Lecture 17: Chronic Pain Management (Exam 3) Flashcards
(88 cards)
1
Q
Slide 4
A
2
Q
What does the NMDA receptor do
A
Slide 5
3
Q
Slide 6
A
4
Q
T/F: Genetics and past experience are involved in how we handle pain
A
True
5
Q
What happens to the movement when there is pain in an area of the body
A
- The kinesthetics of movement change
- See compensation for painful or stiff regions leads to additional probs
- ex. support limb OA, myofascial strain patterns, & Tendon & ligament injury
6
Q
What is there a balance of in the body
A
Pro-inflammatory & anti-inflammatory mediators
7
Q
What happens to the balance of pro & anti-inflammatory mediators if there is injury
A
Slide 8
8
Q
What happens to inflammation as a px ages
A
It increases
9
Q
What is fascia
A
- White connective tissue
- Directly under the skin
- Deeper & broader bands of connecting muscles & tendons
- The connection btw/ bones
- The “interstitium” around organs & vessels
10
Q
What is the clinical relevance of fascial tissue
A
- Contractile elements of fascial enable modulating role in force generation & mechanosensory fine-tuning
slide 11
11
Q
What is the role of connective tissue in disease
A
Slide 12
12
Q
Slide 13
A
13
Q
How can we use myofascial to determine pain
A
- By palpating
- Hold alot of the pain
- Doesn’t give the exact location of pain but an area where it is located
14
Q
Slide 16
A
15
Q
Slide 17
A
16
Q
T/F: Opioids play a very important role in chronic pain management
A
False it is very questionable b/c of neuro-inflammatory, poor long-term efficacy, increasing doses req, & poor bioavailability
17
Q
Slide 19
A
18
Q
Describe Gabapentin
A
- Most relevant anti-epileptic drug
slide 20
19
Q
A
20
Q
_______ leads to modifications in pain pathways that are more complex than acute pain.
A
chronic pain
21
Q
rehabilitation
A
certification provides fundamental skills for pain management.
22
Q
_____ can make pain feel more intense and should be managed alongside pain
A
stress
23
Q
What is a key advantage of regional nerve blocks in chronic pain?
A
They can help reset pain pathways
24
Q
_____________ can help reset the nervous system in chronic pain cases.
A
regional nerve blocks
25
What is a key benefit of strengthening exercises in hip dysplasia?
Strengthening gluteal muscles helps stabilize the hip
26
What is a key consideration when using laser therapy?
It has a biphasic dose response
27
What is a potential concern with using Gabapentin in elderly patients?
Ataxia and sedation
28
________ only needs to be dosed ______ daily, unlike gabapentin.
pregabalin; 2X
29
A receptor in the spinal cord that becomes activated during chronic pain, leading to pain amplification
NMDA receptor
30
Which physical therapy modality is most beneficial for weight loss in patients with mobility issues?
Underwater treadmill
31
What is a key benefit of non-steroidal anti-inflammatory drugs in chronic osteoarthritis?
They can prevent joint degeneration
32
_____________ includes treatments that don't put drugs into the body, such as acupuncture and laser therapy.
physical medicine
33
________ is more beneficial than passive stretching, especially in cats.
active exercise
34
What is a key advantage of Pregabalin over Gabapentin?
Less ataxia and twice daily dosing
35
Critical factor in reducing chronic pain and inflammation
weight optiization
36
Which drug is most appropriate for blocking NMDA receptors orally?
Amantadine
37
can be used to break the pain cycle in chronic cases.
ketamine
38
NSAIDS role
Anti-inflammatory medications that can provide disease-sparing effects when used long-term
39
Myofascial Palpation
Gentle examination technique to detect fascial abnormalities and pain sources
40
___________ is preferred over high-velocity adjustments in elderly patients.
joint mobilization
41
Period of intensive pain control to reset central wind-up and improve chronic pain management
pain vacation
42
Intrinsic immune imbalance that occurs in elderly patients
Inflemaging
43
support limb changes
Overuse of diagonal leg when compensating for osteoarthritis in one limb
44
What is the primary concern with underwater treadmill therapy in neurologic patients?
Risk of fatigue leading to loss of function
45
What is the recommended monitoring frequency for long-term NSAID use?
Every 6 months
46
What is a key advantage of Librela for osteoarthritis?
It targets nerve growth factor
47
What is the role of fascia in chronic pain?
It carries body awareness and can become sticky with disuse
48
What is the recommended approach for chronic pain in elderly patients?
Multimodal therapy including physical medicine
49
which nerve is important as an analgesic factor in pain management.
vagus
50
What is the recommended daily dosage of EPA and DHA for dogs?
5,200 mg per kg
51
What is the primary concern with using opioids for chronic pain?
They are neuroinflammatory
52
How often should blood work be checked initially when starting NSAIDs?
Within 3-4 weeks
53
Products like Adequan and Dasequin that help protect joint health
joint supplements
54
are important omega-3 fatty acids for pain management.
