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Revision Cards > Week 230 - Pain > Flashcards

Week 230 - Pain Flashcards

1
Q

Week 230 - Pain: What are the short-term side effects of morphine?

A
  • Nausea and Vomiting
  • Constipation
  • Addiction
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2
Q

Week 230 - Pain: What are the long-term side effects of morphine?

A
  • Hormonal imbalance (leading to reduced testosterone, reduced libido, erectile dysfunction, gynaecomastia, fatigue)
  • Opioid-induced hyperalgesia.
  • Immune system dysfunction.
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3
Q

Week 230 - Pain: How do opioids reduce testosterone?

A
  • Inhibit GnRH
  • Low gonadotrophin secretion.
  • Reduced gonadal androgen (Testosterone) secretion.
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4
Q

Week 230 - Pain: What is nociceptive pain?

A

• Pain caused by signals sent by nociceptive receptors in tissues.

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5
Q

Week 230 - Pain: What is neuropathic pain?

A

• Pain caused by damage to the nerves themselves.

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6
Q

Week 230 - Pain: What are the five levels of Loeser’s model of pain?

A

1) Nociceptive
2) Attitudes and Beliefs
3) Suffering
4) Pain escape behaviour
5) Social environment

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7
Q

Week 230 - Pain: What is the chronic pain cycle?

A

1) Pain
2) Fear of movement
3) Avoidance or over-activity
4) Rest
5) Distress, Frustration, Worry
6) Physically De-conditioned
1) Pain

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8
Q

Week 230 - Pain: Give examples of the two main types of drugs used for analgesia.

A

• Non-opioid analgesics:
- Paracetamol, Ibuprofen, Naproxen

• Opioid analgesics:
- Codeine, dihydrocodeine, fentanyl, morphine, oxycodone, tramadol.

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9
Q

Week 230 - Pain: Which two drugs, indicated for other uses, are commonly used for the treatment of pain?

A

Gabapentin and amitrityline.

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10
Q

Week 230 - Pain: What are the three steps of the WHO analgesia ladder?

A

1) Non-opioid analgesic. +/- adjuvants.
2) Weak opioid and non-opioid. +/- adjuvants.
3) Strong opioid and non-opioid. +/- adjuvants.

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11
Q

Week 230 - Pain: What are the adjuvants that may be added to analgesia treatment for pain?

A
  • Bisphosphonates.
  • Steroids.
  • Muscle relaxants.
  • Antidepressants.
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12
Q

Week 230 - Pain: Which opioids are classed as ‘weak’?

A

Codeine and dihydrocodeine.

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13
Q

Week 230 - Pain: Which opioids are classed as ‘strong’?

A

Morphine, fentanyl, oxycodone.

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14
Q

Week 230 - Pain: What is the mechanism of action of paracetamol?

A

• Reduces central prostaglandin synthesis.

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15
Q

Week 230 - Pain: How do NSAIDS work?

A

They are competitive inhibitors of COX.

  • COX2 - Reduces prostaglandin secretion and therefore inflammation.
  • COX1 - GI damage, Renal damage leading to sodium and water retention, Worsens asthma.
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16
Q

Week 230 - Pain: If a patient has any GI risk factors what should you add when prescribing NSAIDS?

A

PPI

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17
Q

Week 230 - Pain: What are the beneficial effects of opioids?

A

Analgesia, Euphoria, Sedation, Cough Suppression, Anti-diarrhoeal activity.

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18
Q

Week 230 - Pain: Tramadol also has non-opioid effects, what are they?

A

• Inhibits the re-uptake of norepinephrine (noradrenaline) and stimulates serotonin release.

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19
Q

Week 230 - Pain: What cautions should be taken when prescribing tramadol?

A

• Caution taken in patients with risk of seizures, increased risk of CNS toxicities if given with anti-depressants.

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20
Q

Week 230 - Pain: What are the side-effects of opioids?

A

Common - Nausea and vomiting, Drowsiness, Unsteadiness, Delirium
Occasional - Sweating, Dry mouth, Hallucinations, Pruritus,

21
Q

Week 230 - Pain: What is the first-line strong opioid analgesic?

A

Morphine

22
Q

Week 230 - Pain: Which drug is used to reduce muscle spasm which may be causing pain?

A

Baclofen

23
Q

Week 230 - Pain: What is gabapentin?

A

GABA analogue, reduces neuronal excitability.

24
Q

Week 230 - Pain: What are the side-effects of gabapentin?

A

• Drowsiness, confusion, dizziness.

25
Q

Week 230 - Pain: What are the side-effects of Amitriptyline?

A

• Drowsiness, arrhythmias, dry mouth, blurred vision.

26
Q

Week 230 - Pain: Give examples of some of the local anaesthetics that can be used in the treatment of pain?

A
  • Lidocaine patch
  • Emla cream (Lidocaine, prilocaine)
  • Nerve blocks.
27
Q

Week 230 - Pain: What is the impact of Congenital Insensitivity to Pain (CIP)?

