Pain psychobiology/pharmacology

Question 1

passive, direct transmission system from peripheral receptors to the cortex

Answer 1

nociceptive pain

Question 2

Examples of nociceptive pain

Answer 2

acute trauma, arthritis, and tumor invasion

Question 3

Acute pain starts in

Answer 3

the periphery, is relayed to the spinal cord, and then passes up to the brain where it produces a negative reaction

Question 4

Pain producing stimuli are detected by

Answer 4

specialized afferent neurons called nociceptors

Question 5

free nerve endings that respond to a broad range of physical and chemical stimuli at intensities that can cause damage

Answer 5

nociceptors

Question 6

Which pain fibers send the signal to the dorsal horn of the spinal cord by way of the dorsal root ganglion?

Answer 6

Aδ and C

Question 7

Which pain fibers are myelinated axons that quickly send the first sharp signals of pain?

Answer 7

Aδ

Question 8

Which unmyelinated pain fibers send a slower dull pain signal; major player in chronic pain?

Answer 8

C fibers

Question 9

nociceptive afferent nerve fibbers synapse to neurons that cross to the contralateral side of the brain

Answer 9

Spinal cord dorsal horn

Question 10

After crossing the dorsal horn, the ascending pain signal can be modified by

Answer 10

descending fibers or from simultaneous activity by non pain neurons

Question 11

Dampen the pain Signal in the gate theory of pain

Answer 11

AB fibers

Question 12

This type of pain allows the subject to become aware of the location of the pain and answer the question, where does it hurt? Signal travels up the spinothalamic tract, synapses in the lateral thalamus and proceeds to the somatosensory cortex

Answer 12

Sensory discriminative domain

Question 13

Signals communicate the intensity of the sensation and answer the question, “how much does it hurt?”.

Answer 13

Affective-motivational domain

Question 14

This explains the natural occurrence of depression, hyperfocus, and anxiety we see with patients in pain.

Answer 14

The affective-motivational domain end in the cerebral cortex

Question 15

a term used to describe rare genetic conditions in which people lack the ability to sense pain.

Answer 15

Congenital Insensitivity to pain

Question 16

No A-delta and C fibers

Answer 16

Frank Congenital Insensitivity to Pain

Question 17

These people feel pain, but are not motivated to do anything about it. Normal peripheral nerves but have a central impairment of affective-motivational component

Answer 17

Congenital indifference to pain

Question 18

This is an autosomal recessive disorder; inability to incorporate growth factor into nerve cells. Has no pain fibers.

Answer 18

Congenital Insensitivity to Pain with Anhidrosis

Question 19

How is pain tolerance affected in those with schizophrenia?

Answer 19

Increased pain tolerance

Question 20

Pain pathways are

Answer 20

Descending (top down control of pain)

Question 21

kappa opioid receptor is thought to play a role in

Answer 21

pain and depressive symptoms

Question 22

Activation of the kappa opioid receptor can provide some

Answer 22

analgesia

Question 23

Antagonism of the kappa opioid receptor can provide

Answer 23

relief from some depressive symptoms associated with opioid withdrawal

Question 24

The delta opioid receptor is thought to play a role

Answer 24

in modulating chronic pain and is activated by enkephalins

Question 25

Antagonizing delta opioid receptors may play

Answer 25

an active role in pain relief

Question 26

The Mu receptor's activation is required for

Answer 26

most analgesics

Question 27

The affinity that a medication has for the mu receptor correlates with

Answer 27

its potency as an analgesic

Question 28

What binds with the mu receptor and acts as the quintessential antagonist for it, blocks activation, and can precipitate withdrawal

Answer 28

Naloxone

Question 29

Which receptor is most closely associated with euphoria and abuse

Answer 29

mu

Question 30

Evidence for long-term use of opioids for nonmalignant chronic pain is

Answer 30

almost nonexistent

Question 31

Why is dose escalation a bad thing?

