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Flashcards in 230 Pain Deck (38):
1

What is the definition of chronic pain?

Pain which persists longer than normal healing times

2

What are the 4 components of the IMMPACT guidelines for chronic pain?

1. Pain intensity
2. Physical function
3. Emotional function
4. Participant rating of improvement

3

Which hereditary condition is due to mutations in the voltage gates Na channels?

Congenital insensitivity to pain

4

What is the TRPV-1 receptor?

Capsaicin receptor which is activated with heat or cold
Pain when >43 degrees

5

What are A-delta fibres?

Myelinated nociceptors - quick, unimodal

6

What are C-fibres?

Unmyelinated nociceptors

7

What are A-beta fibres?

Nerves which detect pressure and tactile sensation - can inhibit nociception

8

Name 3 endogenous opioids

Endorphins
Enkephalins
Dynorphins

9

Through which part of the spinal cord do 1st order spinothalamic neurones ascend 1-2 levels in the spinal cord before decussating?

Lissauer's fasciculus

10

Where in the grey matter do 1st order neurones synapse with 2nd order neurones in the spinothalamic tract?

Substantia gelatinosa

11

Name 3 parts of the brainstem which receive fibres from the spinothalamic tract

Periaqueductal grey
Locus coeruleus
Raphe nucleus

12

What do the descending tracts from the brainstem stimulate spinal interneurones to release in the feedback system?

Enkephalins

13

What 2 things do the enkephalins released from the spinal interneurones cause to 'dampen down' pain APs?

1. Inhibits NT release from the presynaptic neurone
2. Hyperpolarises the post-synaptic membrane

14

Which opioid receptors do endorphins have the highest affinity for?

Miu

15

Which opioid receptors do enkephalins have the highest affinity for?

Delta

16

Which opioid receptors do dynorphins have the highest affinity for?

Kappa

17

Which inflammatory factors activate/sensitise nociceptors during inflammation?
(4 listed)

ATP
PGs
Bradykinin
Histamine

18

What is the action of substance P in nociception?

Stimulates release of histamine
Dilates blood vessels

19

What is primary hyperalgesia?

Increased pain sensitivity immediately following tissue injury

20

What is the treatment for trigeminal neuralgia?

Carbamazepine

21

Which NSAID has the lowest thrombotic risk?

Naproxen

22

Name 2 weak opioids
(3 listed)

Codeine
Dihydrocodeine
Tramadol

23

What is the treatment for opioid O/D?

Naloxone

24

Name 3 strong opioids
(5 listed)

Fentanyl
Morphine
Oxycodone
Methadone
Pethidine

25

Which strong opioid is strongest against kappa and delta opioid receptors?

Oxycodone

26

Name 2 common opioid S/E
(5 listed)

N&V
Drowsiness
Unsteadiness
Delerium
Constipation

27

What is the MOA of ketamine?

NMDA receptor antagonist

28

What is the intensive theory of pain?

Pain = emotional state caused by intense stimuli

29

What is Descartes theory of pain?

Single wire theory - pain has its own apparatus independent of other senses

30

What is the gate theory of pain?

Pain is not just related to extent of tissue damage - can have things which 'open' and 'close' pain gate.

31

Name 2 things which open the 'pain gate'
(5 listed)

Negative thoughts
Pain watching
Anxiety and panic
Sedentary lifestyle
Fear of pain

32

Name 2 things which close the 'pain gate'
(5 listed)

Distraction
Happiness and laughter
Relaxation and calm
Excercise
Reassurance

33

What is dolorimetry?

Measuring pain threshold

34

What is the MOA of tramadol?

Inhibits reuptake of NA
Stimulates serotonin release

35

What are celecoxib and etoricoxib?

COX2 inhibitors

36

What is the precursor for COX enzymes?

Arachidonic acid

37

What does COX 1 stimulate?
(3 listed)

Thromboxane A2 for platelet aggregation
PGs in upper GIT - gastroprotective
PGs in kidneys - renal perfusion

38

What is the peak-end rule?

Theory that the last pain you felt of e.g. a procedure in the one you remember despite the intensity of the pain prior to the end pain.