Therapy of pain

Question 1

nociceptive pain

Answer 1

range of musculoskeletal conditions that involve inflammatory, ischemic, infectious or mechanical injury

Question 2

neuropathic pain

Answer 2

maladaptive response to damage or disease of the somatosensory nervous system

Question 3

nociplastic pain

Answer 3

pain that is not fully described by tissue injury or nerve injury

Question 4

musculoskeletal chronic pain

Answer 4

spinal pain syndromes, osteoarthritis, regional muscle pain disorders

Question 5

neurologic chronic pain

Answer 5

migraine, tension type headache, neuropathies, neuralgia, MS

Question 6

GI chronic pain

Answer 6

irritable bowl syndrome, Crohn disease, UC, pancreatitis

Question 7

Urogynaecological chronic pain

Answer 7

interstitial cystitis, vulvodynia, chronic endometriosis, chronic pelvic pain

Question 8

metabolic chronic pain

Answer 8

diabetes, pernicious anaemia

Question 9

infectious chronic pain

Answer 9

post-herpeutic neuralgia, HIV-associated neuropathy, Lyme disease

Question 10

autoimmune disorders

Answer 10

rheumatoid arthritits, Sjörgens syndrome, chronic inflammatory demyelinating polyneuropathy

Question 11

neoplastic chronic pain

Answer 11

cancer survivor pain syndromes

Question 12

WHO ladder

Answer 12

from NSAIDs to opioids

Question 13

analgesic

Answer 13

pain killing

Question 14

antipyretic

Answer 14

fever reducing

Question 15

COX enzyme

Answer 15

responsible for formation of prostanoids, including thromboxane and prostaglandins

Question 16

COX 1 and 2 inhibitors

Answer 16

aspirin, ibuprofen, naproxen, diclofenac

Question 17

COX2>COX1 inhibitor

Answer 17

meloxicam

Question 18

COX2»>COX1 inhibitor

Answer 18

etoricoxib, celecoxib

Question 19

non-selective COX inhibitor

Answer 19

causes decrease in PG leading to a decrease in vasodilation and pain, decrease in TXA2 causing anti-aggregation of platelets, causes damage to mucus layer

Question 20

COX2 selective inhibitors

Answer 20

less GI damage, no effect on platelet aggregation, hypersensitive reactions, can lead to high BP and thrombosis

Question 21

MOA

Answer 21

activation of descending serotonergic inhibitory pathways, decomposes in inflamed tissue

Question 22

SE

Answer 22

hepatotoxic, metabolized in the liver, acute overdose of paracetamol can cause fatal liver damage, interacts with alcohol

Question 23

opioids ascending pathway

Answer 23

direct effect in primary afferent nociceptive terminals, then via dorsal horn to amygdala in brain

Question 24

opioids descending pathway

Answer 24

inhibiting GABA release in the brain stem, from midbrain, to medulla/pons to spinal cord

Question 25

central effects opioids

Answer 25

analgesia, respiratory depression, tolerance and dependence

Question 26

peripheral effects opioids

Answer 26

histamine release, constipation, miosis, urinary retention, increase in biliary pressure

Question 27

opioid tolerance

Answer 27

causes the therapeutic effect to go down

Question 28

opioid dependence

Answer 28

very strong physical and psychological dependence, withdrawal causes abstinence syndrome

Question 29

neuropathic pain

Answer 29

treatment with SSRI, TCA (antidepressants) and gabapentin/pregabalin (antiseizure)