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59 Cards in this Set
- Front
- Back
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Is tissue damage a requirement for pain?
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No
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What are the most important nerves in relation to pain?
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Bare nerve endings
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What type of pain fibers end up taking information to the CNS?
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1. C Fibers
2. Poorly myelinated Alpha-delta fibers |
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How long must you experience pain for it be considered chronic?
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Six months
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What percentage of people entering the medical system are motivated by pain?
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60-80%
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What percentage of the population will experience chronic pain in their lifetime?
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33%
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What are the two pieces of information that one needs to classify pain effectively?
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1. Location
2. Cause of pain |
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What are some examples of qualititative descriptors of pain?
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Burning, flashing ect
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What are the two main classifications of pain in relation to time?
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1. Chronic
2. Acute |
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What type of pain is short acting? What can the presence of this pain considered?
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1. Acute pain
2. Warning sign or behavioral modifying pain |
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What is pain that lasts longer than it should or is recurrent?
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Chronic pain
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Does chronic pain often have defined etiology, time course or treatment processes?
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Nope
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If the etiology of chronic pain is not known, how is a diagnosis made?
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Using more descriptive than etiological diagnoses.
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What are three ways to classify chronic pain in relation to the source of the pain?
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1. Nociceptive - pain due to tissue damage
2. Neuropathic - pain due to a nervous system injry 3. Other - mix between the previous two descriptors |
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What is the typical treatment for nociceptive pain?
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Use traditional analgesics
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What is the course of treatment for people with neuropathic pain?
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More adjuvant analgesics such as anti-depressants and anti-convulsants are used
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What type of stimuli do C and Alpha-delta respond to?
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1. Thermal
2. Chemical 3. Mechanical stimuli |
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What are the four symptoms of nociceptive pain?
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1. Pain
2. Redness 3. Swelling 4. Warmth |
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What process results in the generation of nociceptive pain?
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Inflammatory response
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What are two main bodily responses to nociceptive pain?
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1. Increased sympathetic response
2. Psychological affects - aversion and distress |
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Temporally, neuropathic pain either be ________ or ________.
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1. Delayed
2. Immediate |
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Immediate pain can often be seen when?
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Post-operatively
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What type of pain might seem bizzare and why?
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Neuropathic pain may seem bizzare because there is no redness or swelling associated with the pain. Stimuli might even evoke strong emotional reactions or reactions that don't seem in proportion to the pathology.
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What is the only reliable effect of neuropathic pain?
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Psychological effects, the rest are unreliable.
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What are two cardinal symptoms of neuropathic pain?
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1. Allodynia - pain from stimuli that are not usually considered painful
2. Hyperalgesia - exaggerated pain response from something that usually does evoke a pain response |
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What is pain from stimuli that are not usually considered painful?
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Allodynia
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What is an exaggerated pain response from something that usually does evoke a pain response?
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Hyperalgesia
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What type of dysfunction can be associated with neuropathic pain?
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Autonomic dysfunction - mainly bizzare sympathetic outflow
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What syndrome is seen in spinal cord injury patients that presents in an autonomic change contralateral stimulus?
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Harlequin Syndrome
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What are three manifestations of neuropathic pain?
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1. Autonomic dysfunction
2. Trophic changes 3. Motor impairment and neurological signs of impairment |
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What are five pain types associated with neuropathic pain?
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1. Compressive
2. Deaffertation 3. Central injury 4. Sympathetic nervous system injury 5. Inflammatory |
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Is compressive pain immediate or delayed?
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Immediate
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What type of neuropathic pain can be associated with compressive pain due to swelling along with pain caused by autoimmune disorders?
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Inflammatory pain
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What type of neuropathic pain is often seen in patients that lose part of an afferent signal, ie amputation?
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Deaffertation pain
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What type of neuropathic pain is associated with damage to the CNS?
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Central injury
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Is disruption as you get closer to the CNS greater or less than the disruption seen in peripheral damage?
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Greater the closer you get to the CNS
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What type of neuropathic pain is seen every time the ANS is fired up? What is a name for this syndrome?
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1. Sympathetic nervous system related pain
2. Complex regional pain syndrome |
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Is most neuropathic pain continuous or episodic throughout the day?
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Episodic
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When doing a neurological history of someone presenting with what seems like neuropathic pain, it is important to inquire what?
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The reasons for the nerve injury
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What percentage of the time is there a definable reason for neuropathic pain?
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90%
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What three things must be done during a neurological exam for neuropathic pain?
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1. Confirm the neurologic function
2. Indicate that there is an actual change in the nervous system 3. Look for autonomic changes |
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What type of fibers are more easily tested?
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1. Alpha-delta
2. Alpha-beta |
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Can there be different combinations of nociceptive pain and neuropathic pain? What problem does this present?
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1. Yes
2. Descerning between the two types of pain |
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What are three theories of why we have neuropathic pain?
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1. Angry backfiring C Fibers
2. Central sensitization 3. Microglia release irritating substances |
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What type of pain do you consider acute pain to be? What are two treatments for this type of pain?
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1. Acute
2. Traditional analgesics 3. Treat the problem |
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What is unique about the acute pain treatment continuum?
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You do not use the most effective treatment first. Instead you use the least invasive treatment first.
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Besides using traditional analgesics, what can you use to treat nociceptive pain(4)?
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1. Opioids
2. NSAIDs/Cox2 inhibitors 3. Corticosteroids 4. Adjuvants with mixed pain |
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Opiates are derived from what?
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Opioids
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If drugs are in the same family they usually have the same what? What about them differs (4)?
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1. Effects
2. Different potency, route, duration and side effects |
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Can people become tolerant to opioids?
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Why yes they can.
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What are the two main sites for opioid action? Name any sublocations for said sites.
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1. Supraspinal
2. Spinal - primary afferent neurons, dorsal horn, peripheral |
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What are the advantages of central delivery of a drug?
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1. Same efficacy with smaller dose
2. Fewer side-effects |
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What are the 6 parts of an opioid treatment for someone who has chronic pain?
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1. Time-contingent dosing
2. Improve function not pain 3. Contact family about addictive nature of drugs 4. Long lasting formulations 5. Use with metastatic cancer patients 6. Continuous dosage for people having trouble with oral dosage |
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What are three types of anti-inflammatories? What is the main side-effect of this classification of drugs?
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1. Corticosteroids
2. Non-specific cyclooxygenase inhibitors 3. Cox-2 inhibitors 4. Supressed immune system |
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What type of neuropathic treatment is used with post-traumatic neuralgia?
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Anti-convuslants
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What type of neuropathic treatment is used with pain related to diabetes?
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Antidepressants
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Do older antidepressants or newer antidepressants work better in adjuvant therapy?
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Older ones such as amitriptyline and imipramine
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Besides anticonvulsants and antidepressants, what other classes of drugs are used in adjuvant therapy?
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Anti-arrhythmic and antispastic agents
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What are some "other" therapies for pain?
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1. Stimulators
2. Blocks 3. Injection therapy 4. Psychological treatment |
