Nsp Week 2: Neuropathic Pain (Gordon)

Front 1

What term is defined as an unpleasant, abnormal sensation, whether spontaneous or evoked?

Back 1

Dysesthesia

Front 2

Pain due to a stimulus that normally does not provoke pain is known as..?

Back 2

Allodynia

Front 3

What is neuralgia?

Back 3

Pain in the distribution of a nerve or nerves

Front 4

A painful syndrome characterized by an abnormally painful reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold is known as...?

Back 4

Hyperpathia

Front 5

Describe the clinical manifestations of neuropathic pain

Back 5

1. Prominent dysthesias and hyperpathia, occurring paradoxically in an area of hypesthesia
2. Burning, lancinating, or shock-like character
3. Allodynia caused by light touch, clothing, breeze..
4. Usually NOT associated with inflammation
5. Atrophy, weakness, hairloss (if peripheral)

Front 6

List 6 causes of peripheral neuropathic pain.

Back 6

1. Polyneuropathy
2. Trigeminal neuralgia
3. Postherpetic neuralgia
4. Spinal stenosis
5. Compressive mononeuropathies
6. Post-amputation phantom pain

Front 7

List 4 causes of central neuropathic pain

Back 7

1. Poststroke
2. Multiple sclerosis
3. Tumor (brain or spinal cord)
4. Trauma (brain or spinal cord)

Front 8

Polyneuropathy is also called..?

Back 8

Peripheral neuropathy

Front 9

List 5 causes of polyneuropathy

Back 9

1. Diabetes mellitus
2. Chemotherapy
3. B12 deficiency
4. Alcoholism
5. HIV

Front 10

What kind of distribution of neuropathic pain is seen in polyneuropathy?

Back 10

Stocking distribution
(both feet)

Front 11

Trigeminal neuralgia typically involves which divisions of CN V?

Back 11

V2 or V3

Front 12

List 2 causes of trigeminal neuralgia

Back 12

1. Compression
2. Multiple sclerosis

Front 13

Describe the quality of pain experienced in polyneuropathy

Back 13

Burning

Front 14

Describe the quality of pain experienced in trigeminal neuralgia

Back 14

Lancinating

Front 15

Dermatomal neuralgia, blisters, and scabs are signs of what type of infection?

If pain persists for >30 days (long after acute infection resolves) what is the likely diagnosis?

Back 15

Shingles (herpes zoster)

Postherpetic neuralgia

Front 16

Does postherpatic neuralgia ever resolve?

Back 16

Yes

Front 17

What causes spinal stenosis?

Back 17

Compression of cauda equina with resultant bilateral sacral radiculopathy

Front 18

Describe the signs and symptoms seen with spinal stenosis

Back 18

1. Neurogenic (pseudo-) claudication (position-related calf pain)
2. Saddle anesthesia, dysesthesias, allodynia
3. Bladder (LMN), bowel, sexual dysfunction

Front 19

List 4 compressive mononeuropathies.

In all cases, what is the most effective therapy?

Back 19

1. Median neuropathy
2. Ulnar neuropathy
3. Lateral femoral cutaneous neuropathy (meralgia paresthetic)
4. Sciatic neuropathy (sciatica)

*Removing the compression is the most effective therapy

Front 20

Sudden changes in weight or a tight girdle belt may result in what type of neuropathic pain?

Back 20

Compressive mononeuropathy

Front 21

Central poststroke pain usually occurs how many weeks after a stroke?

Back 21

2 - 4 weeks AFTER stroke
(not at onset)

Front 22

Which type of neuropathic pain may be associated with thalamic pain?

Back 22

Central postroke pain

Front 23

Thalamic pain is also known as ___________ syndrome

Back 23

Dejerine-Roussy syndrome
(associated w/ central postroke pain)

Front 24

What type of therapies are most effect in altering neuronal activity?

Back 24

1. Antidepressants
2. Antiepileptic drugs

Front 25

How long does it take for each dose of neuropathic pain meds to work?

Back 25

2 - 4 weeks

Front 26

List 5 classes of antiepileptic drugs used for treatment of neuropathic pain

Back 26

1. Gabapentin
2. Pregabalin
3. Carbamazepine
4. Oxcarbazapine
5. Lamotrigine

Front 27

List 3 classes of antidepressants that are used for treatment of neuropathic pain

Back 27

1. Amitriptyline
2. Nortriptyline
3. Duloxetine

Front 28

What is the general MOA of gabapentin and pregabalin?

Back 28

Bind to Ca2+ channels

Front 29

What is the general MOA of Carbamazepine and oxcarbazepine?

Back 29

Slow recovery of inactivated Na+ channels

Front 30

What is the general MOA of lamotrigine?

Back 30

1. Slows recovery of inactivated Na+ channels
2. Decreases glutamate release via effect on Na+ channels

Front 31

What is the MOA of the antidepressants used to treat neuropathic pain?

Back 31

Block presynaptic uptake of serotonin and NE, resulting in increased levels of serotonin and NE

Front 32

List 3 prominent side effects of tricyclic antidepressants.

Back 32

1. Sedation (antihistamine)
2. Constipation (anticholinergic)
3. Weight gain

Front 33

Which neuropathic pain medication is very affordable, but has low patient compliance due to TID dosing?

Back 33

Gabapentin

Front 34

Which 4 neuropathic pain medications have BID dosing?

Back 34

1. Pregabalin
2. Carbamazepine
3. Oxcarbazepine
4. Lamotrigine

Front 35

Which 2 neuropathic pain medications have QHS dosing?

Back 35

(taken each night)

1. Amitriptyline
2. Nortryptyline

Front 36

How often should Duloxetine be taken?

Back 36

daily

Front 37

List 3 surgical and interventional options for treating refractory neuropathic pain

Back 37

1. Dorsal root entry zone (DREZ) lesioning
2. Epidural steroid injections
3. Nerve blocks

Front 38

List 2 typical causes of complex regional pain syndrome

Back 38

1. Limb immobilization
2. Nerve injury

Front 39

Neuropathic pain and focal dysautonomia are associated with which syndrome?

Back 39

Complex regional pain syndrome

Front 40

List some clinical features associated with complex regional pain syndrome

Back 40

1. Sensory (chronic pain, allodynia, hyperalgesia)
2. Vasomotor (changes in skin blood flow, temperature, color)
3. Sudomotor (edema, sweating changes)
4. Trophic (changes in skin, hair, nails)

Front 41

List 2 radiologic features of complex regional pain syndrome

Back 41

1. X-ray--> patchy osteoporosis
2. Nuclear bone scan --> increased uptake/metabolism in joints

Front 42

What is the cause of CRPS Type 1?

Back 42

Limb immobilization

Front 43

What is the cause of CRPS Type 2?

Back 43

Nerve injury

Front 44

List 4 general treatments for complex regional pain syndrome

Back 44

1. Sympathetic neural blockade
2. Medications
3. Physical therapy
4. Psychotherapy

Front 45

What types of medications can be used to manage complex regional pain syndrome?

Back 45

1. NSAIDs
2. Neuropathic pain meds
3. Antihypertensive agents