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35 Cards in this Set
- Front
- Back
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What is the easily forgettable component of pain?
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EMOTIONAL!
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What is sensitization?
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When enough stimulus keeps hitting an area, it becomes sensitized and thus normal, nonpainful stimuli can become painful (think sunburn)
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What is Referred Pain?
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Convergence of sensory inputs into a singe spinal pain-transmission neuron (STT)
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Example of Referred Pain?
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Stimulus under diaphragm gives shoulder and upper back pain
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What is up with Pain Modulation?
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Its a top-down deal. Like go to doctor=pain
Activated via hypothalams, midbrain, medulla Activates endorphins and enkephalins |
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Two types of pain?
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Nociceptive
Neuropathic |
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Nociceptive vs Neuropathic
origin of stimulus? |
Noci: outside nervous system
Neuro: from primary lesion or dysfunction in NS |
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Nociceptive vs Neuropathic
proportion to receptor stimulus? |
Noc: is proportionate to receptor stimulus
Neuro: Dispraportionate |
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Fxn of Nociceptive Pain?
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Protective
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Examples of Mixed Nociceptive and Neuropathic Pain
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Lower Back Pain
Fibromyalgia Neck Pain Cancer Pain |
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As far as nerve conduction speeds go, who is fastest and who is slowest?
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Fastest = Motor
Middle = DC/ML Slowest= Spinothalamic (PAIN) |
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As far as diameter of axons and amount of myelin, how would i create the fastest nerve possible?
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Larger Diameter and Lots of Myelin
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Two types of fibers affected by DPN?
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Large Fibers (A-alpha/beta)
Small Fibers (C and A-delta) |
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As far as the two types of fibers which one is typically present in DPN patients?
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a Mixture of both
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For DPN: Small Fibers, what is the first Sx?
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Pain and Hyperalgesia
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For DPN: Small fibers, what comes later?
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Loss of sensitivity for temperature and pinpricks
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What are two other issues that can arise with DPN: Small Fibers?
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Autonomic Sx's (constipated, pee retention)
Foot Disease (can go deep and become osteomyelitis) |
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Typical Sx's with DPN: Large Fibers
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Vibratory Sense Loss
Proprioception Loss Deep, gnawing, achy pain Muscle Wasting (hammertoes) |
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Something to watch out for with Large Fiber DPN?
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Falls (esp in shower)
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How can Electrophysiology be used with DPN?
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It can be used to detect nerve damage in Large Fiber DPN, but not in Small Fiber
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Progression of Treatment for Acute Pain?
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Aspirin, Acetaminophen, NSAIDs
Opioids Opioids + COX inhibitors |
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Fxn of Aspirin and NSAIDS
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Nociceptive more than neuropathic
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SE's of aspirin and NSAIDs
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GI, Bleeding, Renal
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One downfall of acetaminophen?
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Not anti-inflammatory
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What about COX-2 inhibitors?
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stroke and MI
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Which pain do Opioids take care of?
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Noci and Neuro
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Which opioid do we avoid?
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Demerol (Meperidine)
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Why are Opioid + COX Inhibitors good?
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Additive effect on pain w/o additive side effects b/c you can lower the dose of each
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What is the issure with acetaminophen and opioid tolerance?
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if its a combo, the though would be to increase dose if opioid tolerance develops, but acetaminophen can be really hepatotoxic, so you have to figure out another option
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Causes of Chronic Pain
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Painful Diseases w/ no Cure
Cured Diseases that left nerve damage Psychological factors (depression) |
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How do we approach the causes of Chronic Pain?
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Hit them all from the beginning
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Rx for Chronic Pain
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Antidepressants
Anticonvulsants and Antiarrhythmics Chronic Opioids |
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Besides helping with depression, how can antidepressants help pain?
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TCA's at low doses can potentiate opioid effects, but have anticholinergic effects
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What are anticonvulsants and antiarrhytmics best for?
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Neuropathic Pain
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Examples of good Anticonvulsants for Pain
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Carbamazepine
Gabapentin Pregabalin |
