_Clinical pain_ Clinical pain, as the name suggests, is seen in clinics Associated with damage to tissues, including the nervous system Mechanisms can be nociceptive and/or neuropathic ... - normal functioning of nociceptors in response to tissue injury ... - Pain in response to injury to the nervous system

Clinical pain, as the name suggests, is seen in clinics Associated with damage to tissues, including the nervous system Mechanisms can be nociceptive and/or neuropathic Nociceptive - normal functioning of nociceptors in response to tissue injury Neuropathic - Pain in response to injury to the nervous system

_Clinical pain_ Clinical pain, as the name suggests, is seen in clinics Associated with damage to tissues, including the nervous system Mechanisms can be nociceptive and/or neuropathic Nociceptive - normal functioning of nociceptors in response to tissue ... Neuropathic - Pain in response to injury to the ... ...

Clinical pain, as the name suggests, is seen in clinics Associated with damage to tissues, including the nervous system Mechanisms can be nociceptive and/or neuropathic Nociceptive - normal functioning of nociceptors in response to tissue injury Neuropathic - Pain in response to injury to the nervous system

_Acute pain mechanisms_ Acute pain is due to the excitation of nociceptors E.g. ... activation via: ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors Proton/acid binding to acid sensing ion channels serotonin binding to the 5-HT3 receptor sitting on the terminals of nociceptors Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain OR: Mechanisms of acute pain may also be due to ... sensitisation - leads to hyperalgesia: ... -reduces threshold for activation, opens more easy ... - reduce threshold of firing of these channels

Acute pain is due to the excitation of nociceptors E.g. Direct activation via: ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors Proton/acid binding to acid sensing ion channels serotonin binding to the 5-HT3 receptor sitting on the terminals of nociceptors Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain OR: Mechanisms of acute pain may also be due to peripheral sensitisation - leads to hyperalgesia: Bradykinin -reduces threshold for activation, opens more easy Prostaglandins - reduce threshold of firing of these channels

_Acute pain mechanisms_ Acute pain is due to the ... of nociceptors E.g. Direct activation via: ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors .../... binding to ... sensing ion channels ... binding to the 5-HT3 receptor sitting on the terminals of nociceptors Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain OR: Mechanisms of acute pain may also be due to peripheral sensitisation - leads to ...: Bradykinin -reduces threshold for activation, opens more easy Prostaglandins - reduce threshold of firing of these channels

Acute pain is due to the excitation of nociceptors E.g. Direct activation via: ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors Proton/acid binding to acid sensing ion channels serotonin binding to the 5-HT3 receptor sitting on the terminals of nociceptors Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain OR: Mechanisms of acute pain may also be due to peripheral sensitisation - leads to hyperalgesia: Bradykinin -reduces threshold for activation, opens more easy Prostaglandins - reduce threshold of firing of these channels

_Acute pain treatments_ Lots of acute pain treatments Very effective Sites of action are: 1. ... (i.e. at the site of injury) 2. ... 3. Or both

Lots of acute pain treatments Very effective Sites of action are: 1. PNS (i.e. at the site of injury) 2. CNS 3. Or both

_NSAIDs_ Examples include ..., ibuprofen Act in periphery Mechanism of action: Reduce the inflammatory response by inhibiting ... synthesis Reduce peripheral sensitisation Cyclooxygenase (...) inhibited -\> ... synthesis reduced - \> Prevents decrease in Na+ channel threshold

Examples include aspirin, ibuprofen Act in periphery Mechanism of action: Reduce the inflammatory response by inhibiting prostaglandin synthesis Reduce peripheral sensitisation Cyclooxygenase (COX) inhibited -\> Prostaglandin synthesis reduced - \> Prevents decrease in Na+ channel threshold

_Paracetamol/Acetaminophen_ Paracetamol is not a ... (no anti-... properties) Acts ... Mechanism of action: Exact mechanism not known Inhibits cyclooxygenase enzymes in ...NS Acts on ... serotonergic pathway

Paracetamol is not a NSAID (no anti-inflammatory properties) Acts centrally Mechanism of action: Exact mechanism not known Inhibits cyclooxygenase enzymes in CNS Acts on descending serotonergic pathway

