= works better An example (acetaminophen against acute postoperative pain): 500/1000 patients taking acetaminophen had at least 50% pain relief 250/1000 patients taking placebo had at least 50% pain relief NNT = 1 500/1000) - ( 250//1000 )

Answer 34

Number of ppl need to give drug to before having adverse reaction Can be minor or major

Answer 35

Subjective- what the person feels, persons perception of their pain vs objective measures of pain- visual or quantifiable pain- cold water test Subjective= feeling and perception Objective- measurement of activity or reduction in ability Why are objective measures better than subjective measures?- can be compared across participants, more reliable and easier to make conclusions Q2. Why are subjective measures better than objective measures?- can get at individual differences at pain and help us better understand perception of pain, pain itself is subjective Objective metal- cant focus, slow thinking

Answer 36

Tissue damaging sihnalling- neuroceptors Neuron and gila- send the signals via the white matter Sensing pathway ends in cortex- decides what to do Salience network- what we pay attention to, pain activated this Brain has to cope with pain- activating motor and modulation pathways- endorphins and calechomines- regukate pain Sensitivity and efficacy of these circuits- how we respond and feel pain

Answer 37

NSAIDS- bring down at site of inflammation The drugs make it into bloodstream- circulated through body- where it works_NSAIDS- localized to inflammation Pain sensitivity measure- use pressure device, apply to localized region, measuee sensitivity, common for fibromyalgia- tender joints through body, sensitivity in the joint points Cold pressor test- place hand in cold water- leave for amount of time and rate pain, or keep in till cant tiolerate can do with heat as well- measure latency before they say pain Start to feel pain= threshold Can no longer deal with the pain- tolerance What is time (i.e., latency) a proxy for? How long it takes for them to feel the pain Q2. Why do we need anything else?- yes ppl have different tolerances and thresholds, doesn’t apply to all pain types Duschek et al., J. Psychophysiol., 2008

Answer 38

Verbal pain intensity Visual analogue scale 0-10 pain scale Faces scale when? (right now, average in the last week, maximum in the last week, etc.) -in what context? (at rest, when standing, in the morning, etc.) When around doctors, your pain usually reduces These scales are very vague- hard to know what its acc asking pegs”: worst possible pain”, “worst pain imaginable”, “pain as bad as it can be”, “unbearable”, “excruciating”, etc.

Answer 39

Gracely pain scale, log scale Pain that is milder- easier to make distinctions When pain is more intense, harder to make distinction

Answer 40

Pain ratings can be used to communicate different things Can communicate if drug worked based on scale- pain rating gets lower

Answer 41

One can have more experiences with pain- a more vast scale- the pain ratings would look different than they actually are, hard to compare the ratings Your pain experiences affect how you deal and rate pain, makes it less painful Makes pain look different than actually is because the participants have a different worst pain experience, more pain experienced= larger graph

Answer 42

Imagined pain is often greater than the actual pain except for childbirth- sample is very small for actual rating

Answer 43

Factors affecting thr rating Allpodynia painful when not usually Hyperalgesia- pain greater than usual Pain patients- one thing they wish to solve= sleep Ongoing pain burning, stabbing Allodynia Hyper Algeria Functioning

Answer 44

Category Scoring Face No particular expression or smile Occasional grimace or frown, withdrawn, disinterested Frequent to constant quivering chin, clenched jaw Legs Normal position or relaxed Uneasy, restless, tense Kicking, or legs drawn up Activity Lying quietly, normal position, moves easily Squirming, shifting back Arched, rigid or jerking and forth, tense Cry No cry (awake or asleep) Moans or whimpers; occasional complaint Crying steadily, screams or sobs, frequent complaints Consolability Content, relaxed Reassured by occasional touching, hugging or being talked to, Difficult to console or comfort Rating by Others: FLACC Scale for Babies distractible Each of the five categories (F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Consolability is scored from 0-2, which results in a total score between 0 and 10. Designed by nurses for babies

Answer 45

Facial Action Coding System (FACS) -Paul Ekman Facial action coding system- looks at face and codes for motions- muscle movement predicts the emotion, developed for emotions

Answer 46

Sensory- sore hurting, heavy, affective- tiring, suffocating, vicious , evaluative- mild, annoying, distressing Melzack- medial pain questionnaire and control gate theory Found pain descriptors- ppl use similar words Categorized the words – sensory, affective and evaluative More sensory- how much and where Affective= more emotional, psych

Answer 47

Pick 1 word from each category that best describes their pain or leave blank if no word PPI- PARTIAL pain index- how is pain being described overall Has outdated words, and cant use for all ages, also long Short form May be more helpful for diagnosing and understanding similarities between conditions

Answer 48

Neuropathic pain only 4 questions and interview Hypoesthesia- reduced sensitivity Brushing- aggravates area in neuropathic pain Why is this so short?- used cinically

Answer 49

Subscales: Pain Intensity Personal Care ((walking, Dressing) Lifting Walking Sitting Standing Sleeping Social Life Travelling Employment / Homemaking Measures function\ How much does pain interfere with functioning Can be used clinically or research- use to see efficacy of drug

Answer 50

Used primarily for research How does person think and feel of pain Helplessness- no hope, nothing they can do Magnification-pain is worse than actually is Rumination- obsessive thinking abt pain Gives ideas into how anxiouys/ fearful about pain

Answer 51

For osteoarthritis How much pain do you have? 1. On walking over even ground 4. When seated or lying down 2. On going up or down stairs 5. When standing 3. At night in bed SECTION B: How much stiffness do you have? 1. After waking up in the morning 2. During the rest of the day after sitting, lying down or resting SECTION C: What degree of difficulty do you have...? 1. Walking down stairs 10. Getting out of bed 2. Walking up stairs 11. Removing stockings or socks 3. Getting up after sitting 12. Lying in bed 4. Standing 13. Getting in/out of the shower/bath 5. Picking up something from the floor 14. Sitting 6. Walking over even ground 15. Sitting/getting up from the toilet 7. Getting in and out of a car 16. Doing heavy domestic chores 8. Going shopping 17. Doing light domestic chores 9. Putting on stockings or socks Answer_ marking one of the following options

Answer 52

Quantitative sensory asseement- best way to quantify pain Use machine- vary intensity and see how u feel it, lowers it then increases it again Want to hone in on what pain threshold is Looking at average of responses across trials QST and Heat Hyperalgesia Change pain stimulus to find threshold There us sine sensitization The line= base temp/ skin temp