Pain

Question 1

Tourniquet pain mediated by …

Answer 1

C fibers

Question 2

2 medications found to be useful in treating tourniquet pain?

Answer 2

Clonidine + ketamine

Question 3

Spinal stenosis is intermittent claudication, is worse with … and relieved with …

Answer 3

Ambulation

Rest and siting

Question 4

DDx of back pain?

Answer 4

No rediculopathy and axial pain -> Discogenic pain

Axial pain + rediculopathy -> Disc herniation

Lateral pain + precipitation with lateral rotation -> facet joint pain

Worst with ambulation -> spinal stenosis

Question 5

Drug tolerance definition?

Answer 5

Exposure to a drug results in diminution of an effect or the need for higher dose to maintain an effect.

Question 6

Drug dependence definition?

Answer 6

Drug is administered to prevent withdrawal symptoms or in which it is associated with tolerance or both.

Question 7

Addiction definition?

Answer 7

A state of heavy physical or emotional dependence on a drug (compulsive or pathological use), this term is often synonymously used with drug dependence

Question 8

Examples of neuropathic pain?

Answer 8

Postherptic neuralgia

Phantom limb pain

Trigeminal neurolgia

Complex regional pain syndrome

Question 9

First line ttx of trigaminal neuralgia pain?

Answer 9

Carbamazepine (others: oxycarbamazepine which is less SE, and phenytoin)

Caused by vascular compression of trigaminal nerve root.

It’s unilateral, episodic and stabbing pain

Question 10

Type of sympathetic blockade for Face and upper extremity?

Answer 10

Stellate ganglion block

Question 11

Type of sympathetic blockade for Lowe extremity ?

Answer 11

Lumber symptomatic block

Question 12

Type of sympathetic blockade for Upper abdomen?

Answer 12

Celiac plexus block

Question 13

Type of sympathetic blockade for Pelvis?

Answer 13

Hypogastric plexus block

Question 14

Indications for lumber sympathetic block?

Answer 14

CRPS (primarily)

Vascular insufficiency
Phantom limb pain

Question 15

Stellate ganglion ?

Answer 15

It’s formed by fusion of inferior cervical and first thoracic ganglion and it is anterior to C7 vertebral body.

SE’s: Horner’s syndrome, hoarseness (involvement of recurrent laryngeal nerve).

Complications: pneumothorax, phernic nerve palsy, intrathecal, intravascular injection.

Question 16

Myofacial pain?

Answer 16

Muscle pin with specific trigger points

Not neuropathic nor has dermatomal distirbution

Question 17

Treatment of phantom limb pain?

Answer 17

Gabapentin/amitriptyline

Opioids maybe useful

TENS

Spinal cord stimulation

Intrathecal opioid pump

Stump revision if stump triggers the pain

Question 18

Gabapentin acts on …

Answer 18

Ca channels

Question 19

Phenol vs alcohol in baricity ?

Answer 19

Alcohol is hypobaric

Phenol is hyperbaric

Question 20

Postherpetic neruralgia;

Common site

RFs

Treatment

Answer 20

Thoracic dermatologist followed by trigaminal distribution

> 60, sever pain or abnormalities during acute phase.

Acyclovir or corticosteroid not effective during acute phase

TCA, gaba, topical capsaicin

Question 21

Allodynia definition

Answer 21

Painful response to a usually non-painful stimulus

Question 22

Hyperalgesia definition

Answer 22

Increased response to a stimulus that is normally painful

Question 23

Hyperpathia definition

Answer 23

A painful syndrome, characterized by increased rxn to stimulus , especially a repetitive stimulus, as well as an increased threshold. It may occur with hyperesthesia, hyperalgesia, or dysethesia.

Question 24

CRPS 1 vs CRPS 2?

Answer 24

Both are sympathetic mediated however type 2 associated with nerve injury

Question 25

The comments SE of morphine is

Answer 25

Constipation

Question 26

Muscle rigidity from opiates treated with

Answer 26

Po Baclofen, or muscle relaxation

Question 27

How long fentanyl patch works after removal?

Answer 27

12-16 hours It’s prolonged action due to dermal deposits Indication: opioid dependent chronic pain ptn

Question 28

``` SE of major non opioids Gaba Carbamazepine Amitriptyline Tylenol ```

Answer 28

Dizziness, sedation, weight gain, peripheral edema Dizziness, sedation, elevated liver enzymes, leuopenia, leukocytosis, thrombocytopenia, agranulocytosis, aplastic anemia. Dry mouth, sedation, seizures Hepatotoxic

Question 29

Baclofen Toxicity

Answer 29

GABA b agonist, decreases excitatory neuro transmission. Drowsiness, dizziness, GI upset. Higher doses; seizures, delirium, tachycardia, bradycardia, hypotension. Ttx: supportive. Charcoal or hemodialysis

Question 30

Indication for spinal cord stimulation?

Answer 30

Failed back surgery syndrome Refractory angina pectoris Peripheral vascular disease CRPS type 1

Question 31

TENS machine principle?

Answer 31

Gate control theory of pain and conduction block theory Gate control theory -> afferent input from large fibers decreases the transmission from small fibers (pain). Conduction block theory -> high rate of stimulation decreases the ability of small fibers to transmit the signal.