A
  • Need to ‘learn’ to avoid dangerous behaviour.
  • Musculoskeletal problems.
  • Shorter life span.
28
Q

Week 230 - Pain: What is the TRPV1 receptor?

A
  • Capsaicin receptor.
  • Pain receptor that reacts to thermal changes.
  • It is activated by temperature above 43º.
29
Q

Week 230 - Pain: Give examples of chemicals that cause sensitization of nociceptors and in turn produce the sensation of pain.

A
  • Histamine
  • Prostaglandins.
  • Bradykinin.
  • Substance P.
30
Q

Week 230 - Pain: What are the two types of nociceptors?

A
  • A∂ fibres.

* C-fibres.

31
Q

Week 230 - Pain: What are the characteristics of A∂ (delta) nociceptors?

A
  • Myelinated.
  • ‘Fast’ pain sensation.
  • Unimodal.
32
Q

Week 230 - Pain: What are the characteristics of C nociceptors?

A
  • Unmylinated.
  • ‘Slow’ pain sensation.
  • Unimodal.
33
Q

Week 230 - Pain: When you, for eg bang your knee, you may rub it to alleviate the pain. What is the physiological basis behind this?

A
  • The A-beta fibres are responsible for pressure sensation.
  • These fibres travel along the same pathway into the spinal cord as A∂ and C fibres.
  • A-beta stimulation can therefore inhibit the action of the A∂ and C fibres, through inhibitory interneurons, reducing the sensation of pain.
34
Q

Week 230 - Pain: Pain travels through which spinal tract?

A

The spinothalamic, to the thalamus.

35
Q

Week 230 - Pain: What are the 1st,2nd and 3rd order neurons in terms of the pain pathway?

A

1st - Nociceptor from pain stimulus to spinal cord.
2nd - Spinothalamic tract to thalamus.
3rd - Thalamocortical from thalamus to cortex.

36
Q

Week 230 - Pain: At which level does the pain pathway cross the spinal cord?

A

They decussate at the same level that they enter.

37
Q

Week 230 - Pain: Which parts of the cortex are responsible for the ‘unpleasant’ sensation of pain?

A

• Insula and Cingulate cortex.

38
Q

Week 230 - Pain: Which part of the brain is responsible for locating the source of the pain?

A

Primary somatosensory cortex.

39
Q

Week 230 - Pain: What are the three locations that the descending pathways of pain begin from?

A
  • Periaquaductal grey.
  • Nucleus raphe magnus.
  • Locus coeruleus.
40
Q

Week 230 - Pain: What are the receptor types for each of the locations of the descending pain pathway?

A
  • Periaquaductal grey - Opioidergic
  • Locus coeruleus - Noradrenergic
  • Nucleus raphe magnus - Seretonergic
41
Q

Week 230 - Pain: How does phantom limb pain arise?

A
  • Massive loss of sensory input.
  • Prolonged Nociceptive stimulation.
  • There is a re-organisation in the dorsal horn, A-beta fibres may attach themselves to the remaining 2nd-order neurons causing stimulation of the pain pathway and a perception of pain in a limb that is no longer there.
42
Q

Week 230 - Pain: What is the difference between opioids and opiates?

A

They are often used inter-changeably but in reality, opioids are endogenous ligands for opioid receptors. Whilst opiates are exogenous (e.g. morphine, codeine).

43
Q

Week 230 - Pain: What type of receptors are opioid receptors? What are the main classes of opioid receptors?

A
  • Metabotropic.

* Mu, Delta, Kappa.

44
Q

Week 230 - Pain: Which class of opioid receptor is the most addictive?

A

Mu

45
Q

Week 230 - Pain: What are the three types of opioids? Which receptor type does each have affinity for?

A
  • Endorphins - Agonist for all three but primarily Mu.
  • Enkephalins - Primarily a delta-agonist.
  • Dynorphins - Primarily a kappa-agonist.
46
Q

Week 230 - Pain: How do endogenous opioids modulate the pain pathway?

A
  • Spinal interneurones release enkephalins into the synapse between the 1st and 2nd order pain neurons.
  • These shutdown synaptic activity by inhibiting neurotransmitter release and hyper-polarizing the postsynaptic membrane.
  • The interneurons themselves are controlled by opioids.
47
Q

Week 230 - Pain: What are the other effects of opioids?

A
  • Euphoria
  • Sedation
  • Cough suppression
  • Respiratory depression
  • Nausea and Vomiting
  • Constipation
  • Miosis
48
Q

Week 230 - Pain: What is Allodynia?

A

A stimulus that causes pain when it shouldn’t.

49
Q

Week 230 - Pain: What is trigeminal neuralgia? How is it treated?

A
  • An intense episodic pain that is caused by compression of the trigeminal nerve.
  • It is often triggered by stimulation of the sensory areas of the trigeminal nerve.
  • It is treated with anti-convulsants e.g. Carbamazapine.

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