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25 Cards in this Set
- Front
- Back
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primitive vs 'modern' pain pathways
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primitive - medial spinothelamic tract (paleo STT), dorsum column, spino-parabrachio-amygloid, spino-hypothelamic, visceral, diffuse, aching, significant autonomic response with behabvioral components such as anxiety and fear modern - lateral spinothelamic tract (neo STT) - well localized, sharp and fast) cutanious |
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operent vs classical conditioning
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classical - form of learning - one stimulus comes to signal occurrence of second stimulus operant - behavior is modified by its consequences |
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conditioning and fear avoidance model
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sees pain as a phobia with reinforcement of pain related cognitions by exposure to noxious stimuli such as physiotherapy or work
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common dysfunctional cognitions associated with chronic pain
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catastrophisation, rumination, dependency and helplessness
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definition of somatoform disorder
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The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits
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things contributing to placebo effect (placebo mechanisms)
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psychosocial nature around the patient patient belief, desire and expectation for symptom change patient Dr relationship, empathy, charisma, route of administration of drug, technical nature of treatment |
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what is a placebo
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it is a treatment without the active component of a given therapy. it shows the effect of the psychosocial context or treatment ritual on the patients brain this identifies that the therapeutic rituals and environment around a patient changes the way a patient processes symptoms. |
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how do placebo effects work?
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in pain - mediation through endogenous opoids - placebo effects can be reversed by naloxone multiple biological and psychological effects may be due to expectancy of benefit - not always tho conditioning mechanisms (if had active drug in the past) in pain the psychosocial context can switch on mechanisms bith psychologically and biologically - thus creating a placebo effect affected by prior drug experiance |
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evidence of past drug experience effecting placebo effect
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if conditioned with opioid then placebo - naloxone will stop the effect of the placebo mu receptor and opioid mediated placebo effect if conditioned with NSAID then placebo will not be effected by naloxone CB1 canaboid receptor and non opioid mediated effect |
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do you have to give a placebo to generate a placebo effect?
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no, placebo effects are a part of every health care encounter |
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what is open - hidden paradigm
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open administration of drug - I will give you 'x' - tells us drug in psychosocial context hidden administration of drug - e.g. - computer give drug by computer pump - IV - pt not known when - effect of drug by itself |
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difference in effect of drug between open and hidden paradigm
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usually drugs are around 50% less effective is person does not know if the drug has gone into their system - standard for analgesics
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tension between placebo in studies vs clinical
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studies aim to reduce the placebo effect to illustrate the effect of the drug clinically we aim to maximize the placebo effect to improve the outcome for the patient |
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discussed classical conditioning in more detail - particularly in regards to placebo effect
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unconditioned stimulus evokes unconditioned response neutral stimulus is associated - becomes conditioned stimulus conditioned stimulus then develops same response making it a conditioned response in placebo effect unconditioned stimulus is the effective drug conditioned stimulus is taking the drug unconditioned response is the drugs characteristic effect conditioned response is the contextual effect of the drug |
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things that contribute to the nocebo effect
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prior unsuccessful treatments distrust in clinician, route, or treatment being given lack of hope or expectation for clinical recovery |
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Criticism of IASP pain definition |
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What is a pain disorder |
Pain behaviour that can not be discribed in history, examination etc Can be conscious - malingering Uncounses- conversion disorder |
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Pathway of opioid receptor agonism |
G coupled receptor - heterotrinemic complex disassociates - inhibits adenile cyclase by alpha sub unit - inhibits cyclic AMP - inhibs neurotransmissikn |
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Pathway of opioid receptor agonism |
G coupled receptor - heterotrinemic complex disassociates - inhibits adenile cyclase by alpha sub unit - inhibits cyclic AMP -
Presynaptic- which inhibs neurotransmission such as glutinate release
Post synaptic - hyperpolerise nociceptive neurone to prevent transmission of message |
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Which endogenous opioids work on which receptor |
Mop Dop Kop |
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Pathway of opioid receptor agonism |
G coupled receptor - heterotrinemic complex disassociates - inhibits adenile cyclase by alpha sub unit - inhibits cyclic AMP -
Presynaptic- which inhibs neurotransmission such as glutinate release
Post synaptic - hyperpolerise nociceptive neurone to prevent transmission of message |
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Which endogenous opioids work on which receptor |
Mop Dop Kop |
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Mechanisms for diversity to opioid receptor signalling |
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Diabetes insipidus vs SIADH on bloods |
X |
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Siadh/ diabetes insipitus |
Di too little ADH - large vol urine - dilute < 700osmol Osmal high > 295 High na
SIADH - too much ADH Low na - corrected by volume depletion Continued renal excretion na Osmal > 280 Not volume deplete |
