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23 Cards in this Set

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Define pain
unpleasant sensory & emotional experience assoc w/ actual or potential tissue damage, or described in terms of such damage.
What is the main reasons patients go to their doctor.
Reassurance.
What are the 3 types of pain patterns?
1. Paresthesias (pins & needles, abnl sensation, spontaneous or evoked)
2. Dysthesias (painful paresthesias, unpleasant)
3. Hyperpathias (too much pain, an abnl intense pain secondary to repetitive stimulus)
In which common condition does one get peripheral & distal neuropathy (starts distally & moves inward)?
Diabetes Mellitus
What are the three pain syndrome categories?
1. Neuropathic
2. Nociceptive
3. Idiopathic (most common, we don't know cause)
What do you think of with Neuropathic Pain? What is the cause of this pain?
NUMBNESS, TINGLING, BURNING. (need to do nerve conduction study--check for DM)
Its a result of aberrant somatosensory activity in either PNS or CNS-->NS LESION. Characterized by paroxysmal shooting, electrical shock-like pain, background of burning or constricting sensations, 'dysethesias'.
What is the cause of nociceptive pain and what is this pain characterized as?
Nociceptive pain is a result of chemical (nerve/muscle breakdown), thermal, or mechanical activation of nociceptive afferent receptors-TISSUE DAMAGE. Described as constant, aching, gnawing.
What are some examples of nociceptive pain?
Arthritis, mechanical low back pain, sport/exercise injuries, postoperative pain.
What are some examples of neuropathic pain?
PHN, Neuropathic low back pain, trigeminal neuralgia, central poststroke pain, complex regional pain syndrome, distal HIV polyneuropathy.
What are the 2 categories of nociceptive pain?
1. Somatic Nociceptive: well localized path in skin, muscles, fascia, bones
2. Visceral Nociceptive: poorly localized.
Describe idiopathic pain.
Psychogenic pain--any pain syndrome thats perceived by doc to be excessive for degree of organic pathology. Often misinterpreted as malingering. Dx dependent on physical knowledge of pain medicine (Waddel's sign)
What is the difference b/w acute & chronic pain?
Chronic lasts longer than 6 months.
What are some diagnoses of non-malignant pain?
RA (inflammation unlike osteo), OA (cartilage breakdown), Sickle Cell Dz, Diabetic Peripheral Neuropathy, Post-Herpetic Neuralgia, HA (get CT scan of brain), Low Back Pain.
Pain can be modulated by which neurotransmitters?
GABA, NE, 5-HT, NMDA
What are the 2 main categories of pain management?
Pharmacological and non-pharmacological. One is equally as important as the other.
What are some examples of non-pharmacologic interventions for pain?
1. Anesthesia & Surgical Procedures (Epidurals, selective nerve blockers, extradural rhizotomy, neuroma excition, sympathectomy).
2. Cognitive-Behavioral Intervention: Education/Instruction, Relaxation, Imagery, Distraction (eg Music), Biofeedback,
3. Physical Agents (heat, cold, transcutaneous nerve stimulation, acupuncture, exercise.
What are the three categories of analgesics?
1. Non-Opioid
2. Opioid
3. Adjuvant.
What are 2 examples of non-opiods?
1. Acetaminophen
2. NSAIDS
What are three examples of opioids?
1. Morphine (used in ER)
2. Darvocet (toxicity to liver, kids)
3. Tramadol (Ultram--often put in w/ COX-2)
[Demerol not used b/c short half-life. Oxycontin is short acting]
What are adjuvant analgesics?
Drugs whose primary indication is for something other than pain. Have been shown to have analgesic properties--anecdose, animal, pt trials.
What is the WHO's Analgesic Ladder?
Ring I Mild Pain-->Non-Opioid Adjuvant, Rung II Moderate Pain-->'Weak' Opioid, Rung III Severe Pain-->'Strong' Opioid
What is Venlafaxine/Effexor XR used for?
People with pain, sleep problems, depression. (Antidepressants downregulate pain receptors @ low dose & depression affects your sleep)
What is the 5th vital sign?
Pain
Final pts: Pain can't be treated until pain generator in identified