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Flashcards in Pain Management Deck (19)
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1
Q

is chronic pain recognised as a chronic disease?

A

yes

2
Q

Pain sensation pathway?

A

stimulus on skin > A delta and C fibres > glutamate and substance P released onto laminae 1 and 5 > fibres travel to thalamus > fibres travel to somatosensory cortex

3
Q

emotional/affective pathway of pain?

A

fibres from laminae 1 and 5 > parabrachial > amygdala hypothalamus > attention

4
Q

what causes pain after injury?

A

peripheral tissue injury changes nervous system in 2 ways

  • peripheral sensitisation (reduction in threshold of peripheral afferent nociceptors)
  • central sensitisation (increased excitability of spinal neurones, rewiring in spinal cord, changes in brain)
5
Q

chronic regional pain syndrome?

A

chronic pain in one limb lasting over 6 months

unknown cause, probably genetic component

6
Q

features of chronic pain syndrome?

A
allodynia
hyperalgesia
swelling
blue/red/white areas
hair and nail changes
osteopenia (pre osteoporosis)
7
Q

2 main categories of pain?

A

nociceptive (normal reaction to painful stimulus)
neuropathic (nervous system behaving abnormally)
others exist and can also be mixed

8
Q

description of neuropathic pain?

A

burning
shooting
tingling
sensitivity

9
Q

2 main features of neuropathic pain?

A

allodynia and hyperalgesia

10
Q

common causes of neuropathic pain?

A
shingles
post herpetic neuralgia
surgery
trauma
diabetic neuropathy
amputation
11
Q

how is neuropathic pain managed biologically?

A
tricyclic antidepressants (amitriptyline)
anticonvulsants (gabapentin, pregabalin)
opioids
NMDA antagonists (Ketamine)
sodium channel blockers (lignocaine)
capsaicin
GABA agonists (baclofen)
12
Q

what drugs are more often used in children?

A

topical levomenthol and capsaicin
lidocaine patch
tricyclics (amitriptyline)
gabapentin/pregabalin

13
Q

what can commonly cause chronic pain in cancer patients?

A
post surgery
chemo induced (peripheral neuropathies)
chronic graft vs host disease
radiation induced pain
hormonal therapy and arthralgias
14
Q

what procedures can be used in chronic pain?

A
lidocaine infusions
epidural steroids
facet denervation after test
stellate ganglion block
guanethidine block
15
Q

how are genetics involved in chronic post surgical pain?

A

40-50% inherited
SCN9A may be involved
- no pain if absent
- increased pain if abnormal

16
Q

who is most likely to progress to chronic post surgical pain?

A

may be related to childhood anxiety, depression and parental catastrophising
more severe post op pain = more likely to become chronic

17
Q

chronic pain in amputation?

A

immediate amputation = less likely to have chronic pain than delayed amputation

18
Q

opiates are more useful in which category of pain?

A

nociceptive

not as much in neuropathic

19
Q

side effects of long term opiate use?

A

hormonal (adrenal, libido)
immunomodulation
hyperalgesia (OIH)