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11 Cards in this Set
- Front
- Back
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Substance P
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-Nociceptor terminals in periphery (e.g. antidromic nociceptor sensitization)
-C-fibers at dorsal horn of spinal cord |
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Glutamate
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Excitatory nt
-both Aδ and C-fibers at dorsal horn of spinal cord |
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Serotonin
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Raphe nucles of RVM sends inhibitory projection to dorsal horn, releasing serotonin on nociceptive neurons there
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Dopamine
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-In frontal and limbic reward systems as input to the PAG
-descending pathway from hypothalamus to dorsal horn of spinal cord |
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Norepinephrine
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-descending inhibitory pathway from pons (DLPT) to dorsal horn of spinal cord
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GABA
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inhibitory nt
-interneurons in spinal cord |
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Features of neuropathic pain
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-absence of damaged tissue
-dysesthesia: burning, electric -paroxysmal: stabbing, shooting -allodynia -summation and after-reaction with repetitive stimuli -delayed onset after injury -sensory deficit in same region |
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Neuropathic pain mechanisms
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-peripheral sensitization: neurogenic inflammation, ion channel upregulation
-central sensitization: reorganization of synaptic connections in CNS by glial cells -inflammation due to degenerating nerve cells -disinhibition of neighboring nociceptors |
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Complex regional pain syndrome
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-antecedent injury
-severe neuropathic pain -autonomic abnormalities: edema, temp change, skin/hair changes, hyperhidrosis |
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Principles of Pain Management
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1. Titrate analgesics to severity of pain
2. Regularly scheduled dosing better than PRN 3. Use adjuvant meds to achieve results Goal: complete pain relief |
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Opioid receptors
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Present in PAG of midbrain, RVM of medulla, and dorsal horn of spinal cord, (primary afferent peripheral nerve terminals)
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