4 - Chronic Pain

Question 1

What is a phenotypic switch?

Answer 1

Although acute noxious stimuli are transmitted to the spinal cord via Aδ and C fibers, the presence of allodynia is thought to be mediated by the activation of large-diameter Aβ fibers

AB fibers develop the ability to secrete substance P

Question 2

What causes radicular spinal pathology?

Facet pathology?

Answer 2

mechanical nerve root compression by a herniated disc

degenerative changes to the joints (like arthritis)

Question 3

What is the treatment for radiculopathy?

Answer 3

Often ESI

Question 4

What is the treatment for facet pain?

Answer 4

Radiofrequency rhizotomy of the medial branches

Question 5

Which nerves are most commonly effected by herpetic neuralgia?

Answer 5

Cervical

Thoracic

Trigeminal

Question 6

What are the two metabolites of morphine?

Answer 6

Morphine - 6 - gluconuride (analgesic)

Morphine - 3 - gluconuride (harmful)

Question 7

What is NNT?

Answer 7

Numbers Needed to Treat

Question 8

Why should oxycodone not be taken with alcohol?

Answer 8

Increases its plasma concentration by 300%

Question 9

What are the weak opiods?

Answer 9

codeine

tramadol

hydrocodone

tapentadol

Question 10

For what age group is codeine not effective?

Answer 10

Children under 12 lack the enzymes to convert prodrugs to morphine

Get all the side effects but no analgesia

Question 11

Why are anticonvulsants useful in treating chronic pain?

Answer 11

Block membrane activity (usually via sodium channel blocking)

Question 12

How long does it take for lidocaine patches to be effective?

Answer 12

A couple of days

Question 13

What is chronic pain?

Answer 13

Persistent pain with distinct periods of uninterrupted pain for 3 months

Question 14

Increases in substance P and substance P receptors is specifically related to what kind of pain?

Answer 14

Inflammatory

Question 15

What are three big differences between inflammatory and neuropathic pain

Answer 15

1. Inflammatory pain gets better when inflammation decreases. Neuropathic pain is persistent, even when tissue healing is evident.
2. neuropathic pain causes allodynia, inflammatory does not
3. neuropathic pain is not adequately managed with NSAIDs

Question 16

What is CPSP?

Answer 16

Chronic Postsurgical Pain

persistent pain more than 2 months postop that can’t be explained by other causes

Question 17

The most common surgical procedures assocaited with CPSP are:

Answer 17

thoracic:

mastectomy, thoracotomy, chole, sternotomy etc

AND amputations

AND inguinal surgeries

Question 18

Which factors predict a LOW likelihood of CPSP?

Answer 18

Young age

Immunosuppression

Question 19

What is the first line treatment for CPSP?

Answer 19

Antidepressants

Question 20

What is windup?

Answer 20

Chronic discharge of neurons that leads to overwhelming of the inhibitory systems of neuropathways

Question 21

What happens when pathologic chronic pain causes displacement of magnesium?

Answer 21

1. NMDA receptors are activated
2. Calcium ions enter cells, causing exaggerated release of sub P and excitatory AAs

Question 22

Placebo analgesia is actually ______

Answer 22

a neurochemical event

Question 23

Why is tylenol lumped in with NSAIDs?

Answer 23

It inhibits COX, but in the brain. It has no impact on systemic inflammation

Question 24

What are the big ticket side effects from prolonged/excessive NSAID use?

Answer 24

nephrotoxicity

thrombotic events

peptic ulcers

bleeding

Question 25

What is Acetylsalicylic Acid?

Answer 25

ASA Aspirin is an NSAID nonselevtive *irreversible* COX inhibitor

Question 26

Why is oxycodone highly addictive?

Answer 26

significant kappa receptor activity

Question 27

Which is more effective in managing pain: SSRIs or SNRIs?

Answer 27

SNRIs

Question 28

How long is flexeril effective?

Answer 28

Only about four days of use

Question 29

Baclofen is only indicated:

Answer 29

for extreme spasmodic conditions like cerebral palsy, teatnus, and MS

Question 30

Withdrawal from baclofen can cause:

Answer 30

respiratory failure, seizures, delirium, hemodynamic changes

Question 31

What is the most common interventional procedure for back pain?

Answer 31

lumbar epidural injections

Question 32

What are IESI and TESI?

Answer 32

**Interlaminar epidural steroid injection** (put the needle through the intervertebral lamina and into the epidural space **transforaminal epidural steroid injection** (placing the needle into the neuroforamen of the affected nerve root)

Question 33

Which is more effect and which is safer and easier: TESI or IESI

Answer 33

TESI better therapeutic outcome IESI is safer and easier

Question 34

What are facet joints?

Answer 34

synovial joints between the lateral aspect of each vertebrae that help to limit movement and resist excessive force on the spine

Question 35

How is facet joint pain diagnosed? Treated long term?

Answer 35

diagnostic block radiofrequency ablation

Question 36

What is the largest joint in the human body?

Answer 36

Sacroiliac supports the spine and transfers weight off the pelvis and spine

Question 37

What has been shown to decrease pain in infants?

Answer 37

smell of amniotic fluid, mother's milk, baby oil Swaddling, holding, rocking, skin-to-skin, auditory stimuli

Question 38

What is perceptual dominance?

Answer 38

a person with pain in one knee is more likely to experience chronic back pain that is less intense intense pain at one location may cause an increase in the threshold of the other location

Question 39

Myofascial Pain Syndrome

Answer 39

regional pain syndrome associated with injury to muscle/fascia/tendons includes myositis, fibrositis, myalgia etc

Question 40

Complex Regional Pain Syndrome is usually associated with \_\_\_\_\_\_\_\_\_

Answer 40

limb injury changes in hair and nail growth, inflammation, redness, temperature, hypersensitivity and allodynia