Answer 31

Tolerance to analgesic and euphoric effects develops quickly, which requires dose escalation. Tolerance for respiratory depression develops slower, which explains why dose escalation by well-meaning prescribers can precipitate an overdose

Question 32

Long term use of opioids leading to increased sensitivity to painful stimuli is called

Answer 32

opioid hyperalgesia

Question 33

This sensitivity is induced by morphine and is caused by an inflammatory response (cytokines) mediated by spinal microglia; possibly having acute pain transition into chronic pain.

Answer 33

Persistent pain sensitivity

Question 34

Athletes, performing artists, soldiers wounded in battle some women in labor may have a stimulated opioid dependent pathway to inhibit pain or an endocannabinoid accumulation in the PAG. This is called.

Answer 34

Stress induced analgesia

Question 35

This treatment causes a decrease awareness in pain perception brain areas associated with endogenous opioids. Increased activity involved with top down suppression of pain.

Answer 35

Placebos

Question 36

Chronic neuropathic pain syndromes can be treated with psychiatric medications such as...

Answer 36

alpha-2-delta ligands and SNRIs

Question 37

Pain that arises from damage to, or dysfunction of, any part of the peripheral or central nervous system

Answer 37

neuropathic pain

Question 38

Pain that is caused by activation of nociceptive nerve fibers

Answer 38

Nociceptive pain

Question 39

When plastic changes occur in the dorsal pain (such as phantom pain) it is called

Answer 39

segmental central sensitization

Question 40

Hyperalgesia

Answer 40

exaggerated or prolonged response to any noxious input

Question 41

When plastic changes occur in brain sites within the nociceptive pathway especially the thalamus and cortex (fibromyalgia, syndrome of chronic widespread pain, painful depression, anxiety disorders such as PTSD with pain)

Answer 41

Suprasegmental central sensitization (the brain learns from former pain and starts spontaneously activating its pain pathways)

Question 42

SSRIs improve depression and

Answer 42

do not touch pain

Question 43

SNRIs improve depression and

Answer 43

can treat neuropathy

Question 44

Drugs that relieve pain without causing the loss of consciousness

Answer 44

Analgesics

Question 45

A general term that is defined as any drug, natural or synthetic that has actions like those of morphine

Answer 45

Opioid agents

Question 46

A term that applies only to compounds present in opoium

Answer 46

opiate

Question 47

Drugs that act at opioid receptors can be

Answer 47

agonists, partial agonists, antagonists or, agonist/antagonists

Question 48

Activate mu receptors and kappa receptors, produce analgesia euphoria, sedation, respiratory depression, physical dependence, constipation, and other effects...

Answer 48

pure opioid agonists

Question 49

what are two examples of pure opioid agonists?

Answer 49

morphine and codeine

Question 50

Higher dose-response curve, so same amount produces partial response. higher affinity for mu receptors than opioids, so will block them. Slower dissociation from mu receptors than opioids so styas around.

Answer 50

Partial agonist opioids

Question 51

What is an example of a partial agonist opioid?

Answer 51

Buprenorphine (Subutex)

Question 52

Blocks the post-syanptic receptors from binding with exogenous or endogenous agonist, thus preventing or reversing binding of the opioid agonist. Causes immediate reversal of respiratory and CNS depression of the opioid but also reerses any pain blocking.

Answer 52

Pure opioid antaginist

Question 53

What are examples of pure opioid antagonists?

Answer 53

Naloxone and Methylnaltrexone (treats opioid induced constipation)

Question 54

What are combination agents such as Buprenorphine/Naloxone (suboxone) used for?

Answer 54

medication assisted treatment (MAT) of opioid dependence

Question 55

Morphine relieves pain by mimicking the actions of

Answer 55

endogenous opioid peptides, primarily at mu receptors

Question 56

If morphine metabolites build up they cause

Answer 56

headaches

Question 57

What is a population that morphine is contraindicated in?

Answer 57

compromised renal function or on dialysis

Question 58

Adverse effects of morphine

Answer 58

respiratory depression, constipation, orthostatic hypotension, urinary retention and hesitancy, emesis, euphoria/dysphoria, sedation, neurotoxicity

Question 59

What are the signs and symptoms of morphine withdrawal? how long does it last? how lethal is it?

Answer 59

yawning, rhinorrhea, sweating, violent sneezing, weakness, N/V/D, abdominal cramps, bone and muscle pain, muscle spasms, and kicking movements. 7-10 days without treatment. unpleasant but not lethal.

