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JG Year 2 > 230 Pain > Flashcards

230 Pain Flashcards

1
Q

What is the definition of chronic pain?

A

Pain which persists longer than normal healing times

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2
Q

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

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

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

A

Congenital insensitivity to pain

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4
Q

What is the TRPV-1 receptor?

A

Capsaicin receptor which is activated with heat or cold

Pain when >43 degrees

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5
Q

What are A-delta fibres?

A

Myelinated nociceptors - quick, unimodal

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6
Q

What are C-fibres?

A

Unmyelinated nociceptors

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7
Q

What are A-beta fibres?

A

Nerves which detect pressure and tactile sensation - can inhibit nociception

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8
Q

Name 3 endogenous opioids

A

Endorphins
Enkephalins
Dynorphins

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9
Q

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

A

Lissauer’s fasciculus

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10
Q

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

A

Substantia gelatinosa

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11
Q

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

A

Periaqueductal grey
Locus coeruleus
Raphe nucleus

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12
Q

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

A

Enkephalins

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13
Q

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

A
  1. Inhibits NT release from the presynaptic neurone

2. Hyperpolarises the post-synaptic membrane

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14
Q

Which opioid receptors do endorphins have the highest affinity for?

A

Miu

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15
Q

Which opioid receptors do enkephalins have the highest affinity for?

A

Delta

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16
Q

Which opioid receptors do dynorphins have the highest affinity for?

A

Kappa

17
Q

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

A

ATP
PGs
Bradykinin
Histamine

18
Q

What is the action of substance P in nociception?

A

Stimulates release of histamine

Dilates blood vessels

19
Q

What is primary hyperalgesia?

A

Increased pain sensitivity immediately following tissue injury

20
Q

What is the treatment for trigeminal neuralgia?

A

Carbamazepine

21
Q

Which NSAID has the lowest thrombotic risk?

A

Naproxen

22
Q

Name 2 weak opioids

3 listed

A

Codeine
Dihydrocodeine
Tramadol

23
Q

What is the treatment for opioid O/D?

A

Naloxone

24
Q

Name 3 strong opioids

5 listed

A 
Fentanyl
Morphine
Oxycodone
Methadone
Pethidine
25
Q

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

A

Oxycodone

26
Q

Name 2 common opioid S/E

5 listed

A 
N&V
Drowsiness
Unsteadiness
Delerium
Constipation
27
Q

What is the MOA of ketamine?

A

NMDA receptor antagonist

28
Q

What is the intensive theory of pain?

A

Pain = emotional state caused by intense stimuli

29
Q

What is Descartes theory of pain?

A

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

30
Q

What is the gate theory of pain?

A

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

31
Q

Name 2 things which open the ‘pain gate’

5 listed

A 
Negative thoughts
Pain watching
Anxiety and panic
Sedentary lifestyle
Fear of pain
32
Q

Name 2 things which close the ‘pain gate’

5 listed

A 
Distraction
Happiness and laughter
Relaxation and calm
Excercise
Reassurance
33
Q

What is dolorimetry?

A

Measuring pain threshold

34
Q

What is the MOA of tramadol?

A

Inhibits reuptake of NA

Stimulates serotonin release

35
Q

What are celecoxib and etoricoxib?

A

COX2 inhibitors

36
Q

What is the precursor for COX enzymes?

A

Arachidonic acid

37
Q

What does COX 1 stimulate?

3 listed

A

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

38
Q

What is the peak-end rule?

A

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.

JG Year 2 (28 decks)

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