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23 Cards in this Set
- Front
- Back
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Define pain
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unpleasant sensory & emotional experience assoc w/ actual or potential tissue damage, or described in terms of such damage.
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What is the main reasons patients go to their doctor.
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Reassurance.
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What are the 3 types of pain patterns?
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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) |
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In which common condition does one get peripheral & distal neuropathy (starts distally & moves inward)?
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Diabetes Mellitus
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What are the three pain syndrome categories?
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1. Neuropathic
2. Nociceptive 3. Idiopathic (most common, we don't know cause) |
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What do you think of with Neuropathic Pain? What is the cause of this pain?
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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'. |
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What is the cause of nociceptive pain and what is this pain characterized as?
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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.
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What are some examples of nociceptive pain?
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Arthritis, mechanical low back pain, sport/exercise injuries, postoperative pain.
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What are some examples of neuropathic pain?
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PHN, Neuropathic low back pain, trigeminal neuralgia, central poststroke pain, complex regional pain syndrome, distal HIV polyneuropathy.
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What are the 2 categories of nociceptive pain?
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1. Somatic Nociceptive: well localized path in skin, muscles, fascia, bones
2. Visceral Nociceptive: poorly localized. |
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Describe idiopathic pain.
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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)
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What is the difference b/w acute & chronic pain?
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Chronic lasts longer than 6 months.
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What are some diagnoses of non-malignant pain?
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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.
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Pain can be modulated by which neurotransmitters?
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GABA, NE, 5-HT, NMDA
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What are the 2 main categories of pain management?
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Pharmacological and non-pharmacological. One is equally as important as the other.
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What are some examples of non-pharmacologic interventions for pain?
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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. |
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What are the three categories of analgesics?
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1. Non-Opioid
2. Opioid 3. Adjuvant. |
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What are 2 examples of non-opiods?
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1. Acetaminophen
2. NSAIDS |
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What are three examples of opioids?
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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] |
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What are adjuvant analgesics?
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Drugs whose primary indication is for something other than pain. Have been shown to have analgesic properties--anecdose, animal, pt trials.
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What is the WHO's Analgesic Ladder?
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Ring I Mild Pain-->Non-Opioid Adjuvant, Rung II Moderate Pain-->'Weak' Opioid, Rung III Severe Pain-->'Strong' Opioid
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What is Venlafaxine/Effexor XR used for?
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People with pain, sleep problems, depression. (Antidepressants downregulate pain receptors @ low dose & depression affects your sleep)
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What is the 5th vital sign?
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Pain
Final pts: Pain can't be treated until pain generator in identified |
