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Applied Pathophysiology > Neuropathic Pain > Flashcards

Neuropathic Pain Flashcards

1
Q

What is the definition of pain?

A

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

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2
Q

what are the two main types of pain?

A

nociceptive

neuropathic

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3
Q

what is nociceptive pain?

A

acute pain associated with injury and inflammation

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4
Q

what causes nociceptive pain?

A

nociceptor is stimulated by noxious or potentially damaging stimuli through mechanical, thermal, or chemical means associated with inflammation

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5
Q

give an example of mechanical, thermal, and chemical pain

A

mech - break fingers
therm - hand on hot stove
chem - HCl on skin

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6
Q

what is neuropathic pain?

A

chronic sensory abnormalities; pain initiated by a lesion or dysfunction of the somatosensory system, resulting in abnormal activity of the nociceptive pathway

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7
Q

what are 3 potential causes of neuropathic pain?

A

drugs
disease
trauma

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8
Q

what are the pain and temp nerve fibers? what do they look like? which one is better at conducting pain transmission?

A

Adelta - small, myelinated (better)

C - small, unmyelinated

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9
Q

what is the touch nerve fiber? what does it look like?

A

Abeta - large, myelinated

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10
Q

out of the mentioned nerve fibers, which is the last to develop in neuropathic pain?

A

Abeta fibers

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11
Q

What are the steps of the pain pathway?

A

1) pain source goes to peripheral nerve
2) afferent fiber travels to dorsal horn (goes to DRG)
3) travels up spine to brain (thalamus, sensory cortex, limbic system)
4) motor response travels down spine
5) efferent fiber travels from spinal cord (ventral horn) to body part to move it away from pain source

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12
Q

What is the membrane potential at rest?

A

-70mV

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13
Q

What ions are involved with the membrane potential?

A

Na, K, Cl, Ca

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14
Q

Why is the membrane potential closer to Ek rather than Ena?

A

membrane is more permeable to K (Ek = -90mV)

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15
Q

how does the Na/K pump re-establish membrane potential?

A

pump out 3Na for every 2K pumped in

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16
Q

What is the first step in initiating an AP?

A

a stimulus causing depolarization and Na channels to open, allowing Na to rush into the cell

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17
Q

what is the 2nd step in initiating an AP?

A

internal membrane potential becomes more positive

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18
Q

what is the 3rd step in initiating an AP?

A

if the cell depolarizes to threshold, an AP will result (all or nothing)

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19
Q

what is the 4th step in initiating an AP?

A

Na channels start to close as K channels start to open

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20
Q

what is the 5th step in initiating an AP?

A

Em returns to resting potential and a refractory period occurs where Na channels cannot open

21
Q

What do excitatory NTs do? give an example of an excitatory NT

A

bind to post synaptic receptors and cause depolarization

ex: Glu, substance P

22
Q

what do inhibitory neurons do? give an example of an inhibitory neuron

A

bind to post-synaptic receptors and cause hyperpolarization

ex: GABA, glycine

23
Q

What causes hyperexcitability?

A

enhancement of excitatory mechanisms or loss/reduction of inhibitory mechanisms

24
Q

what happens when cell permeability is increased?

A

Na and Ca concentrations increase intracellularly, leading to depolarization and firing of neurons

25
Q

what causes a “windup”? how is it related to neuropathic pain?

A

adjacent neurons produce AP in response to ectopic firing thereby increasing the strength of the pain signal

26
Q

what receptors are associated with Asp and Glu?

A

Asp - AMPA

Glu - NMDA

27
Q

what GABA receptor is associated with opening Cl? What receptor is associated with opening K/closing Ca?

A

GABA-A: Cl-

GABA-B: K, Ca

28
Q

What are the triggers for neuropathic pain? (10pts)

A 
alcoholism
amputation
diabetes
drugs
herpes zoster (shingles)
HIV/AIDS
multiple sclerosis
spinal injury
stroke
tumour
29
Q

what are some symptoms of neuropathic pain? (12pts)

A 
allodynia
hyperalgesia
paraesthesia
pins and needles
burning
shooting
stabbing
numbness
tingling
jabbing
throbbing
aching
30
Q

what is the pain triad?

A

chronic pain sufferers usually develop additional disorders such as insomnia, fatigue, lack of concentration, stress, depression, and anxiety

31
Q

what is allodynia? what causes it?

A

pain due to a stimulus that doesn’t normally cause pain (exaggerate pain symptoms from non-noxious stimuli)
cause: recruitment of Abeta fibers that become pathogenic

32
Q

what is hyperalgesia?

A

increased pain response than usual to a normally painful stimulus
(exaggerated pain symptoms from noxious stimuli)

33
Q

what is paraesthesia?

A

abnormal numbing/prickling of the skin

34
Q

what are two questionnaires used to diagnose NP?

A

DN4 questionnaire

Visual analogue scale

35
Q

what is the DN4 questionnaire? at what point can you classify it as NP?

A

10 yes or no questions

get a 4 or higher is classified as NP

36
Q

what is a visual analogue scale? at what point can you classify it as NP?

A

rank pain on a scale of 1-10

if higher than a 4 (or a 4), pain is classified as NP

37
Q

what are 3 things needed to confirm an NP diagnosis?

A

4 or more on DN4
4 or more on visual analogue scale
2-3 hallmark NP symptoms

38
Q

what are the 4 points in the pain pathway that are targets for NP treatment?

A

1) inhibition of 1st order sensory afferent
2) synaptic inhibition between 1st order sensory afferent and DRG
3) synaptic inhibition between DRG and dorsal horn interneurons
4) synaptic inhibition between dorsal horn interneurons and ascending tract

39
Q

is there a cure for NP?

A

nope

40
Q

what are two ways to regulate AP in NP patients?

A

decrease excitation

increase inhibition

41
Q

what are some classes of drugs that could decrease excitation of neurons?

A

Na channel blockers
Ca channel blockers
blocking excitatory receptors (AMPA, NMDA)

42
Q

what are some classes of drugs that could increase inhibition of neurons?

A

GABA agonists

inhibition of serotonin and noradrenalin reuptake

43
Q

Why are antiepileptics used for treating NP? (3pts)

A

1) reduce Na and Ca influx
2) enhane inhibitory effects like GABA
3) decrease concentration of Glu and/or blocks NMDA receptor

44
Q

What are two classes of anti-depressants that could be used for treating NP?

A

Tri-cyclic

selective serotonin reuptake inhibitors (SSRIs)

45
Q

how would tri-cyclic antidepressants help treat NP?

A

block reuptake of noradrenalin and serotonin

blocks Na and Ca channels and NMDA receptors

46
Q

how would SSRIs help treat NP?

A

inhibit serotonin reuptake without affecting noradrenalin

47
Q

What is the proposed reason why topical anti-neuralgic agents help treat NP?

A

desensitizes afferent neurons by depleting the release of substance P

48
Q

what are other therapeutic options for NP patients?

A 
analgesics
narcotics
refractory treatment
combination therapy
surgery

Applied Pathophysiology (11 decks)

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