Unit 12: Misc Topics: Misc Pain Topics

Question 1

What is allodynia?

Answer 1

pain due to stimulus that does not normally produce pain

Question 2

define alogenic

Answer 2

a stimulus that is normally expected to produce pain

Question 3

define analgesia

Answer 3

no pain is sensed in response to a stimulus that produces pain

Question 4

define dyseesthesia

Answer 4

abnormal and unpleasant sense of touch

Question 5

define hyperalgesia

Answer 5

exaggerated pain response to a painful stimulus

Question 6

define neuralgia

Answer 6

pain localized to dermatomes

Question 7

define neuropathy

Answer 7

impaired nerve function

Question 8

define paresthesia

Answer 8

abnormal sensation described as pins and needles

Question 9

which drug classes can be used to treat chronic pain?

Answer 9

TCAs
SSRIs/SNRIs

Question 10

which TCAs can be used to treat chronic pain?

Answer 10

amitriptyline
nortriptyline
imipramine

Question 11

Which SNRIs can be used to treat chronic pain?

Answer 11

Venlafaxine
duloxetine
milnacipran

Question 12

what are some SSRIs that can be used to treat chronic pain?

Answer 12

fluoxetine
citalopram

Question 13

what are some common side effects of TCAs?

Answer 13

QT prolongation and orthostatic hypotension

Question 14

which are the two types of complex regional pain syndrome?

Answer 14

Type 1 reflex sympathetic dystrophy
type 2 causalgia

Question 15

List some treatment options for complex regional pain syndrome

Answer 15

ketamine infusion
memantine
gabapentin
regional sympathetic blockade
physical therapy
steroids
amitriptyline

Question 16

For what procedures can a paravertebral nerve block be used?

Answer 16

breast surgery, thoracotomy, and rib fracture

Question 17

when can celiac plexus block be used?

Answer 17

cancer pain of the upper abdominal organs

Question 18

When can superior hypogastric plexus block be used?

Answer 18

cancer pain of the pelvic organs

Question 19

What is one complication that can occur with superior hypogastric plexus block?

Answer 19

retrograde migration of the injectate. This is a problem if neurolytic is used.

Question 20

Name a clinical indication for a sphenopalatine block

Answer 20

to relieve postdural puncture headache.

Question 21

Why is the optic nerve unique?

Answer 21

It is the only cranial nerve that is part of the central nervous system.

Question 22

what happens if a local anesthetic is injected into the optic sheath?

Answer 22

it can migrate towards the optic chiasm, where it will anesthetize CN 2 and 3 on the contralateral side, causing amaurosis (blindness)

Question 23

Define post-retrobulbar block apnea syndrome

Answer 23

local anesthetic from a retrobulbar block reaches the brainstem causing apnea

Question 24

how quickly would post-retrobulbar block apnea syndrome be evident?

Answer 24

Within 2-5min after the injection.

Question 25

how quickly would spontaneous ventilation resume if post-retrobulbar block apnea syndrome occured?

Answer 25

Usually 15-20min, but it may take 60min for a full recovery

Question 26

Name a clinical indication that would clue you in to the development of post-retrobulbar block apnea syndrome?

Answer 26

contralateral pupil dilation

Question 27

If you notice contralateral pupil dilation shortly after placing a retrobulbar block what should you do?

Answer 27

get ready to provide cardiopulmonary support until the block wears off

Question 28

Name risk factors of developing complex regional pain syndrome

Answer 28

female gender
previous trauma or previous surgery

Question 29

what is the key distinction between type 1 and type2 complex regional pain syndrome?

Answer 29

type 2 is always preceded by nerve injury when type 1 is not.

Question 30

a paravertebral block is essentially a single shot unilateral what?

Answer 30

single shot unilateral epidural.