Question 60

What is the classic triad of morphine toxicity?

Answer 60

coma, respiratory depression, pinpoint pupils

Question 61

What is the relative potency of fentanyl?

Answer 61

100 times the potency of morphine

Question 62

What is codeine's action

Answer 62

10% converts to morphine in liver

Question 63

What makes Buprenorphine such an effective choice in medication-assisted treatment for opioid dependence?

Answer 63

It is a mu-receptor partial agonist (main assistance in treating opioid dependence) but it also antagonizes kappa and delta subtypes which relieve some of the depressive symptoms associated with opioid withdrawal.

Question 64

Define "use" in relationship to opioids

Answer 64

intake of substances that is consistent with health care needs and social norms

Question 65

Define "abuse" in relationship to opioids

Answer 65

Intake of substances that is inconsistent with health care needs or social norms

Question 66

Define "physical dependence" in relationship to opioids

Answer 66

State in which an abstinence syndrome will occur if the dependence producing drug is abruptly withdrawn. Not equated with addiction.

Question 67

Define "addiction" in relationship to opioids

Answer 67

Behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm.

Question 68

What are the four pure opioid antagonists?

Answer 68

Naloxone (Narcan), Naltrexone (ReVia), Methylnaltrexone (Relistor), Alvimpoan (Entereg)

Question 69

If Naloxone is given to an individual who is physically dependent on opioids it will...

Answer 69

precipitate an immediate withdrawal reaction

Question 70

Naltrexone is contraindicated for patients with

Answer 70

acute hepatitis or liver failure

Question 71

Alvimopan is especially useful for treating

Answer 71

the adverse effects of opioids on bowel function WITHOUT reducing the pain relieving effects of narcotics. Only available under a special program.

Question 72

What does tramadol treat?

Answer 72

mild to severe pain (has a suicide risk). No respiratory depression, physical dependence or abuse.

Question 73

What does Ziconotide (Prialt) treat?

Answer 73

pain management available only through intrathecal pump. Non-opioid.

Question 74

What does Clonidine treat?

Answer 74

withdrawal symptoms. Not an opioid.

Question 75

What does Dexmedetomidine (Precedex)?

Answer 75

Sedation or for overdose of amphetamines/cocaine. IV only.

Question 76

Tramadol should not be combined with?

Answer 76

CNS depressants (cause fatal overdose)

Question 77

What can happen if Tramadol is taken with an SSRI?

Answer 77

Tramadol also blocks the uptake of serotonin and can cause serotonin syndrome.

Question 78

Adverse effects of Clonidine?

Answer 78

Cardiovascular: severe hypotension, rebound hypertension, and bradycardia

Question 79

Ziconotide is an opioid antagonist at

Answer 79

voltage-sensitive calcium channels

Question 80

This nonopioid centrally acting analgesic is typically used for intubation and mechanical ventilation or short-term surgical procedures

Answer 80

Dexmedetomidine

Question 81

What are the three types of severe headaches?

Answer 81

migraine, cluster, tension

Question 82

Cluster headaches the primary therapy is directed at...and the medications used are...

Answer 82

prophylaxis; glucocorticoids, verapamil, and lithium

Question 83

Tension headaches are treated by

Answer 83

non-opioid analgesics and NSAIDS along with stress management

Question 84

Migraine headaches are used both to prevent and abort migraines. What are two migraine specific drugs?

Answer 84

Sumatriptan, Ergotamine

Question 85

What drugs are contraindicated when taking sumatriptan?

Answer 85

drugs that cause vasodilation

Question 86

Adverse effects of sumatriptan include

Answer 86

chest symptoms, coronary vasospasm, teratogenesis, vertigo, malaise, fatigue, and tingling sensations...bad taste with intranasal form

Question 87

Ergotamine can cause dependency and toxicity causes

Answer 87

Ergotism

Question 88

What are the symptoms of ergotism?

Answer 88

painful seizures, spasms, diarrhea, paresthesias, itching, mania/psychosis, headaches, nausea, and vomiting. Dry gangrene.