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Neurology > Management of Chronic Pain > Flashcards

Management of Chronic Pain Flashcards

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1
Q

What is pain?

A

An unpleasant sensory and emotional experience, associated with actual tissue damage or described in terms of such damage

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2
Q

What kind of experience is pain?

A

Unique and conscious

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3
Q

What are the 3 main variables in pain?

A
  • Sociocultural
  • Biological
  • Psychological
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4
Q

What is obvious in acute pain?

A

Tissue damage

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5
Q

What type of function may acute pain have?

A

Protective

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6
Q

There is INCREASED nervous system activity in acute pain

A

TRUE

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7
Q

When does pain in acute pain resolve?

A

Upon healing

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8
Q

What is chronic pain?

A

Pain beyond expected period of healing

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9
Q

Describe chronic pain.

A
  • Pain no longer serves a useful purpose
  • Changes in pain signalling and detection
  • Degrades health and function
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10
Q

What should you always use when taking a measurement of pain?

A

Verbal scale rating

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11
Q

What should you always look for in examination?

A

To see if the person is in pain

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12
Q

What kind of behavioural observations might you see in someone who is in pain?

A
  • Grimacing
  • Rigid body posture
  • Limping
  • Frowning
  • Crying
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13
Q

What are some physiological responses to pain?

A
  • Increased HR

* Increased BP

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14
Q

RULE 1

A

Listen to the patient

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15
Q

RULE 2

A

The pain is what they say it is

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16
Q

RULE 3

A

They can be in pain even if they don’t look like it

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17
Q

Name the 2 main types of pain.

A
  • Nociceptive

* Neuropathic

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18
Q

Describe nociceptive pain.

A

An appropriate physiologic response to painful stimuli via an intact nervous system

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19
Q

Describe neuropathic pain.

A

An inappropriate response caused by a dysfunction in the nervous system

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20
Q

How is a diagnosis of neuropathic pain achieved?

A

History + Exam

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21
Q

How do patient usually describe neuropathic pain?

A
  • Burning
  • Shooting
  • Tingling
  • Sensitivity
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22
Q

On examination of a patient with neuropathic pain, what sensory changes are observed?

A
  • Allodynia

* Hyperalgesia

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23
Q

What is allodynia?

A

Pain from a stimulus that isn’t normally painful

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24
Q

What is hyperalgesia?

A

More pain than expected from a painful stimulus ie. pin prick

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25
Suggest some causes of neuropathic pain.
* Shingles, post-herpetic neuralgia. * Surgery. * Trauma. * Diabetic neuropathy. * Amputation. * Many of unknown origin
26
What is neuroplasticity?
The ability of the nervous system to form and recognise synapses
27
What does a lower degree of chronicity relate to?
A better therapy result
28
Chronic pain is associated with MORPHOLOGICAL CHANGES IN THE CNS
TRUE
29
Once pain is present, it is often persistent and seldom totally resolves, even with treatment
TRUE
30
Give examples of non-opioid analgesics.
NSAID's | Paracetamol
31
Give examples of opioid analgesics.
Tramadol. Codeine. Morphine. Oxycodone.
32
Give examples of 2 antidepressants.
Amytriptyline | Duloxetine
33
Give examples of 2 anticonvulsants.
Gabapentin | Pregabalin
34
Give examples of 2 topical analgesics.
Capsaicin | Lidocaine 5% plaster
35
Topical analgesics reduce pain impulses transmitted by what?
* A delta fibres | * C fibres
36
What are the main side effects of topical analgesics?
* Rash * Pruritus * Erythema
37
List the main side effects of opioids.
* N+V * Constipation * Dizziness * Vertigo * Somnolence * Dry skin * Pruritus
38
List the main side effects of NSAID's.
* GI irritation/bleeding * Renal toxicity * Drug-drug interactions * CVS side effects
39
List the main side effects of anti-convulsants.
* Sedation * Dizziness * Ataxia * Peripheral oedema * Nausea * Weight gain
40
List the main side effects of SNRI's.
* N+V * Constipation * Somnolence * Dry mouth * Increased sweating * Loss of appetite
41
Severe chronic pain is ________
MULTIFACTORIAL
42
What kind of pain do NSAID's work on?
Nociceptive
43
What is the mod of action of NSAID's?
* Inhibition of cyclooxygenase | * Prosatglandin synthesis decreases
44
Name some NSAID's.
* Ibuprofen | * Aspirin
45
What is paracetamol a derivative of?
Analine derivative ie. Panadol
46
What is the efficacy of paracetamol?
* Analgesic | * Antipyretic
47
What is the mode of action of paracetamol?
* Inhibition of central prostaglandin synthesis
48
Give 2 examples of week opioids.
* Tramadol | * Codeine
49
Give 2 examples of strong opioids.
* Morphine | * Oxycodone
50
Describe the efficacy of opioids.
* For nociceptive pain * Less effective in chronic states * Only partially effective in neuropathic pain
51
Describe the mode of action of opioids.
* Activates the endogenous analgesic system * Stimulate receptors in the limbic system to eliminate the subjective feeling pain * Affect descending pathways that modulate pain perception * Reduce ascending pain signal transmission in the spinal cord
52
Give 2 examples of antidepressants.
* Amitriptyline | * Imipramine
53
Describe the efficacy of antidepressants.
* Neuropathic pain * Complex regional pain syndrome * Tension headache
54
Describe the mode of action of antidepressants.
Inhibition of neuronal re-uptake of noradrenaline and/or serotonin (5-HT)
55
Give 2 examples of Selective Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs +SNRIs).
* Duloxetine. | * Venlafaxine.
56
Under what category do Selective Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs +SNRIs) come?
Antidepressants
57
Describe the efficacy of SSRI's and SNRI's.
* Neuropathic pain
58
SSRI's are better than SRNI's
FALSE - SNRI's are better
59
Describe the mode of action of SSRI's and SRNI's.
* Selectively inhibit reuptake of noradrenaline +/- serotonin * Provide analgesia by intensifying descending inhibition
60
Give 3 examples of anticonvulsants.
* Carbamazepine. * Gabapentin. * Pregabalin.
61
Describe the efficacy of anticonvulsants.
* Neuropathic pain
62
Describe the mode of action of anticonvulsants.
Different modes of action: • Gabapentin: binds to presynaptic voltage-dependent calcium channels1 • Pregabalin: interacts with special N-type calcium channels1 • Carbamazepine: blocks Na+1 and Ca2+ channels

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