_Topical capsaicin treatment_ Component of ... ... Acts in ... - Topically applied to skin Mechanism of action: TRP... agonist - Persistent opening of TRP... -\> Calcium overload -\> ... stops working

Component of chili peppers Acts in periphery - Topically applied to skin Mechanism of action: TRPV1 agonist - Persistent opening of TRPV1 -\> Calcium overload -\> Nociceptor stops working

_Gate control theory_ Pain evoked by nociceptors can be reduced by the simultaneous activation of low threshold ... (Aβfibres) Simply put, ... or blowing on the painful area can ... the pain ... of pain at the spinal cord level

Pain evoked by nociceptors can be reduced by the simultaneous activation of low threshold mechanoreceptors (Aβfibres) Simply put, rubbing or blowing on the painful area can reduce the pain Modulation of pain at the spinal cord level

Physiology of Pain 2 Flashcards by Chrissy Taaffe

Clinical pain

Clinical pain, as the name suggests, is seen in clinics
Associated with damage to tissues, including the nervous system
Mechanisms can be nociceptive and/or neuropathic
- … - normal functioning of nociceptors in response to tissue injury
- … - Pain in response to injury to the nervous system

Clinical pain, as the name suggests, is seen in clinics
Associated with damage to tissues, including the nervous system
Mechanisms can be nociceptive and/or neuropathic
- Nociceptive - normal functioning of nociceptors in response to tissue injury
- Neuropathic - Pain in response to injury to the nervous system

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Clinical pain

Clinical pain, as the name suggests, is seen in clinics
Associated with damage to tissues, including the nervous system
Mechanisms can be nociceptive and/or neuropathic
- Nociceptive - normal functioning of nociceptors in response to tissue …
- Neuropathic - Pain in response to injury to the … …

Clinical pain, as the name suggests, is seen in clinics
Associated with damage to tissues, including the nervous system
Mechanisms can be nociceptive and/or neuropathic
- Nociceptive - normal functioning of nociceptors in response to tissue injury
- Neuropathic - Pain in response to injury to the nervous system

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Pain < 3 months = …

Pain < 3 months = acute

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Pain > 3 months = …

Pain > 3 months = chronic

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Acute pain

Due to tissue … or …
- E.g. following surgery, musculoskeletal injury, burn, headache, visceral pain
… mechanism - when injury site recovers - pain stops

Due to tissue injury or inflammation
- E.g. following surgery, musculoskeletal injury, burn, headache, visceral pain
Nociceptive mechanism - when injury site recovers - pain stops

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Acute pain

Due to tissue injury or inflammation
- E.g. following surgery, musculoskeletal injury, …, headache, … pain
Nociceptive mechanism - when injury site … - pain …

Due to tissue injury or inflammation
- E.g. following surgery, musculoskeletal injury, burn, headache, visceral pain
Nociceptive mechanism - when injury site recovers - pain stops

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Acute pain mechanisms

Acute pain is due to the excitation of nociceptors
- E.g. … activation via:
  - ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors
  - Proton/acid binding to acid sensing ion channels
  - serotonin binding to the 5-HT3 receptor sitting on the terminals of nociceptors
Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain
OR: Mechanisms of acute pain may also be due to … sensitisation - leads to hyperalgesia:
- … -reduces threshold for activation, opens more easy
- … - reduce threshold of firing of these channels

Acute pain is due to the excitation of nociceptors
- E.g. Direct activation via:
  - ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors
  - Proton/acid binding to acid sensing ion channels
  - serotonin binding to the 5-HT3 receptor sitting on the terminals of nociceptors
Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain
OR: Mechanisms of acute pain may also be due to peripheral sensitisation - leads to hyperalgesia:
- Bradykinin -reduces threshold for activation, opens more easy
- Prostaglandins - reduce threshold of firing of these channels

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Acute pain mechanisms

Acute pain is due to the … of nociceptors
- E.g. Direct activation via:
  - ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors
  - …/… binding to … sensing ion channels
  - … binding to the 5-HT3 receptor sitting on the terminals of nociceptors
Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain
OR: Mechanisms of acute pain may also be due to peripheral sensitisation - leads to …:
- Bradykinin -reduces threshold for activation, opens more easy
- Prostaglandins - reduce threshold of firing of these channels

