Brain & Behaviour #6

Front 1

Define: Allodynia

Back 1

an exaggerated response to otherwise non-noxious stimuli and can be either static or mechanical.

Front 2

Define: Hyperalgesia

Back 2

increased pain response to a suprathreshold noxious stimulus as a result of abnormal processing of nocireceptor input

Front 3

what is breakthrough pain dosing?

Back 3

Use of immediate release (short-acting) opiods to provide relief of pain which breaks through the baseline pain relief established with regular dosing.

Front 4

List the types of Chronic pain

Back 4

Pain that
- persists beyond normal healing time ofr an acute injury
- is related to a chronic disease
- has no identifiable organic cause
- involves both acute and chronic pain associated with cancer

Front 5

List the NT involved in pain transmission

Back 5

1. Peptides: substance P, calcitonin, somatostatin)
2. Excitatory (Asp, Glu)
3. Inhibitory (GABA, Gly)
4. NO
5. Arachidonic acid metabolites
6. Endogenous opiods
7. Adensomine
8. Monoamines

Front 6

What can lead to altered pain generation or an abnormal response / perception?

Back 6

1. Damage to the neuron which can result in spontaneous firing along the axon or in the dorsal horn.
2. Normal inhibitory processes in the dorsal horn are altered resulting in an exaggerated response to stimuli
3. Exposure to neuron growth factor encourages the spread of transmission to adjacent neurons (increases pain transmission)

Front 7

how is mild pain treated?

Back 7

Acetaminophen
NSAIDs

Front 8

how is moderate to severe pain treated?

Back 8

opioids

Front 9

List the types of opioids used for pain management

Back 9

1. Morphine (good 1st line)
2. hydromorphone (good 1st or 2nd line)
3. Codeine (good if pain is mild to moderate)
4. Oxycodone (no advantage over morphine)
5. Fentanyl (reserved for those that can't take oral meds)

Front 10

How are breakthrough doses calculated?

Back 10

Based on 5 to 10% of total 24 hr dose

Front 11

What are the pharmokinetic considerations for opioids?

Back 11

1. Renal - decreased clearance will decrease clearance of morphine metabolites
2. hepatic function - decreased conversion of codeine to morphine, slower metabolism to active metabolites

Front 12

What are the two cannabinoid receptors and where are they found

Back 12

CB1 - brain, spinal cord, sensory neurons
CB2 - non-neural tissues

Front 13

define: nociceptors

Back 13

A nociceptor is a sensory receptor that responds only after a high level of stimuli or a level enough to hurt the individual. When they are activated they can generate a reflex and pain.

Front 14

Define: two types of nociceptors

Back 14

1. A(Delta): Lamina III
- These fibres carry sharp prickling pain
2. C: Lamina IV
- These fibres carry pain with a slow conduction velocity because they lack myelination

Front 15

A(Delta) fibers project to which 2 lamninae of the dorsal horn?

Back 15

Laminae I(pain specific)& V

Front 16

C fibers project to which lamninae of the dorsal horn?

Back 16

Laminae I, II(Substantia gelatinosa) & V

Front 17

Which laminae do the A(beta) Fibers project to?

Back 17

Laminae III, IV & V

Front 18

What is the main synaptic transmitter present in all types of primary afferents?

Back 18

Glutamate