B7-005 Pain 2

Question 1

acute pain goes through the […] system

Answer 1

spinothalamic

Question 2

carried by unmyelinated C fibers
dull, burning pain-poorly localized

Answer 2

slow pain

Question 3

carried by A-delta thinly myelinated fibers
sharp pricking pain
accurately localized

Answer 3

fast pain

Question 4

slow pain is carried in the […] tract

Answer 4

paleothalamic

has several “waypoints” on way to thalamus, envokes “memories” of pain

Question 5

fast pain is carried in the […] tract

Answer 5

neothalamic

goes straight to thalamus

Question 6

why does slow pain invoke an emotional response?

Answer 6

it is diffusely projected throughout the cortex

Question 7

why does pain persist after the noxious stimuli is removed?

Answer 7

peripheral :sensitization by chemical mediators (they depolarize the receptor and make it more sensitive to subsequent stimuli)

central: decreased pain receptor thresholds and changes in synaptic central circuits over time

Question 8

similar to slow pain, affecting the internal organs

Answer 8

visceral pain

Question 9

why is visceral pain hard to localized?

Answer 9

very high percentage of C fibers going through paleothalamic tract which projects diffusely

Question 10

has characteristics of slow pain
is commonly referred to overlying somatic structures

Answer 10

visceral pain

Question 11

describe the mechanism of referred pain

Answer 11

convergence of cutaneous and visceral nociceptors onto same dorsal horn
OR
branching pattern of sensory nerve

Question 12

secondary to disruption of normal pain physiology caused by abnormal sensitization, conduction, modulation, or perception

Answer 12

chronic (abnormal) pain

Question 13

mildly painful stimuli perceived as more painful that it is

Answer 13

hyperalgesia

Question 14

nonpainful stimuli perceived as pain

Answer 14

allodynia

Question 15

painful tingling (like foot asleep)

Answer 15

dysesthesia

Question 16

persistant hyperpathia associate with vasomotor changes after an injury

usually after a period of immobilization, affected limb may have color changes

Answer 16

Complex Regional Pain Disorder

AKA reflex sympathetic dystrophy, causalgia (with nerve injury)

Question 17

focal area of demyelination with cross talk between bare axons

Answer 17

neuralgia

Question 18

treatment of trigeminal neuralgia

Answer 18

carbamezapine
surgery

Question 19

treatment of Complex Regional Pain Disorder [3]

Answer 19

aggressive mobilization
pain control
sympathetic blockade

Question 20

damage to somatosensory systems, associated with numbness

presumed secondary to decreased modulation

Answer 20

defferentation pain

Question 21

describe the gate control theory of pain

Answer 21

modulation of pain wants the non-painful and painful stimuil to be balanced

a decrease in either one would cause an increase in the other and vice versa

Question 22

loss of non-painful sensory inputs causes a relative pain increase, pain is perceived

Answer 22

defferentation pain

Question 23

inhibitory pain pathway
triggered by fight or flight

Answer 23

central pain modulation

Question 24

describe the central pain modulation pathway

Answer 24

periaqueductral gray –> opiate receptors –> rostroventral medulla –> NE 5HT –> dorsal horn –> enkephalin interneurons

Question 25

treatment used to decrease sensitization [4]

Answer 25

early mobility
capsacin
NSAIDs
steroids

Question 26

treatment used to decrease pain conduction [3]

Answer 26

nerve block
spinothalamic tractotomy (used for cancer with poor prognosis)
stabilize nerves with anti-epilepsy drugs

Question 27

treatments used to increase pain modulation [2]

Answer 27

increase non-painful input: mechanical stimulation, trans-cutaneous stimulator, posterior column stimulator, stimulate periaqueductal gray

medication: antidepressants, opiates

Question 28

treatments used to change pain perception

Answer 28

behavior/relaxation therapy
biofeedback
treatment for anxiety/depression

Question 29

recurrent brief episodes of pain in the CN V distribution

Answer 29

trigeminal neuralgia

Question 30

most cases of trigeminal neuralgia are caused by

Answer 30

vascular compression of the CN V root

Question 31

electric “shock” like pain over the jaw triggered by talking, chewing, or touch

Answer 31

trigeminal neuralgia

Question 32

treatment for trigeminal neuralgia

Answer 32

carbamazepine (epilepsy drug)

**if no response, they need surgical intervention

Question 33

“burning” pain and allodynia following herpesvirus infection

Answer 33

postherpetic neuralgia

Question 34

describe the pathophysiology of postherpetic neuralgia

Answer 34

decreased modulation from defferentation

Question 35

used to reduce the risk of postherpetic neuralgia

Answer 35

antivirals

**diagnosis must be caught early to have better prognosis

Question 36

damage to descending pain inhibitory pathways can cause

Answer 36

decreased modulation

Question 37

treatment of postherpetic neuralgia

Answer 37

amitriptyline

Question 38

acute migraine treatment

Answer 38

triptans (diptans if risk of stroke)
antiemetics

Question 39

prophylactic migraine treatment

Answer 39

beta blocker
amitriptyline
valproate, topiramate (anti-epileptics)
botulinum toxin
anti-CGRP monoclonal antibodies
NSAIDs

Question 40

treatment of deafferentation syndrome

Answer 40

tricyclic antidepressant

Question 41

blocks sodium channels in the nerve

Answer 41

lidocaine

Question 42

[…] syndrome following a thalamic stroke is common

Answer 42

deafferentation pain

Question 43

allodynia with swelling, redness of skin, and skin changes

Answer 43

complex regional pain syndrome/reflex sympathetic dystrophy

Question 44

the projection of pain impulses to the cerebral cortex is […]

Answer 44

diffuse

extends beyond somatosensory complex

Question 45

physiologic basis of referred pain

Answer 45

convergence of primary sensory neurons from the skin and affected organ on the same populations of secondary sensory neurons within the spinal cord