Acute pain is due to the excitation of nociceptors
- E.g. Direct activation via:
  - ATP - binds to purinergic receptors sitting at the peripheral terminals of nociceptors
  - Proton/acid binding to acid sensing ion channels
  - serotonin binding to the 5-HT3 receptor sitting on the terminals of nociceptors
Overall - Compounds bind to receptor - switches on nociceptor - triggers spinothalamic tract - pain
OR: Mechanisms of acute pain may also be due to peripheral sensitisation - leads to hyperalgesia:
- Bradykinin -reduces threshold for activation, opens more easy
- Prostaglandins - reduce threshold of firing of these channels

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Acute pain treatments

Lots of acute pain treatments
Very effective
Sites of action are:
- 1. … (i.e. at the site of injury)
- 1. …
- 1. Or both

Lots of acute pain treatments
Very effective
Sites of action are:
- 1. PNS (i.e. at the site of injury)
- 1. CNS
- 1. Or both

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Local anaesthetics

Examples include …, …
- Act in periphery
- … applied to skin
Mechanism of action:
- Prevents nociceptor firing by … sodium channels

Examples include lidocaine, lignocaine
- Act in periphery
- Topically applied to skin
Mechanism of action:
- Prevents nociceptor firing by blocking sodium channels

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Local anaesthetics

Examples include lidocaine, lignocaine
- Act in …
- Topically applied to skin
Mechanism of action:
- Prevents … firing by blocking … channels

Examples include lidocaine, lignocaine
- Act in periphery
- Topically applied to skin
Mechanism of action:
- Prevents nociceptor firing by blocking sodium channels

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NSAIDs

Examples include …, ibuprofen
Act in periphery
Mechanism of action:
- Reduce the inflammatory response by inhibiting … synthesis
- Reduce peripheral sensitisation
Cyclooxygenase (…) inhibited -> … synthesis reduced - > Prevents decrease in Na+ channel threshold

Examples include aspirin, ibuprofen
Act in periphery
Mechanism of action:
- Reduce the inflammatory response by inhibiting prostaglandin synthesis
- Reduce peripheral sensitisation
Cyclooxygenase (COX) inhibited -> Prostaglandin synthesis reduced - > Prevents decrease in Na+ channel threshold

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Paracetamol/Acetaminophen

Paracetamol is not a … (no anti-… properties)
Acts …
Mechanism of action:
- Exact mechanism not known
- Inhibits cyclooxygenase enzymes in …NS
- Acts on … serotonergic pathway

Paracetamol is not a NSAID (no anti-inflammatory properties)
Acts centrally
Mechanism of action:
- Exact mechanism not known
- Inhibits cyclooxygenase enzymes in CNS
- Acts on descending serotonergic pathway

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Topical capsaicin treatment

Component of … …
Acts in … - Topically applied to skin
Mechanism of action:
- TRP… agonist - Persistent opening of TRP… -> Calcium overload -> … stops working

Component of chili peppers
Acts in periphery - Topically applied to skin
Mechanism of action:
- TRPV1 agonist - Persistent opening of TRPV1 -> Calcium overload -> Nociceptor stops working

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Opioids

Examples include …, …, tramadol
Most … pain relief but numerous side effects
Act … and …
Mechanism of action - … of the endogenous opioid system:
- Brainstem (disinhibition)
- Spinal Cord
- Peripheral (inhibits channels on nociceptors)

Examples include morphine, codeine, tramadol
Most effective pain relief but numerous side effects
Act centrally and peripherally
Mechanism of action - agonists of the endogenous opioid system:
- Brainstem (disinhibition)
- Spinal Cord
- Peripheral (inhibits channels on nociceptors)

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Gate control theory

Pain evoked by nociceptors can be reduced by the simultaneous activation of low threshold … (Aβfibres)
Simply put, … or blowing on the painful area can … the pain
… of pain at the spinal cord level

Pain evoked by nociceptors can be reduced by the simultaneous activation of low threshold mechanoreceptors (Aβfibres)
Simply put, rubbing or blowing on the painful area can reduce the pain
Modulation of pain at the spinal cord level
*

