Exam 2 Pain

Question 1

What is transduction?

Answer 1

A-delta & C-fibers send signals from periphery to the CNS

Question 1

What is allodynia?

Answer 1

Reduced threshold to pain stimulus

Question 2

What is hyperalgesia?

Answer 2

Increased response to pain stimulus

Question 3

What are 2 inflammatory mediators?

Answer 3

Bradykinin
Prostaglandin

Question 4

What are 6 excitatory mediators?

Answer 4

• Glutamate
• Calcitonin gene-related peptide (CGRP)
• Nerve growth factor (NGF)
• Asparte
• ATP
• Substance P

Question 5

What is transmission?

Answer 5

Pain signal is sent through three-neuron afferent pathway along the spinothalamic tract

Question 6

Where are second-order neurons?

Answer 6

Dorsal horn to thalamus

Question 7

Where are third-order neurons?

Answer 7

Thalamus to cerebral cortex

Question 8

Where are first-order neurons?

Answer 8

Periphery to dorsal horn

Question 9

What is modulation?

Answer 9

Pain signal is modified (inhibited or augmented) as it advances to cerebral cortex

Question 10

Where is the most important site of modulation?

Answer 10

Substantia gelatinosa in the dorsal horn

Question 11

Which laminae make up the substantia gelatinosa?

Answer 11

Laminae 2 & 3

Question 12

Spinal neurons can release ___ & ___ to inhibit pain signals?

Answer 12

Gaba & glycine

Question 13

The descending pathway releases ____, ____, & ____ to inhibit pain?

Answer 13

NE, 5-HT, & endorphins

Question 14

Pain is augmented by ______ & _____?

Answer 14

Central sensitization & wind-up

Question 15

What neurons are affected by wind-up & sensitization?

Answer 15

Second-order neurons

Question 16

What is supraspinal inhibition?

Answer 16

Supraspinal structures send fibers down the spinal cord to inhibit pain at the dorsal horn.

Question 17

What is segmental inhibition?

Answer 17

Pain is stopped in the second-order neuron & spinothalamic tract.

Question 18

What is Perception & where does it happen?

Answer 18

Processing of afferent pain signals in the cerebral cortex & limbic system

Question 19

What medication classes affect transmission?

Answer 19

Local anesthetics
opioids

Question 20

What medication classes affect modulation?

Answer 20

Opioids
alpha2 agonists
NMDA antagonists

Question 21

What medication classes affect perception?

Answer 21

Opioids
alpha2 agonists
general anesthetics

Question 22

What medication classes can inhibit transduction?

Answer 22

NSAIDs
antihistaminics
opioids
local anesthetics
cannabinoids
Somatostatin (SST)

Question 23

Neuropathic pain can be ____ &/or _____?

Answer 23

Central & peripheral

Question 24

Visceral pain can be __ &/or __?

Answer 24

True & parietal

Question 25

Somatic pain can be __ &/or __?

Answer 25

Superficial & deep

Question 26

What is the most common kind/cause of acute pain?

Answer 26

Nociceptive (physiologic)

Question 27

What are the types of nociceptive pain?

Answer 27

Somatic & visceral

Question 28

What is parietal pain?

Answer 28

Localized or referred sharp, stabbing pain

Question 29

What are types of nonmalignant pain?

Answer 29

Neuropathic musculoskeletal inflammatory

Question 30

What causes neuropathic pain?

Answer 30

An injury to the nervous system

Question 31

What is sensitization?

Answer 31

Repeated stimuli reduce the threshold of primary afferent nociceptors progressively.

Question 32

What are the risk factors for developing CRPS?

Answer 32

Previous trauma or surgery nerve injury female work-related injury

Question 33

What is the difference between type 1 & 2 CRPS?

Answer 33

Type 2 has a documented prior nerve injury

Question 34

What are the S/S of CRPS?

Answer 34

Spontaneous pain hyperalgesia allodynia active & passive movement disorders

Question 35

Describe type 1 CRPS?

Answer 35

Pain disproportionate to injury, pain persists beyond the time the tissue-damaging process has ended

Question 36

What is the most common site of type 2 CRPS?

Answer 36

Brachial plexus

Question 37

Where is the pain with type 2 CRPS?

Answer 37

Generally localized to the area around the injured nerve

Question 38

What are first-line treatments for chronic pain?

Answer 38

TCA’s SNRI’s Gabapentanoids Topicals

Question 39

What are second-line treatments for chronic pain?

Answer 39

Tramadol combination of first-line treatments

Question 40

What are third-line treatments for chronic pain?

Answer 40

Specialist referral interventional therapies SSRI’s anticonvulsants NMDA antagonists Capsaicin

Question 41

What are fourth-line treatments for chronic pain?

Answer 41

Neuromodulation

Question 42

What are fifth-line treatments for chronic pain?

Answer 42

Low dose opioids

Question 43

What are sixth-line treatments for chronic pain?

Answer 43

Targeted drug delivery (pain pump)

Question 44

What is the MOA for Tricyclic antidepressants?

Answer 44

Inhibit serotonin & norepinephrine re-uptake. Also block histamine, adrenalin, acetylcholine & sodium channels

Question 45

What is the TCA dose for chronic pain?

Answer 45

20 – 30% of the effective antidepressant dose

Question 46

What is the MOA of SNRI’s?

Answer 46

Facilitate descending inhibition by blocking serotonin & noradrenaline re-uptake.

Question 47

What medication class is helpful in diabetic neuropathy, osteoarthritis, fibromyalgia, & chronic low back pain?

Answer 47

SNRI’s

Question 48

Why is carbamazepine not a first-line drug in treating chronic pain?

Answer 48

Due to its sedative effects.

Question 49

What is the MOA for capsaicin?

Answer 49

Binds to the TRPV 1 receptor located on the A-delta & C-fibers → release of substance P depolarizing the nerve → desensitization.

Question 50

What is the MOA of tramadol?

Answer 50

Mu-opioid agonist & inhibits serotonin & norepinephrine reuptake.

Question 51

What are some examples of somatic blocks?

Answer 51

Trigeminal nerve paravertebral facet trans sacral

Question 52

What are some examples of sympathetic blocks?

Answer 52

Stellate ganglion celiac plexus sympathetic chain blocks.

Question 53

What is the hallmark of neuropathic pain?

Answer 53

Elevated extracellular glutamate levels

Question 54

What post-synaptic cells take up glutamate?

Answer 54

Glial cells

Question 55

What are the benefits of targeted drug delivery?

Answer 55

Bypasses first metabolism & blood-brain barrier. Increased potency & decreased side effects

Question 56

What type of medication is ziconotide?

Answer 56

An N-type calcium channel antagonist