Flashcards in pain Deck (39):
1 week or less
at least 6 months. many consider an autonomous disorder.
chronic regional pain syndrome
limb is cold, red, muscle wasting, nail changes.
what is nociception
the sensation and transmittance of pain.
first pain form which fibers?
A-delta fibers. fast. myelinated. reflexes. also think acute.
C-fibers. think chronic pain
what transmits pain?
the vanniloid receptor. receives input from heat, acid, ionic...capsaicin
spread of pain sensation to close regions associated with injury or pain.
injury, trauma, etc released a number of inflammatory molecules that ultimately affect close regions.
what is the descending pain system?
it is modulatory system. it can desensitize pain signals. it inhibits ascending pain through inhibition of substance P. it can also activate enkephalin interneurons that inhibit pain through activation of the descending pain system.
what is nociception vs pain
nociception is sensation. pain is emotion.
what are the five functions of the medial pain system?
limbic and autonomic activation, learning and anticipation, nocifensive behavior, empathy, inhibition.
synapses in the reticular formation and the medial intralaminar thalamic nucleus. projects to limbic structures and the anterior cingulate and insular cortex.
ascends bilaterally and terminates in two levels of the reticular formation.
caudal reticular formation
sends recurrent signal to the interomediolateral cell columns as a method of activating the sympathetic system.
projects to the locus ceruleus. innervates the parabrachial nucleus and the MITN
doral horn neurons innervate the periaqueductal gray. parabrachial, paraventricular nucleus, and the amgydala.q
most important thing about the spinomesenchephalic tract?
it has cross-wiring from the visceral neurons and causes referred pain. this causes visceral pain to be perceived as cutaneous pain.
neuroopathic pain treated how?
using anticonvulsants and tricyclics.
inflammatory pain treated how?
whats does opioid treatment do?
it makes the patient less concerned about pain.
where do non-noxious sensations transmit?
through the Abeta-fibers.
full pain response achieved through what?
signif Na and Ca influx.
what happens when the system goes awry?
inc Na Ca and glutamate.
what are carbamezine, topiramate and lamotrigine?
they re all sodium channel blockers.
what is gabapentin/pegabalin
they are calcium blockers.
what are the SE of the anti epileptics?
cause sedation, psychomotor/cognitive impairment,
antidepressants for treating pain?
yes. fibromyalgia, neuropathic.
how do antidepressants work for pain?
depression and pain run together through NE. strengthen NE and pain and depression usually go away. remember the monoamines are all very similar and uptake pumps usually do all of them or cross-react. also remember the enkephalin systems AKA strengthens the descending pathway. it also activates GABAnergic neurons in the ascending to inhibit pain signals upward.
SNRI antidepressants for pain. both have serotonin SE -HA, GI, insomnia, fatigue, sexaul and weight gain. NE SE -dry mouth, HTN.
TCA used for pain. serotonin and NE SE. Na channel blockade. also cholinergic symptoms such as dry mouth, constipation, blurred vision.
reflexive pain occurs where? conscious pain?
spinal cord maybe thalamus, limbic and cortex.
patient assuming you can't or won't help and that you will be short and not listen and even rude.
you will likely be stressed, irritated, short and rude as these patients never follow the rules.
when to give the opiate?
when the pain is severe.
what type of pain is trauma?
burning in nature is what pain?
what might explain neuropathic pain?
glutamate excess signaling