Week 13

Question 1

key components of pain processes

Answer 1

• stimulus
• nociceptor
• PNS
• spinal cord
• ascend spinal cord
• brain

Question 2

what parts of the brain involved in pain

Answer 2

thalamus & cortex

Question 3

what parts of the ascend spinal cord involved in pain

Answer 3

• spinothalamic (pain)
• spinoreticular (emotional)

Question 4

when is pain considered chronic

Answer 4

> 3 months

Question 5

types of pain

Answer 5

• nociceptive
• neuropathic
• nociplastic

Question 6

location of nociceptive / neuropathic pain

Answer 6

somatic nociceptive pain = localized
visceral nociceptive pain = generalized
neuropathic = follow nerve path / diffuse

Question 7

pain description of nociceptive / neuropathic pain

Answer 7

somatic nociceptive pain =sharp
visceral nociceptive pain = ache, cramping
neuropathic = burning, tingling, prickling

Question 8

how does central sensitization of chronic pain development work

Answer 8

persistent pain after injury resolved > signals continue over protracted period of time > amplifies danger > CNS sensitized > more pain felt

Question 9

central pain

Answer 9

CNS damage > increased pain sensitivity

Question 10

ischemic pain

Answer 10

hypoxia from decreased blood flow > tissue damage & release of inflammatory mediators which cause pain

Question 11

phantom pain

Answer 11

pain from limb no longer present

Question 12

allodynia pain

Answer 12

pain from stimulus which normally does not provoke pain

Question 13

hyperalgesia pain

Answer 13

increased pain from stimulus that normally provokes pain

Question 14

referred pain

Answer 14

pain from site other than origin

Question 15

social management of chronic pain involves

Answer 15

support groups / spirituality / relationships

Question 16

pharmacological management of chronic pain involves

Answer 16

procedural intervention / physiotherapy / acupuncture / Tui na

Question 17

education management of chronic pain involves

Answer 17

managing psychiatric disorders such as anxiety / depression

Question 18

psychological management of chronic pain involves

Answer 18

cognitive behavioral therapy / meditation / mindfulness

Question 19

systemic pharmaco pain management

Answer 19

analgesics / anti-epileptics / anti-depressants / adjuvants / opoids

Question 20

regional pharmaco pain management

Answer 20

peripheral nerve block / central neuraxial

Question 21

simple analgesics effective for __

Answer 21

nociceptive pain

Question 22

caution when using paracetamol include __

Answer 22

low body weight / liver pathology

Question 23

paracetamol overdose leads to

Answer 23

fulminant liver failure

Question 24

antidote to fulminant liver failure

Answer 24

IV acetylcysteine

Question 25

NSAIDs side effects

Answer 25

GI / renal / haematological / CVS

Question 26

NSAIDs mechanism

Answer 26

cyclo-oxygenase (COX) inhibitions

Question 27

non-selective COX

Answer 27

diclofenac / ibuprofen / naproxen

Question 28

COX-2 selective

Answer 28

celecoxib / etoricoxib

Question 29

COX-1 inhibition leads to __

Answer 29

peptic ulcers, GI bleeding

Question 30

COX inhibition leads to __

Answer 30

- Na+ & H2O retention - hypertension - hemodynamic acute kidney injury

Question 31

arachiodonic acid affects __

Answer 31

GI / renal / CVS

Question 32

when more COX-2 inhibited than COX-1

Answer 32

stroke & myocardial infarction occur

Question 33

opioids effective for ___

Answer 33

nociceptive & neuropathic pain

Question 34

opioids are good for __

Answer 34

acute pain / short term use for chronic pain / cancer pain

Question 35

opioids mechanism involves

Answer 35

μ-receptor agonism

Question 36

opioid toxicity / overdose leads to __

Answer 36

sedation / respiratory depression / apnea

Question 37

weak opioids include __

Answer 37

codeine / tramadol

Question 38

strong opioids include __

Answer 38

morphine / pethidine / fentanyl / oxycodone

Question 39

mechanism of tramadol

Answer 39

inhibit serotonin and noradrenaline uptake

Question 40

prominent side effects of tramadol

Answer 40

nausea / vomitting

Question 41

caution when using tramadol

Answer 41

seizures / serotonin syndrome

Question 42

caution when using morphine

Answer 42

renal impairment / elderly / obesity / OSA

Question 43

caution when using pethidine

Answer 43

seizures / renal impairment

Question 44

anti-epileptics & depressants good for __

Answer 44

neuropathic pain

Question 45

anti-epileptics AKA

Answer 45

gabapentinoids

Question 46

mechanism of anti-epileptics

Answer 46

alpha2-delta subunit of calcium channel

Question 47

side effects of anti-epileptics

Answer 47

somnolence, lower limb swelling

Question 48

caution when using anti-epileptics

Answer 48

potential abuse

Question 49

tri-cyclic anti-depressants include

Answer 49

amitriptyline / notriptyline (anything that ends with -tryptyline)

Question 50

serotonin-norepinephrine reuptake inhibitors include

Answer 50

duloxetine, venlafaxine

Question 51

side effect of anti-depressants

Answer 51

serotonin syndrome

Question 52

low dose aspirin will irreversibly inhibit __

Answer 52

platelet COX-1

Question 53

antidote for opioid toxicity/overdose

Answer 53

naloxone

Question 54

sensitivity of nociceptors increases by substances released from __

Answer 54

tissue damage

Question 55

what are the 2 types of afferent fibres carrying painful stimuli

Answer 55

myelinated A & unmyelinated C

Question 56

what are myelinated A-delta

Answer 56

medium size fibre (smaller than Myelinated A-beta) with fast speed of pain transmission

Question 57

what are unmyelinated C

Answer 57

small fibre with slow transmission for chronic pain

Question 58

where do primary afferent nerve synapse at

Answer 58

dorsal horn of spinal cord with secondary afferent neurons

Question 59

what is the purpose of spinothalamic & spinoreticular tract

Answer 59

spinothalamic = pain localization spinoreticular = emotional aspect of pain

Question 60

pain interpretation occurs at

Answer 60

somatosensory cortex

Question 61

pain matrix includes __

Answer 61

- thalamus - primary & secondary somatosensory cortex - prefrontal cortex

Question 62

where does awareness & alertness occur in

Answer 62

reticular formation in pons & medulla

Question 63

where does stress response come from

Answer 63

hypothalamus

Question 64

where does emotional response come from

Answer 64

limbic system

Question 65

activation of ___ has inhibitory effect on dorsal horn

Answer 65

alpha-beta fiber

Question 66

what is nociceptive pain

Answer 66

pain generated due to tissue damage & elicits reflex withdrawal