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Flashcards in 29.7.2013 Deck (25):
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Features associated with acute pain

HR
BP
pupils
Plasma cortisol levels
Limb withdrawal
Abdominal wall rigidity

1

Pain Afferent fibres

A delta
C

2

Chemical irritants that cause pain

ATP
histamine
Serotonin
Bradykinin

3

Silent nociceptors

Respond to mechanical stimuli only when sensitised

4

Major neurotransmitter in pain pathway

Glutamate

5

Pain from diaphragm reaches which spinal segments

C3 and C4
Pain referred to neck and shoulder

6

Hypothesis explaining referred pain

Convergence projection hypothesis

7

Cortical structure that mediates emotional response to pain

Insula
Cingulate cortex

8

Placebo effect is mediated by

Opioids

9

Descending opioidergic system

Rostral anterior cingulate cortex
Rostral ventral medulla
Periaqueductal grey

10

Characteristics of neuropathic pain

Tingling
Burning
Electric shock like pain
Triggered by light touch
Sensory deficit is present in area affected

11

Hyperalgesia

Increased pain intensity in response to same noxious stimulus

12

Hyperpathia

Greatly exaggerated pain sensation to innocuous or mild nociceptive stimuli
Characteristic of neuropathic pain

13

Rx of post-herpetic neuralgia with allodynia

5% lidocaine patch

14

CRPS(complex regional pain syndrome)

CRPS 1- reflex sympathetic dystrophy
CRPS 2- post traumatic neuralgia

15

Causalgia

Severe post traumatic neuralgia

16

NSAID that can be given IV

Ketorolac

17

Narcotic analgesic available as Intranasal spray

Butorphanol

18

Adverse effects of NSAIDS

Hypertension
Gastritis
Nephrotoxicity

19

Why NSAIDS are contraindicated for post op pain?

May increase bleeding due to platelet inhibition

20

Advantages of selective COX-2 inhibitors

Less gastric irritation
Don't affect coagulation
But no protection against nephrotoxicity

21

NSAIDS with cardiovascular risk

All except aspirin

22

Painful conditions that respond to TCA

Postherpetic neuralgia
Diabetic neuropathy
Tension headache
Migrane headache
Rheumatoid arthritis
Chronic low back pain
Cancer
Post stroke pain

23

Antidepressants with pain relieving effects similar to TCA but without their side effects

Venlafaxine
Duloxetine

24

Anticonvulsants used in pain relief

Phenytoin
Carbamazepine
Gabapentin
Pregabalin