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MSII: Behavioral Science > Pain (19.2) > Flashcards

Pain (19.2) Flashcards

1
Q

What are the functions of pain?

A

Protects tissue

Detects, localizes, and identifies tissue damaging processes

Gives diagnostic clues (quality, time course, locations)

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2
Q

Define acute pain:

A

<1 week

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3
Q

Define chronic pain:

A

At least 6 months (considered an autonomous disease)

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4
Q

What is the chronic regional pain syndrome?

A

Limb is cold, red, muscle wasting and nail changes

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5
Q

What are opiates?

A

Derivatives of poppy plants (heroin and morphine)

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6
Q

What are opioids?

A

Any drug that occupies opioid receptors (fentanyl, methadone)

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7
Q

Which opioid receptor is important for pain?

A

Mu receptor

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8
Q

Where are Mu receptors found? (generally)

A

Spread through the CNS and gut and also found on WBCs

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9
Q

How do opioids work in the CNS?

A

Inhibit GABA and thus disinhibit dopamine

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10
Q

Where in the CNS are Mu receptors found?

A

Descending pain circuit: amygdala, mesencephalic reticular formation, PAG, rostral ventral medulla

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11
Q

Where in the PNS are Mu receptors found?

A

Primary afferent neurons, peipheral sensory nerve fibers, DRG

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12
Q

What are the two mechanisms of release for opioids?

A

Peripherally mediated by stress and ACTH co- release

Centrally mediated involves innervation of the hypothalamus, midbrain and rostral medulla

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13
Q

T/F: Opioids are co released with ACTH during stress reactions from the anterior pituitary

A

True

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14
Q

What are the releasing mediators for opioids?

A

5- HETE, LTA4, LTB4 and other lipoxygenase products

Angiotensin II

5- HT

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15
Q

With opioid treatment, what happens to the pressure needed to create pain when opioids are used?

A

Opioid induced hyperalgesia–> the amount of pressure needed to cause a pain response decreases as the time on opioid increases

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16
Q

What can block the opioid recetor?

A

Glutamate

17
Q

Name some criteria that should be followed when prescribing opiods for chronic pain?

A

Further investigation if the patient has Rx for >1 month

A full physical should be completed

High doses of opiates are generally not helpful

Ongoing risk assessments should be made

18
Q

What are NSAIDS?

A

Inhibitors of COX (converts arachidonic acid to prostaglandins and thromboxane)

19
Q

NSAIDs and Opioids should be used to treat….

A

Inflammatory pain… NSAIDS decrease inflammation and opioids make patient less concerned about the pain

20
Q

How do antiepileptic drugs function?

A

Lowering a neurons ability to fire by hyperpolarization or disallowing depolarization

21
Q

Why can AEDs be used to treat conditions other than epilepsy?

A

Treats other conditions like pain/ depression/ anxiety/ migrains because these conditions involve neuronal excessive firing rates

22
Q

Which pain fibers are involved in neuropathic pain?

A

C fibers mainly

23
Q

What are the 3 “bus stops” in inflammatory pain?

A

Cortical consciousness, Thalamus/ Limbic Subconscious, Spinal reflex

24
Q

How can inflammatory pain turn into neuropathic pain?

A

After the inflammation decreases, neurons can get stuck together and cause an excessive/ chronic pain response

Increased Na activity, Increased Ca activity and Increased Glu activity

25
Q

Name the Na channel blocker AEDs?

A

Carbamazepine, lamotrigine topiramate

26
Q

Name the Ca channel blocker AEDs?

A

Gabapentin and pregabalin

27
Q

General side effects of AEDs?

A

Generally may cause sedation psychomotor/ cognitive impairment, ataxia, tremor

28
Q

Specific side effect of carbamazepine?

A

aplastic anemia and P450 induction

29
Q

Specific side effects of lamotrigine?

A

Stevels Johnson syndrome rash

30
Q

Specific side effects of gabapentin?

A

Weight gain and sedation

31
Q

Specific side effects of pregabalin?

A

mild addiction, weight gain, sedation

32
Q

Specific side effects of topiramate?

A

Weight loss, acidosis glaucoma

33
Q

How doe antidepressants help treat neuropathic pain?

A

They work to increase NE in the spinal cord, which in turn decreases pain

34
Q

Increasing NE causes an increase in ______ which leads to decreased pain.

A

GABA

35
Q

What antidepressants are used to treat pain?

A

SSRI and TCA

MSII: Behavioral Science (24 decks)

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