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18 Cards in this Set

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Define: Allodynia
an exaggerated response to otherwise non-noxious stimuli and can be either static or mechanical.
Define: Hyperalgesia
increased pain response to a suprathreshold noxious stimulus as a result of abnormal processing of nocireceptor input
what is breakthrough pain dosing?
Use of immediate release (short-acting) opiods to provide relief of pain which breaks through the baseline pain relief established with regular dosing.
List the types of Chronic pain
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
List the NT involved in pain transmission
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
What can lead to altered pain generation or an abnormal response / perception?
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)
how is mild pain treated?
Acetaminophen
NSAIDs
how is moderate to severe pain treated?
opioids
List the types of opioids used for pain management
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)
How are breakthrough doses calculated?
Based on 5 to 10% of total 24 hr dose
What are the pharmokinetic considerations for opioids?
1. Renal - decreased clearance will decrease clearance of morphine metabolites
2. hepatic function - decreased conversion of codeine to morphine, slower metabolism to active metabolites
What are the two cannabinoid receptors and where are they found
CB1 - brain, spinal cord, sensory neurons
CB2 - non-neural tissues
define: nociceptors
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.
Define: two types of nociceptors
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
A(Delta) fibers project to which 2 lamninae of the dorsal horn?
Laminae I(pain specific)& V
C fibers project to which lamninae of the dorsal horn?
Laminae I, II(Substantia gelatinosa) & V
Which laminae do the A(beta) Fibers project to?
Laminae III, IV & V
What is the main synaptic transmitter present in all types of primary afferents?
Glutamate