Test 4- Dr. Wag Flashcards
pain is a _________ response
learned
typically short lived, resolves when the inciting event removed or healing has taken place, usually sharp and sudden in nature
most pain falls under this category
Acute Pain
lasts longer than the inciting event or the healing phase (3 months), associated with ongoing pathology, nagging persistent dull pain may have break through episodes
Chronic Pain
episodes of exacerbated pain in a chronic pain patient, last for a short period of time before pain returns to baseline chronicity
Breakthrough Pain
controls voluntary movements
Somatic Nervous System
controls involuntary movements
Autonomic Nervous System
On a 1-10 scale, how is pain defined?
0-4 = mild
5-6 = moderate
7-10 = severe
most acute pain is specific and likely _________
nociceptive
most chronic pain is _______
mixed
the only UNMYELINATED fiber, the second in the blockade order, and results in pain relief and loss of temperature sensation when blocked
C Fibers
this fiber is MYELINATED, the first to go off in the blockade, and results in increased skin temperature when blocked
B Fibers
this fiber, along with the C fiber, is the second in the blockade but serves a function for fast pain and temperature
results in pain relief and loss of temperature sensation
A delta Fibers
small fiber
thin, myelinated, slow, causes the gate to open, transmits sharp, prickly pain
A delta fibers
small fiber
thin, UNmyelinated, slow, causes the gate to open, transmits dull, aching pain
C fiber
large fiber
thick, myelinated, fast, causes the gate to close, transmits non-painful stimuli
A beta fibers
what is the end result of peripheral pain?
scarring
what is the end result of neuroinflammation?
constant pain
It is preferable to NOT prescribe medication until the urine toxicology screen is obtained.
TRUE
Depression can cause pain and pain can cause depression
TRUE
pain initiated or caused by a primary lesion or dysfunction in the nervous system (CNS or PNS)
ex: Postherpatic neuralgia, Trigeminal neuralgia, painful diabetic neuropathy, post-surgical neuropathic pain
Neuropathic Pain
How is neuropathic pain often described?
burning
tingling
hypersensitivity to touch or cold
pain caused by injury to body tissues (musculoskeletal, cutaneous, or visceral)
ex: pain due to inflammation, limb pain after a fracture, joint pain due to OA, post-operataive visceral pain
Nociceptive Pain
How is nocicpetive pain often described?
aching
sharp
throbbing
pain with neuropathic and nociceptive components
Mixed pain
**most chronic pain is mixed pain
what are some examples of mixed pain?
LBP with radiculopathy
Cervical Radiculopathy
Cancer Pain
Carpal Tunnel Syndrome
- 80% of adults will get this in life
- female to male is equal
- MC is acute, short term with spontaneous resolution
- majority is musculoskeletal in nature
- chronic is more than 12 weeks
- treat with keeping active and NSAIDS
Low Back Pain
What is the preferred test for working up a patient with LBP?
MRI
can see all structures including nerves and soft tissues
Heat is better for musculoskeletal pain
TRUE
- chronic, affects most often the limbs, usually after injury or trauma
- damage/malfunction to the PNS/CNS and its affects on the sympathetic nervous system
- mild to severe pain with temperature changes, skin color changes, swelling, regional pain
- symptoms vary in severity and duration, most cases are mild and recover gradually over time
- individuals may not recover and have long term disability
- MC is in women, around age 40
CRPS
Complex Regional Pain Syndrome
Type I CRPS
reflex, no injury, RSD, no known cause
Type II CRPS
causative, event starts inflammatory process
Not all anti-depressants are the same, as they vary in their NE effect and serotonin effect
TRUE
this drug has demonstrated effectiveness in the treatment of chronic pain
Nortriptyline (Pamelor)
this drug is indicated for diabetic peripheral neuropathic pain
Duloxetine (Cymbalta)
this drug may decrease neuropathic pain and help with sleep and other mood disorders
Venlafaxine (Effexor, Effexor XR)
Anticonvulsants can cause dizziness, somnolence, HA, confusion, N/V, weight changes, and abnormal thoughts that may lead to suicide
TRUE
DOC for mild to moderate pain
Ibuprofen
What NSAIDs are most commonly linked to hepatotoxicity?
Sulindac and Diclofenac
these injections are best done with ultrasound
trigger point injections
Neurotome blocks can be done anywhere
TRUE
needles should never be placed above C6
TRUE
Pudendal nerve blocks can be done both _________ and ________
internally
externally
What do you do if you have a CSF leak?
perform a blood patch
direct exposure of the nerve
placement of the electrode next to the nerve trunk
done when the patient is awake
biggest problem is erosion that results in revision
PNS
Peripheral Nerve Stimulation
any naturally occurring, semi-synthetic, synthetic compound that binds specifically to opioid receptors and shares properties of one or more of the endogenous opioids
(hydromorphone, hydrocodone, tramadol, fentanyl, etc.)
Opioid
any opioid alkaloid FOUND NATURALLY in the poppy plant
codeine, morphine, thebaine
Opiate
a drug or other substance affecting mood or behavior and sold for non-medical use
Narcotic
How should you order Fentanyl?
as a matrix, not a reservoir
Do differences exists between brand and generic?
active ingredient the same, up to 20% difference in generic
stick with same manufacturer if possible
Neuropathic pain is opioid resistant
TRUE
Respiratory Depression is enhanced when Benzo’s are added to an opioid
TRUE
Opioids are weak bases
TRUE
Patients on 5 or more medications have a 50% risk of drug to drug interaction
TRUE
What are the 4 A’s of pain management?
Analgesia
Adverse Affects
Adverse Events
Aberrant Behaviors
times of breakthrough pain are irregular
takes 10 mins from baseline to peek
69% predictable
2 episodes a day
give patient a long acting baseline medication
short acting must be given before an episode, otherwise drug won’t be treating anything
Chronic Pain
New patient is taking pain meds. When should you screen them with UT?
first 8 to 10 days
(5-HT) CDVD I AMN (NE)
Spectrum of Antidepressants
What Benzo has the Shortest Half Life? Fastest onset?
Shortest half life = Oxazepam
Fastest onset = Diazepam
Neonatal Benzo withdrawal includes hypertonia, hyperreflexia, hyperactivity, and vomiting. How long does this last?
3-6 months
What are the MC SE’s of Benzos?
insomnia
gastric problems
tremors
agitaton
fearfulness
muscle spasms
10% of Benzo patients experience what?
Protracted Withdrawal
Spasticity is a muscle tone disorder that results in the imbalance of excitatory and inhibitory inputs at the level of the __________
spinal cord
What is the only muscle relaxant that DOES have significant effect at the muscle fiber rather than acting at the spinal cord, brainstem or cerebrum?
Dantrolene
Cyclobenzaprine has anti-Ach properties, such as dry mouth, constipation, nausea, urinary retention, tachycardia, blurred vision, and confusion
TRUE
with this muscle relaxant, you must monitor the liver function when initiating
Metaxalone (Skelaxin)
ETOH has cross reactivity with asthma inhalers on a toxicology screen
TRUE
what is the most widely used drug (20% of hospital admissions are due to related diseases of this drug)
Ethanol
ETOH may be present in people with…
a UTI
E. coli
diabetics with bacterial fermentation of urine
single dose of 7grams will cause liver failure
deathly to cats and snakes
metabolized in the liver and is toxic to the skin also (SJS and TENS)
Acetaminophen
If codeine/hydrocodone ration is
TRUE
If codeine/morphine ration is
TRUE