EPA and DHA
55
What is a key consideration when using herbal medicines?
Natural doesn't mean safer
56
can be particularly helpful for joint-specific pain.
shockwave therapy
57
know this
58
Kinesthetics of Movement
Compensation for
painful or stiff regions
leads to additional
problems
59
what other problems can occur from kinesthetic compensation
Support limb OA
* Myofascial strain
patterns
* Tendon and ligament
injury
* Altered body awareness
and increased tendency
toward additional injury
60
physical medicine examples
ouch/massage
* Acupuncture
* Laser or Photobiomodulation
* Therapeutic exercise
* Joint mobilization
* Heat/cold
* Exercise/motion
* Fascial Release
61
Emerging Evidence (Lascelles) that longer
durations of treatment with _________ (6 months)
are associated with less progression of arthritis
and pain in dogs with OA
NSAIDS
62
N-Methyl D-Aspartate
--Become activated by recurrent depolarization- loss of
Mg plug
--When activated- massively amplify calcium release
and thus nerve transmission
--Massive contributor to neuro-inflammation
--Excellent drug targets (receptors not constitutively
active)
63
N-Methyl D-Aspartate drug targets
Ketamine
* Amantadine
* Methadone
* +/- Tramadol (minor)
64
drugs of this classification antagonize central sensitization, glial activation, and decrease opioid tolerance, making a number of drugs more
effective
NMDA antangonists: amantadine and memantine
65
t/f: you should exercise caution when prescribing amantadine to a dog who has a pre-existing seizure condition
true, can cause more seizures
66
________ metabolized by the liver and cleared by the kidneys, so reducing the dose with liver or
kidney disease is recommended. Amantadine is available in tablets, capsules and a liquid solution
that is safe in animals. However,
amantadine
67
Fat is ____________
Reduction in weight is ___________
pro-inflammatory; Analgesic
68
Polysulfonated Glycosamino-Glycans
FDA approved (dogs) injectable drug
* For Non-infectious arthritis
* Decrease catabolic enzymes
* Enhance anabolic enzymes
69
Intra-Articular
Treatments for OA
Corticosteroids
* Hyaluronic acid
* Local anesthetics
* Platelet-rich plasma (PRP)
* Interleukin-1 receptor antagonist (IL-1ra,
IRAP, ACS)
* Mesenchymal or Bone Marrow stem cells
(MSC or BMAC)
* Botulinum A neurotoxin
* TRPV1 agonists (capsaicin)
* Radiation Therapy (Synovetin)
70
Corticosteroids
Reduction in pain from 1-4 weeks
* Not considered a long-term therapy alone
-three doses four weeks apart
71
regenerative therapy that augments natural healing process:
Platelet-Rich Plasma (PRP/ACP)
* Interleukin-1 Receptor Antagonists (IRAP)
* Mesenchymal Stem Cells
* Bone-marrow derived stem cells (BMAC
72
synovetin OA
breaks the vicious cycle of inflammation and chronic pain
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Mechano-transduction from interaction with fascia networks
How fascia are associated with disease
* Modalities that interact with fascia for tissue deformation
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neuomodulation can be
central
spinal
peripheral
visceral
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tissue deformation is a powerful modulator of intrinsic healing in which soft tissues
skin, muscle
* ligaments, tendons
* fascia, cartilage
* periosteum
76
When the connective tissue complex
is deformed
growth factors and a variety of
proteins and neurotransmitters are released
77
Fibroblasts in loose connective
tissue respond to stretch
within minutes
* increasing ATP
* enhancing cytoskeletal relationships with neighboring cells
78
Therapeutic laser
Photons of light energy penetrate tissue and stimulate chromophores in the mitochondria
79
direct healing effects of electricity
-enhance bone and nerve repair mechanisms (nerves grow toward the cathode) at low intensity, but are destructive at high intensity
* PEMF- pulsed electrical magnetic field therapy (Assisi Loops, etc)
80
chemical healing effects of electricity
Receptor mediated effects (CGRP, NGF, Substance P)
81
mechanical healing effects of electricity
Mechanotransduction
82
thermal healing effects of electricity
increase local blood flow
83
which locations can you used electricity for healing
Cellular, Tissue, Segmental and Systemic
84
Important Promoters of De-Amplifying
Neuromodulation
Acupuncture
* Motion, Physiotherapy, Rehabilitation
* Vagal nerve stimulation
* System Modifying Pharmacology
Epi-genetic changes in humans
85
system modifying pharmacology (form of de-amplifying neuromodulation)
* Anti-inflammatories
* Gabapentin/Pregablin
* Cannabinoids (analgesia and inflammation)
* NMDA antagonists
* Pain Vacations
86
Epi-genetic changes in humans 9form of de-amplifying neuromodulation)
* Meditation
* Diet, supplements
* Medical interventions, in general
87
forms of Fascial
Modula,on
* Acupuncture
* Stretching
* Massage/touch
* Pressure waves
-----Tapping
------ibration
------Shock wave therapy
88
