PAIN

Question 1

Provide the 4 steps in the nociceptive pain response

Answer 1

transduction
transmission
perception
modulation

Question 2

the portions involved in the interpretation of pain signals

Answer 2

limbic system
reticular formation
thalamus
hypothalalmus
cortex

Question 3

what is transduction

Answer 3

response to tissue injury
release of chemical mediators
conversion of energy types
generation of an AP

Question 4

List chemical mediators involved in pain

Answer 4

prostaglandins
substance P
histamine
bradykinins
serotonin
potassium

Question 5

3 phases of transmission

Answer 5

injury to SC
SC to brainstem and thalamus
thalamus to cortex

Question 6

how are AP’s generated

Answer 6

voltage gated ion channels embedded in a cell’s plasma membrane

Question 7

what part of the pain cycles provides evidence for the variability in pain experience

Answer 7

modulation

Question 8

A DELTA
_________ myelinated
_______diameter
________ speed conducting fibres
_______ type of pain
acute or chronic

Answer 8

thinly
large
fast
sharp pain
acute

Question 9

C fibres
_________ myelinated
_______diameter
________ speed conducting fibres
_______ type of pain
acute or chronic

Answer 9

unmyelinated
small
slow
dull aching pain
persistant pain

Question 10

A beta
_________ myelinated
_______diameter
________ speed conducting fibres
_______ type of pain
acute or chronic

Answer 10

highly
large
rapid conducting
light touch, non noxious stimuli

Question 11

what is the gate control theory

Answer 11

The Gate Control Theory of Pain is a mechanism, in the spinal cord, in which pain signals can be sent up to the brain to be processed to accentuate the possible perceived pain, or attenuate it at the spinal cord itself. activites such as rubbing can close the gate

Question 12

3 types of pain of which one has 2 subtypes

Answer 12

nocipceptive (somatic vs visceral) neuropathic, somatoform

Question 13

list 4 other types of pain

Answer 13

referred, phantom, cancer, intractable, breakthrough

Question 14

what is intractable pain

Answer 14

pain not relieved by ordinary medical, surgical interventions and pain persistants

Question 15

ACUTE VS PERSISTANT PAIN COMPARE
severity:
NS response:
vitals:
reason:
pt appearance:
reporting:
behaviour:

Answer 15

ACUTE
- mild to severe
- sympathetic
- increased HR, rr, bp
- diaphoresis, dilated pupils
- restless and anxious
- reports pain

PERSISTENT
- mild to severe
- parasympathetic
- dry warm skin, pupils normal
- beyond healing phase
- distressed and withdrawn

Question 16

what is the BPI

Answer 16

brief pain inventory
assesses severity of pain and degree of interference of function 0-10

Question 17

why are adjuvant therapies applied

Answer 17

not typical pain meds but helpful for management and can reduce pain meds required (opiod sparing)

Question 18

examples of adjuvant therapy

Answer 18

amitripyline
carbemazepine
pregab
diazepam

Question 19

how does paractermeol work

Answer 19

not exactly sure
prostaglandin production
serotonergic, opiod, nitric oxide, cannabinoid pathways.

Question 20

Ibuprofen

Answer 20

non selective NSAID

Question 21

celebrex

Answer 21

COX-2 specific

Question 22

naproxen

Answer 22

non selective NSAID

Question 23

MELOXICAM

Answer 23

LONG acting NSAID

Question 24

DICLOFENAC

Answer 24

non selective NSAID

Question 25

indomethacin

Answer 25

non selective NSAID

Question 26

ketorolac

Answer 26

non selective NSAID

Question 27

3 opiod receptors

Answer 27

mu
delta
kappa

Question 28

morphine

Answer 28

common / many routes

Question 29

fentanyl

Answer 29

rapid / strong / many routes

Question 30

oxycodone

Answer 30

oral , step down

Question 31

hydromorphone

Answer 31

5 x as potent as morph. various routes

Question 32

methadone

Answer 32

oral . long acting, chronic pain

Question 33

pethidine

Answer 33

less used, no advantage over other opiods

Question 34

codeine

Answer 34

oral with other drugs v effective

Question 35

which drug works with codeine particuarly effectively

Answer 35

paratemol

Question 36

advantages to using tramadol

Answer 36

reduces risk of respiratory depression
lower abuse risk
less constipating

Question 37

what is tramadol

Answer 37

weak mu opiod receptor antagonist
enhances noraderenergic and serotonergic inhibition

Question 38

what type of antagonist is ketamine

Answer 38

NMDA

Question 39

2 examples of anticonvulsants

Answer 39

pregab and gabapentin

Question 40

how to anticonvulsants work

Answer 40

modulates NT release by binding to voltage gated calcium channels
closes pre synaptic CA channels
diminishes excessive neuronal activity and NT release

Question 41

why are antidep often involved in pain management

Answer 41

exert analgesic properties without effecting mood in PP
lower dose and shorter delay for pain properties that depressant relief

Question 42

how does capsaicin work

Answer 42

alkylamide found in capsicum
selectively stimulates primary afferent C fibres
c fibres express TRV1 that non selectively gate cations (sodium and calcium) which depolarises axons
primary mechanism is depletion of substance P
not instant, build up

Question 43

OPQRSTUV

Answer 43

ONSET
PROVICATION / PALLIATION
QUALITY
REGION
SEVERITY SCALE
TREATMENT
UNDERSTANDING IMPACT
VALUES

Question 44

4 classifications of CAM

Answer 44

whole body systems
mind body medicine
biologically based practices
manipulative and body based practices

Question 45

examples of CAM

Answer 45

CBT
HYPONOSIS
NUTRITION
HERBAL
MESSAGE
MUSIC THERAPY
SPINAL JOINT MANIPULATION
TENS machines
yoga

Question 46

pain assessment tool for children
QUESTT

Answer 46

question child
pain rating scale
evaluate behaviour and physiological change
secure parent involvement
take cause of pain into account
take action and evaluate results