B&b Week 6 Lecture 2

Front 1

What is chronic pain?

Back 1

-lasts greater than 3-6 months
-persists longer than would be expected from an injury, surgery or other disease
-persistent or episodic pain of a duration or intensity that adversely affects the function or well-being of the patient, attributable to any nonmalignant etiology

Front 2

What are associated problems with chronic pain?

Back 2

depression, anxiety, secondary gain issues

Front 3

What type of nerves are typically affected in chronic pain?

Back 3

C fibers- slow conduction (unmyelinated)

Front 4

What is neuropathic pain?

Back 4

pain initiated or caused by a primary lesion or dysfunction in the nervous system

Front 5

What is allodynia?

Back 5

Pain do to a stimulus which does not normally provoke pain.

Front 6

What is hyperalgesia?

Back 6

An increased response to a stimulus which is normally painful.

Front 7

What is neuralgia?

Back 7

Pain in the distribution of a nerve or nerves.

Front 8

What is causalgia?

Back 8

Syndrome: sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes

Front 9

What are some of the goals of chronic pain management(5)?

Back 9

-maximal pain REDUCTION
-help to cope with residual pain
-increase function
-reduction of the use of medical resources
-management of medication misuse/abuse

Front 10

What are some of the interdisciplinary approaches to chronic pain (6)

Back 10

Education
Behavioral(Relaxation, hypnosis, biofeedback, CBT...)
Physical Therapy
Pharmacological
Interventional (local anesthetic nerve blockade, neurolytic nerve blockade, epidural steroid injection)
Implantable methods (epidural/intrathecal drug delivery system, spinal cord stimulation)

Front 11

What are the first line agents for chronic neuropathic pain?

Back 11

TCA
Anticonvulsants (gabapentin and pregabalin)

Front 12

What are the second line agents for chronic neuropathic pain?

Back 12

SSNRIs Selective serotonin and norepinephrine reuptake inhibitors
Topical lidocaine

Front 13

What are third and fourth line agents of chronic neuropathic pain?

Back 13

Opiod analgesics
Tramadol
SSRI
other anticonvulsants
IV lidocaine and mexilitine
topical capsaicin
cannabinoids

Front 14

What are two types of tricyclic antidepressants and examples of each?

Back 14

Seconary Amines
-Nortriptyline
-Desipramine
Tertiary Amines
-Amitriptyline
-Imipramine

Front 15

What is the suspected mechanism of action?

Back 15

Serotonin and norepinepherine reuptake inhibition, increased endogenous inhibition by increasing descending pathway transmission

Front 16

What are some side effects of TCAs?

Back 16

Anticholinergic -dry mouth, blurred vision, constipation, urinary retention
CVS -postural hypotension, conduction delay and myocardial depression

Front 17

What class of drugs in gabapentin?

Back 17

Calcium Channel Alpha 2 Delta Ligand

Front 18

What is the MOA of gabapentin?

Back 18

Binds to Alpha 2 delta subunits of presynaptic voltage gated Ca channels and reduces release of glutamate, norepinepherine, substance P and CGRP

Front 19

What is controversial about gabapentin?

Back 19

Whether it works or not

Front 20

What is Pregabalin?

Back 20

AKA Lyrica. Gabapentin analog but is effective at lower doses.

Front 21

What is carbamazepine?

Back 21

Anticonvulsant drug of first choice for trigeminal neuralgia (tic doloreux)

Front 22

What are some other anticonvulsants to consider?

Back 22

Lamotrigine
Valproic acid
Topiramate

Front 23

What is Tramadol?

Back 23

Synthetic opiod. Weak mu agonist activity, inhibits serotonin and norepinepherine reuptake, peripheral local anesthetic properties
-used for postherpetic neuralgia, diabetic neuropathy, polyneuropathies and post-amputation pain

Front 24

What is topical capsaicin used for?

Back 24

diabetic neuropathy and postherpetic neuralgia
-depletes substance P in C-fibers, nociceptor desensitization

Front 25

What are cannabinoids used for?

Back 25

Buccal spray for neuropathic pain associated with MS, reduces pain and sleep disturbance.

Front 26

What drug is not inidcated in chronic pain?

Back 26

Those containing hypnotics/sedatives (ex. Fiorinal)