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Mechanisms of gate control

Stimulation of … fibres at injury site activates interneurons in dorsal horn, which … spinothalamic neurons
Rubbing/blowing - activates … fibres
- C fibres inhibit inhibitory interneurons – opens gate
- … fibres activate inhibitory interneurons – closes gate

Stimulation of Ab fibres at injury site activates interneurons in dorsal horn, which inhibit spinothalamic neurons
Rubbing/blowing - activates Ab fibres
- C fibres inhibit inhibitory interneurons – opens gate
- Aβ fibres activate inhibitory interneurons – closes gate

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Mechanisms of gate control

Stimulation of Ab fibres at injury site activates interneurons in dorsal horn, which inhibit spinothalamic neurons
Rubbing/blowing - activates Ab fibres
- C fibres … inhibitory interneurons – … gate
- Aβ fibres … inhibitory interneurons – … gate

Stimulation of Ab fibres at injury site activates interneurons in dorsal horn, which inhibit spinothalamic neurons
Rubbing/blowing - activates Ab fibres
- C fibres inhibit inhibitory interneurons – opens gate
- Aβ fibres activate inhibitory interneurons – closes gate

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Chronic pain is pain that persists for over … months - it is very common

over 3 months

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chronic pain is very common -affects …-…% of population

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20-50chronic pain is very common -affects 20-50% of population

Examples leading to chronic pain:

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Chronic back pain, cancer, carpal tunnel syndrome, arthritis, fibromyalgia, diabetes, migraine, post-surgery, postherpetic neuralgia (shingles), phantom limb pain, multiple sclerosis, trigeminal neuralgia

Chronic pain can be … or …

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Chronic pain can be nociceptive or neuropathic

Neuropathic pain

Nerve injury may be a compression, traction, sever, h…, demyelination, t… or n…
Affects …% of the population
However, a nerve injury may not always be obvious on … examination

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Nerve injury may be a compression, traction, sever, hypoxia, demyelination, tumour or neuroinflammation
Affects 8% of the population
However, a nerve injury may not always be obvious on clinical examination

Neuropathic pain

Nerve injury may be a c…, traction, s…, hypoxia, d…, tumour or neuroinflammation
Affects 8% of the population
However, a nerve injury may not always be obvious on clinical …

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Nerve injury may be a compression, traction, sever, hypoxia, demyelination, tumour or neuroinflammation
Affects 8% of the population
However, a nerve injury may not always be obvious on clinical examination

_Symptoms of neuropathic pain_

_Neuropathic pain mechanisms_ * Mechanisms are complex, involving both peripheral and central nervous systems * Main peripheral mechanisms: * 1. Peripheral ... * 2. Increased ... of primary ... * Main central mechanisms: * 1. Central ... - within spinal cord * 2. Changes in activation patterns/cortical ... - within brain

* Mechanisms are complex, involving both peripheral and central nervous systems * Main peripheral mechanisms: * 1. Peripheral sensitization * 2. Increased firing of primary afferents * Main central mechanisms: * 1. Central sensitization - within spinal cord * 2. Changes in activation patterns/cortical remapping - within brain

_Neuropathic pain mechanisms_ * Mechanisms are complex, involving both peripheral and central nervous systems * Main peripheral mechanisms: * 1. Peripheral sensitization * 2. ... firing of primary afferents * Main central mechanisms: * 1. Central sensitization - within ... ... * 2. Changes in ... patterns/... remapping - within brain

_Increased firing of primary afferents_ * At nerve injury sites, the damaged tips of nociceptors fire spontaneously * ... nociceptor - ion channels formed still but ... at site of injury - tips of nociceptors more ... and send pain impulses up the ... tract - site swells to form ... at the injury site * Responsible for spontaneous pain and also phantom limb pain * Underlies ... ... pain mechanisms

* At nerve injury sites, the damaged tips of nociceptors fire spontaneously * Severed nociceptor - ion channels formed still but accumulate at site of injury - tips of nociceptors more excitable and send pain impulses up the spinothalamic tract - site swells to form neuroma at the injury site * Responsible for spontaneous pain and also phantom limb pain * Underlies central neuropathic pain mechanisms

_Increased firing of primary afferents_ * At nerve injury sites, the damaged tips of nociceptors fire ... * Severed nociceptor - ion channels formed still but accumulate at site of ... - tips of nociceptors more excitable and send pain impulses ... the spinothalamic tract - site ... to form neuroma at the injury site * Responsible for ... pain and also ... ... pain * Underlies central neuropathic pain mechanisms

_Central sensitization_ * Increase in the responsiveness of ... neurons within the ... ... system * Normal inputs begin to produce ... responses * Signal amplified due to the reduced threshold for activation (similar to ...)

