What is pain?
Unpleasant sensory or emotional experience
Associated with actual tissue damage OR described in terms of it
Different individuals have different ___ to pain.
What is the function of pain?
Stops you from exposing yourself to dangerous stimuli
When does acute pain resolve?
Once healing has occurred
Chronic pain is (adaptive / maladaptive).
i.e there's no point to it
How is pain measured?
Why is this problematic?
Scales / ratings
Pain is subjective, different people have different sensitivities
What are physiological responses to pain?
___ and ___ are physiological responses to pain.
Patients must be allowed to ___-___ the severity of their pain.
Which brain structures receive nociceptive signals?
Which brain structures are responsible for
in response to nociceptive signals?
a) Amygdala and hypothalamus
b) Thalamus (spinothalamic tract, to post-central gyrus i.e sensory strip)
What is nociceptive pain?
Appropriate response to painful stimuli by an intact nervous system
What is neuropathic pain?
Inappropriate response to stimuli by a dysfunctional nervous system
What history should you take from anyone complaining of pain?
Allodynia and hyperalgesia are types of neuropathic pain.
What do these words mean?
Allodynia - pain in response to non-painful stimuli e.g cotton wool
Hyperalgesia - exaggerated pain in response to a painful stimulus e.g pin prick
What is a chronic pain condition often seen after shingles?
What is a chronic pain condition sometimes seen after back surgery?
Failed back syndrome
Which endocrine disease causes peripheral neuropathy, of which chronic pain can be a symptom?
What is phantom pain?
Chronic pain in amputees, felt where the limb should be
Which pathway should be used when managing pain conditions?
WHO pain ladder
What are some examples of non-opioid drugs used to manage low grade pain?
Aspirin, Ibuprofen, Naproxen, Diclofenac (i.e NSAIDs, which act on cycloxygenase 1, lots of side effects)
Name three examples of NSAIDs.
Which enzyme do they inhibit?
Which inflammatory mediator does this action affect?
Aspirin, ibuprofen, diclofenac, naproxen, indomethacin
COX (cyclo-oxygenase 1 or 2, depends on the drug)
Prostaglandin (so NSAIDs dampen down inflammation)
What are some of the side-effects of NSAIDs?
(COX-2 inhibitors, -coxibs, have cardiovascular side effects)
What is an important side effect of paracetamol?
ESPECIALLY with alcohol
What are some examples of weak opioids used to treat pain?
What are some examples of strong opioids?
What are some opioid side-effects?
What are some adjuvant drugs which can be used to treat chronic pain?
Anti-depressants (amitriptyline, duloxetine)
Anti-convulsants (carbamazepine, gabapentin, pregabalin)
a) tricyclic antidepressant
c) selective serotonin reuptake inhibitor (antidepressant)
which can be used as an adjuvant analgesic?
b) Carbamazepine, gabapentin, pregabalin
Which analgesics can be applied topically and don't affect the brain itself?
Lidocaine (local anaesthetic)