B6.017 Pain Management Flashcards Preview

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Flashcards in B6.017 Pain Management Deck (42):
1

most common reason people seek health care

pain

2

somatosensation

physiological process by which physical stimuli results in the perception of touch, pressure, or pain

3

nociception

physiological process of activation of neural pathways by stimuli that are potentially or currently damaging to tissue

4

pain

conscious experience compared to nociception
unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage, or both

5

how are primary afferent fibers classified

conduction velocity and cutaneous stimuli by which they are activated
-conduction velocity varies directly with axon diameter and presence of myelination

6

3 important characteristics o somatosensation

1. minimal afferent traffic in the absence of stimulation
2. increasing intensity of the stimulus results in increase in discharge frequency
3. different axons may respond more efficiently to a particular stimulus

7

AB fibers

large diameter, fastest conducting, myelinated
low threshold (Pacinian corpuscles)
light touch, pressure, vibration/hair movement

8

C fibers

unmyelinated, very slow conducting, pain transmitting
high threshold thermal, mechanical, and chemical stimuli
free nerve endings
*predominant fiber in afferent nerves
conveys slower onset, burning second pain

9

Ad fibers

lightly myelinated, slow conducting (but faster than C), pain transmitting
conveys rapid onset, first pain sensation

10

describe the ascending nerve pathway

nociceptive inputs enter the CNS at the dorsal horn where primary afferent terminals synapse on second order projection neurons

11

how do primary afferents activate second order neurons?

release excitatory neurotransmitters : glutamate, substance P, CGRP

12

NMDA receptors

glutamate

13

mGlu R receptors

glutamate

14

neurokinin (NK1) receptors

substance P

15

CGRP receptors

CGRP

16

what is the overarching "point" about the descending pain pathway

brain can inhibit OR enhance pain nociceptive inputs
ex: walking miles on a broken leg to get help, brain modulates pain down

17

describe the descending pain pathways

periaqueductal gray sends projections to the rostroventral medulla
RVM produces bidirectional pain modulation

18

cause of nociceptive pain

inflammation or damage

19

clinical features of nociceptive pain

pain is well localized
consistent effect of activity on pain

20

treatment of nociceptive pain

NSAIDs
injections
surgery

21

classic examples of nociceptive pain

OA
autoimmune disorders
cancer pain

22

cause of neuropathic pain

nerve damage or entrapment

23

clinical features of neuropathic pain

follows distribution of peripheral nerves
dermatome or stocking glove
episodic, lancinating, numbness, tingling

24

treatment of neuropathic pain

aimed at nerve: surgery, injections, topical
CNS acting drugs

25

classic examples of neuropathic pain

diabetic painful neuropathy
post herpetic neuralgia
sciatica
carpal tunnel

26

cause of centralized pain

CNS or systemic problem

27

clinical features of centralized pain

pain is widespread and accompanied by fatigue, sleep, memory and/or mood difficulties
previous pain elsewhere in body

28

treatment of centralized pain

CNS acting drugs
non pharm therapies

29

classic examples of centralized pain

fibromyalgia
functional GI disorders: IBS
TMJ
tension headache
interstitial cystitis, bladder pain syndrome

30

components of history when discussing a pain issue

OLDCARTS about pain
comorbid conditions
personality/mental status
psych symptoms
what they've tried previously

31

physical exam with pain issue

palpation
range of motion
inspection
provocative tests
neuro: strength, sensory, reflexes, coordination, gait, cranial nerve

32

what do you have to be careful of when ordering imaging?

can contribute to patient disability
often over ordered
try conservative first if chronic pain

33

use of EMG and NCM

identify:
site of nerve or muscle condition
types of nerves involved
nature of alteration
time course
severity

34

overview of opioid use

produce reliable analgesia
can be an integral part of an approach to acute and chronic pain
optimization of other treatments recommended first, not first line treatment

35

general adverse side effects of opioids

constipation
nausea/vomiting
sedation
resp depression

36

tolerance

physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce a specific effect

37

physical dependence

state of adaptation manifested by drug signs and symptoms that can be produced by abrupt cessation, rapid dose reduction, or antagonist administered

38

pseudo addiction

misinterpretation of relief seeking behaviors as if they are drug seeking behaviors
resolve with analgesic therapy

39

addiction

psychiatric disorder where there is use of a substance characterized by loss of control, compulsive use, preoccupation, and continued use despite harm

40

use of physical therapy for pain

best to use initially as conservative treatment as functional restoration is as important as pain reduction

41

injections for pain management

epidurals, nerve blocks
ablative procedures
joint injections
trigger point injections
plexus block

42

neuromodulation for pain

spinal cord stimulation
dorsal root ganglion stimulation