* Increase in the responsiveness of nociceptive neurons within the central nervous system * Normal inputs begin to produce abnormal responses * Signal amplified due to the reduced threshold for activation (similar to LTP)

_Central sensitization_ * ... in the responsiveness of nociceptive neurons within the central nervous system * Normal inputs begin to produce ... responses * Signal ... due to the ... threshold for activation (similar to LTP)

_Reduced threshold for activation - central sensitization_ * Constant firing of axons from the periphery (following injury) * Sustained release of ... * Prolonged depolarisation of the postsynaptic membrane * Massive influx of calcium ions through ... receptors * Activation of ... * ... of NMDA/AMPA receptors - alters kinetics of channels and causes insertion of more channels - neurons fire more easily - also channel protein ...

* Constant firing of axons from the periphery (following injury) * Sustained release of glutamate * Prolonged depolarisation of the postsynaptic membrane * Massive influx of calcium ions through NMDA receptors * Activation of kinases * Phosphorylation of NMDA/AMPA receptors - alters kinetics of channels and causes insertion of more channels - neurons fire more easily - also channel protein synthesis

_Reduced threshold for activation - central sensitization_ * Constant firing of axons from the periphery (following injury) * Sustained release of glutamate * Prolonged ... of the postsynaptic membrane * ... influx of calcium ions through NMDA receptors * Activation of kinases * Phosphorylation of NMDA/... receptors - alters ... of channels and causes insertion of more channels - neurons fire more easily - also channel protein ...

_Central hyperalgesia mechanism_ * Following central ...: * Activation of nociceptors results in ... spinal cord activation leading to ...

* Following central sensitization: * Activation of nociceptors results in amplified spinal cord activation leading to hyperalgesia

_Central allodynia mechanism_ * Non-noxious A... fibres also synapse onto ... order spinothalamic neurons * Normally these are non-... * Following central sensitization: * Non-noxious afferents activate sensitized 2nd order neurons

* Non-noxious Aβ fibres also synapse onto 2nd order spinothalamic neurons * Normally these are non-functional * Following central sensitization: * Non-noxious afferents activate sensitized 2nd order neurons

_Central allodynia mechanism_ * Non-... ... fibres also synapse onto 2nd order spinothalamic neurons * Normally these are non-functional * Following central ...: * Non-... afferents activate sensitized 2nd order neurons

Problem with central changes (pain) = not easily ...

Problem with central changes (pain) = not easily reversible

_Chronic pain - treatments_ * Difficult to treat - ... pain treatments often do not work * Good individual patient ... is critical * Important to manage primary condition as well as other associated symptoms * Depression * ... disturbances * ...

* Difficult to treat - Acute pain treatments often do not work * Good individual patient management is critical * Important to manage primary condition as well as other associated symptoms * Depression * Sleep disturbances * Fatigue

_Chronic pain - treatments_ * ... to treat - Acute pain treatments often do not work * Good individual patient management is critical * Important to manage primary condition as well as other associated symptoms * ... * Sleep ... * ...

_Current neuropathic pain treatments_ * Drugs: * ... antidepressants * Anti... * Topical ... or ... * ...puncture * Physical therapies – e.g. manipulation of tissues, pacing * Psychological therapies – e.g. ... ... therapy * Surgery – e.g. spinal cord stimulator (activate a-beta fibres as they enter spinal cord - activate inhibitory interneurons which act on our second-order neurons - same as gate control)

* Drugs: * Tricyclic antidepressants * Anticonvulsants * Topical capsaicin or lidocaine * Acupuncture * Physical therapies – e.g. manipulation of tissues, pacing * Psychological therapies – e.g. cognitive behavior therapy * Surgery – e.g. spinal cord stimulator (activate a-beta fibres as they enter spinal cord - activate inhibitory interneurons which act on our second-order neurons - same as gate control)

