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Neurology SOH > Pain > Flashcards

Pain Flashcards

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1
Q

Where does visceral pain originate from?

A

Nociceptors covering tissues or walls of hollow organs

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2
Q

The brain interprets nociceptive information arising from the viscera as originating from an area of skin that may be distant to the internal organ. What is this describing?

A

Referred pain

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3
Q

Acute pain vs chronic pain - which type of pain serves a useful purpose?

A

Acute pain - protective function as it signals there has been tissue damage

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4
Q

What are the 3 forms of pain?

A

Nociceptive pain
Inflammatory pain
Pathological pain

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5
Q

Which type of pain is being described: an appropriate physiologic response to painful stimuli

A

Nociceptive pain

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6
Q

Nociceptive pain is short lived / long lived?

A

Short lived

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7
Q

Nociceptive pain - when are nociceptors normally activated?

A

Activated by intense stimuli from peripheral tissues that are noxious

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8
Q

Nociceptors are second order neurones. True or false ?

A

False

- first order neurones

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9
Q

Nociceptive pain - where are second order neurones located?

A

In the CNS

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10
Q

Nociceptive pain - what is the primary transmitter?

A

Glutamate

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11
Q

Nociceptive pain - what are the 2 types of glutamate receptor

A

AMPA receptors

NMDA receptors

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12
Q

AMPA receptors cause very fast/slow depolarisation?

A

Fast

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13
Q

Nociceptor (First order neurone) enters the Ventral/Dorsal horn of the spinal cord?

A

Dorsal horn of SC

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14
Q

Which ascending tract does pain travel in?

A

Spinothalamic

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15
Q

Name 2 subtypes of nociceptor?

A

A-delta fibres

C fibres

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16
Q

Which nociceptor fibres mediate first/fast pain?

A

A-delta fibres

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17
Q

All nociceptor fibres are myelinated. True or false?

A

False

  • A-delta = myelinated
  • C fibres = un-myelinated
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18
Q

Which nociceptor fibres mediate second/slow pain?

A

C fibres

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19
Q

Inflammatory pain - function

A

Assists in healing

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20
Q

Which peptides are released in neurogenic inflammation?

A

Substance P

CGRP

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21
Q

Neurogenic inflammation - what does substance P cause?

A

Vasodilation
Release of histamine from mast cells
Sensitisation of surrounding nociceptors

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22
Q

Neurogenic inflammation - what does CGRP cause?

A

Vasodilation

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23
Q

Pathological pain has no physiological purpose. true or false?

A

True

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24
Q

Neuropathic pain - description of pain

A 
Burning 
Shooting 
Tingling 
Sensitivity 
Allodynia
Hyperalgesia
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25
What is allodynia
Perception of pain even if the stimulus is non painful
26
What is hyperalgesia
More pain than expected from a painful stimulus
27
Neuropathic pain - causes
``` Shingles Surgery Trauma Diabetic neuropathy Amputation Many of unknown origin ```
28
How is neuropathic pain managed
``` Antidepressants (eg amitryptiline) Anti-convulsants Local anaesthetics (lignocaine) ```
29
How is it possible for pain evoked by activity in nociceptors (C- and Adelta- fibres) to be reduced?
Due to simultaneous activity in low threshold mechanoreceptors (A-beta fibres)
30
When you hurt your knee and rub it to make it feel better, what does this activate?
Activates Abeta fibres
31
Function of Abeta fibres in pain
Help to silence pain projection neurones from going to the brain They try to override C- and Adelta- fibres so that there sis no nociceptor input to travel via the spinothalamic tract, up the spinal cord
32
Important brainstem regions in the regulation of pain
``` Periaqueductal grey (PAG) Nucleus Raphe Magnus (NRM) Locus Coeruleus (LR) ```
33
Important brainstem regions in the regulation of pain - PAG - location
Midbrain
34
Important brainstem regions in the regulation of pain - when they are activated what happens?
They inhibit nociceptive transmission in the dorsal horn of the SC
35
Early treatment of pain is associated with better outcomes. True or false?
True
36
Which type of analgesics reduce nociception and pain by suppressing the sensitisation of nociceptors at the site of injury ?
NSAIDs
37
Which type of analgesics reduce nociception and pain by blocking nerve conduction?
Local anaesthetics (lignocaine)
38
Which type of analgesics reduce nociception and pain by suppressing nociceptor transmission in the dorsal horn of the SC which prevents nociceptor information from travelling up the SC to the thalamus ?
Opioids | Anti-depressants
39
Which receptor do all opioid drugs work on?
GPCR
40
What are the 3 types of opioid receptor?
Mu Delta Kappa
41
Opioids - adverse effects
``` Addiction Apnoea Nausea, vomting Constipation Confusion Euphoria Hallucinations Dizziness ```
42
Opioids - examples
``` Morphine Diamorphine Coedine Fentanyl Buprenophine Tramadol Methadol Naloxone ```
43
Opioids - morphine mainly involves which opioid receptor?
Mu
44
Opioids - morphine - routes of administration
Oral IV IM SC
45
Opioids - morphine - where is it initially metabolised?
Liver | - yielding M3G and MG6
46
Opioids - diamorphine - mainly involves which opioid receptor?
Mu
47
Diamorphine is the same as heroine. True or false?
True
48
Diamorphine use
Severe post op pain
49
Opioids - coedine - weak/strong opioid?
Relatively weak
50
Opioids - codeine can be administered orally or IV. True or false? ?
False | - cannot be administered IV
51
Opioids - coedine - common side effect
Constipation
52
Opioids - fentanyl is more/less potent than morphine?
More potent
53
Opioids - buprenophine is useful in acute/chronic pain?
Chronic pain
54
Opioids - buprenophine - short/long duration of action?
Long duration of action
55
Opioids - buprenophine - route of administration?
IV | SL
56
Opioids - tramadol - avoid in patients with which condition?
Epilepsy
57
Opioids - methadone - short/long duration of action
Long
58
Opioids - methadone - route of administration
Oral
59
Which medication assists in withdrawal from strong opioids such as heroin?
Methadone
60
Methadone is a weak/strong agonist?
Weak
61
Which drug is used to reverse opioid toxicity associated with "strong opioid" overdosage?
Naloxone
62
Opioids - naloxone - route of administration
IV
63
Opioids - naltrexone - clinically similar to naloxone but what is the difference?
Naltrexone can be delivered orally
64
NSAIDs - examples
``` Aspirin Ibuprofen Naproxen Diclofenac Indometacin ```
65
NSAIDs - function
Reduce tissue inflammation and pain
66
NSAIDs - mode of action
Inhibition of COX -> | Decreased prostaglandin synthesis
67
NSAIDs - side effects
GI irritation/bleeding Renal toxicity Potential drug-drug interactions
68
WHO analgesic ladder - step 1
Non-opioid analgesic - NSAID - Paracetamol
69
Paracetamol - mode of action
Central prostaglandin inhibitor
70
Paracetamol - side effects
Risk of toxic liver damage
71
WHO analgesic ladder - step 2
Weak opioid analgesics - tramadol - coedine
72
WHO analgesic ladder - step 3
Strong opioid analgesics - morphine - fentanyl - diamorphine (heroin)
73
WHO analgesic ladder - adjuvants
Anti-depressants Anti-convulsants Topical analgesics
74
What is a first line analgesic used in neuropathic pain?
Gabapentin | Pregablin
75
Neuropathic pain responds well to NSAIDs. True or false?
False | - does not respond to NSAIDs
76
What is the first line treatment to control pain intensity and frequency of attacks in trigeminal neuralgia?
Carbamazepine

Neurology SOH (31 decks)

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