FINAL-Intro to Pain

Question 1

IASP Pain Definition

Answer 1

Unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

Question 2

Nociceptive Visceral Pain

Answer 2

Associated with internal organs

Question 3

Nociceptive Somatic Pain

Answer 3

Soft tissue/myalgic pain

Question 4

Two Major cats of Pain

Answer 4

Nociceptive

Neuropathic

Question 5

Neuropathic Pain def

Answer 5

Stimuli abnormally processed by the nervous system

• disengaged from noxious stimuli or healing process
• nerve damage
• tingling, sharp, shooting, skin crawling

Question 6

Maladaptive (Functional) Pain

Answer 6

Abnormal operation of nervous system

• disengaged from noxious stimuli or healing
• Pain appears to be generated from inbalance in pro-nociceptive signals and anti-nociceptive signals in the CNS
• influenced heavily by stress, anxiety etc.
• typically seen i n fibromyalgia, IBS

Question 7

Acetylsalicylic Acid

Answer 7

Aspirin
Max dosing: 4,000
325-1000 q 4-6hrs

Question 8

Acetaminophen

Answer 8

Tylenol
Parenteral-Ofirmev
Max Dose: 4000mg/day
325-1000mg q 4-6hrs

Question 9

Meclofenamate

Answer 9

Max dose-400mg/day

Question 10

Mefenamic Acid

Answer 10

Ponstel

Question 11

Diclofenac

Answer 11

Cataflam, Voltaren gel
Max dose 150
Flector Patch: 2x daily to painful area

Question 12

Indomethacin

Answer 12

150 max dose day

Question 13

Ibuprofen

Answer 13

Motrin
Caldolor IV
3400mg/day

Question 14

Naproxen

Answer 14

Naprosyn

1000max dose daily

Question 15

Naproxen Na

Answer 15

Aleve

660mg/day max

Question 16

Celecoxib

Answer 16

Celebrex

400mg/day max

Question 17

Meloxicam

Answer 17

Mobic
Max 15mg/day
7.5 mg dosing!

Question 18

What NSAID has the least amount of CV risk?

Answer 18

Naproxen

Question 19

What NSAIDs have the least amount of risk for GI bleeding?

Answer 19

Celecoxib, Nabumetone, Meloxicam

Question 20

If aspirin is indicated, should you give ibuprofen?

Answer 20

No because it interferes with the antiplatelet effect of aspirin

Question 21

Hyperalgesia

Answer 21

Exaggerated painful response to normally noxious stimuli

Question 22

Allodynia

Answer 22

Painful response to normally non-noxious stimuli

bed sheet on foot, exposure to cold

Question 23

A- δ (delta) fibers description…

Answer 23

Large diameter, sparsely myelinated that evoke sharp, well localized pain

Question 24

C-fibers description…

Answer 24

Small diameter, Unmyelinated produce aching, poorly localized pain

Question 25

Generation of action potentials that are conducted along

Answer 25

afferent A delta and C nerve fibers to the spinal cord

Question 26

What is Maladaptive Pain?

Answer 26

Functional Pain AKA Dysfunctional Pain - Think of it as abnormal operation of the nervous system that become disengaged from noxious stimuli or healing - Imbalance in pro-nociceptive signals and anti-nociceptive signals in CNS -This kind of dysfunctional pain is heavily influenced by stress, anxiety, depression, or illness

Question 27

Diseases that are Maladaptive Pain?

Answer 27

Fibromyalgia, IBS, Intersitial Cystitis

Question 28

Opioids bind to what receptors?

Answer 28

kappa, mu, delta

Question 29

Opioids MOA

Answer 29

Bind to GPCR via 2nd messengers to reduce adenylate cyclase, open K+ channels, and moify Ca2+ Bind to mu, delta, kappa

Question 30

Dorothy Effect

Answer 30

Dopamine + Opioid Response Dopamine is our primary reward system and Endorphins and opioid receptors maximize our achieve the reward Occurs in susceptible individuals on exposure to opioids (depression, chronic stress/anxiety, genetic predisposition, substance abuse dx)

Question 31

Drug of choice for Trigeminal Neuralgia

Answer 31

TEGRETOL(Carbamazepine)

Question 32

SNRI approved for Pain and fibromyalgia

Answer 32

CYMBALTA (Duloxetine)

Question 33

Opioids on list...

Answer 33

``` Morphine Hydrocodone Oxycodone Oxymorphone Hydromorphone Fentanyl Methadone Codeine ```

Question 34

TCA adjuncts

Answer 34

Amitriptyline (ELAVIL) Nortriptyline (PAMELOR) Desipramine(NORPAMIN) Imipramine(TOFRANIL)

Question 35

Antiepileptic Adjuncts

Answer 35

Carbamazepine (TEGRETOL) Pregabalin (LYRICA) Neurontin (GABAPENTIN)

Question 36

SSRI adjunct

Answer 36

``` Sertaline Citalopram Escitalopram Paroxetine Fluoextine ```

Question 37

SNRIs

Answer 37

Duloxetine Venlafaxine Milnacipran (SAVELLA)