_Current neuropathic pain treatments_ * Drugs: * Tricyclic ... * ... * Topical capsaicin or ... * ... * Physical therapies – e.g. manipulation of tissues, pacing * Psychological therapies – e.g. cognitive behavior therapy * Surgery – e.g. spinal cord ... (activate a-beta fibres as they enter spinal cord - activate inhibitory interneurons which act on our second-order neurons - same as gate control)

_Tricyclic antidepressants_ * Examples include ... and duloxetine * Act centrally * Mechanism of action: * Act on ... ... pathways * Inhibits reuptake of ... (and noradrenalin)

* Examples include amitriptyline and duloxetine * Act centrally * Mechanism of action: * Act on descending inhibitory pathways * Inhibits reuptake of serotonin (and noradrenalin)

_Anticonvulsants_ * Examples include ... - fewer side effects, gabapentin and carbamazepine * Act centrally * Mechanism of action: (proposed) * Act in spinal cord to reduce ... * Blocks calcium (...) and ... (carbomazepine) channels * ... blocks presynaptic voltage-gated Ca2+ channels - Prevent release of glutamate

* Examples include pregabalin - fewer side effects, gabapentin and carbamazepine * Act centrally * Mechanism of action: (proposed) * Act in spinal cord to reduce excitability * Blocks calcium (pregabalin) and sodium (carbomazepine) channels * Pregabalin blocks presynaptic voltage-gated Ca2+ channels - Prevent release of glutamate

_Anticonvulsants_ * Examples include pregabalin - fewer side effects, gabapentin and ... * Act centrally * Mechanism of action: (proposed) * Act in ... ... to reduce excitability * Blocks calcium (pregabalin) and sodium (...) channels * Pregabalin blocks presynaptic voltage-gated Ca2+ channels - Prevent release of ...

_NICE guidelines on treatment of neuropathic pain_ * First-line of treatment: * ..., duloxetine, P... or gabapentin * Second-line of treatment: * ... drugs or ... * Third-line of treatment: * Refer patient to a ... pain service and consider oral tramadol (opioid) or in combination with the second-line treatment consider topical lidocaine

* First-line of treatment: * Amitriptyline, duloxetine, pregabalin or gabapentin * Second-line of treatment: * Switch drugs or combine * Third-line of treatment: * Refer patient to a specialist pain service and consider oral tramadol (opioid) or in combination with the second-line treatment consider topical lidocaine

_NICE guidelines on treatment of neuropathic pain_ * First-line of treatment: * ..., duloxetine, pregabalin or gabapentin * Second-line of treatment: * Switch drugs or combine * Third-line of treatment: * ... patient to a specialist pain service and consider oral ... (opioid) or in combination with the second-line treatment consider topical ...

_Placebo and complimentary alternative medicines_ * Important to consider the ... effect * ... analgesia has been demonstrated (in well controlled studies) for the treatment of neuropathic pain - Due to activation of descending inhibitory pathways * Many Complementary Alternative Medicines * Examples include ..., massage therapy, homeopathy, hypnosis, reiki * BUT - ‘Very few forms of CAM reduce pain in a clinically relevant way’ * Exceptions include ... -trigger release of endorphins

* Important to consider the placebo effect * Placebo analgesia has been demonstrated (in well controlled studies) for the treatment of neuropathic pain - Due to activation of descending inhibitory pathways * Many Complementary Alternative Medicines * Examples include acupuncture, massage therapy, homeopathy, hypnosis, reiki * BUT - ‘Very few forms of CAM reduce pain in a clinically relevant way’ * Exceptions include acupuncture -trigger release of endorphins

_Placebo and complimentary alternative medicines_ * Important to consider the placebo effect * Placebo analgesia has been demonstrated (in well controlled studies) for the treatment of neuropathic pain - Due to activation of ... ... pathways * Many ... Alternative Medicines * Examples include acupuncture, massage therapy, homeopathy, hypnosis, reiki * BUT - ‘Very few forms of CAM reduce pain in a clinically relevant way’ * Exceptions include acupuncture -trigger release of ...

_What's gone wrong in chronic pain?_

Physiology of Pain 2 Flashcards

(49 cards)