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Anesthesiology > Pain Management > Flashcards

Pain Management Flashcards

1
Q

Definition: Physiologic pain

A

Normal response to a noxious stimulus producing protective behavioral responses to potential actual tissue damage

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2
Q

Definition: Acute pain

A

Sudden onset of pain which may be severe but disappears when stimulus is removed

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3
Q

Definition: Chronic pain

A

Pain that lasts several weeks to months and persists beyond the expected healing time

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4
Q

Definition: Somatic pain

A

Originates from damage to bone, joint, muscle, or skin; well localized

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5
Q

Definition: Visceral pain

A

Originates form internal organs; poorly localized

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6
Q

Definition: Neuropathic pain

A

Originates from injury to the peripheral or central nervous system

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7
Q

Definition: Inflammatory pain

A

Originates from tissue damage

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8
Q

Definition: Referred pain

A

Originates from one part of the body but perceived as occurring in another

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9
Q

What is the pain pathway?

A
  1. Transduction- activation of receptors
  2. Transmission- communication of fibers
  3. Modulation- modification by the spinal cord
  4. Perception- conscious recognition of pain
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10
Q

What do mechanoreceptors respond to?

A

Stretching, compression, or crushing

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11
Q

What do thermoreceptors respond to?

A

Heat and cold

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12
Q

What do chemoreceptors respond to?

A

Chemicals- endogenous or exogenous

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13
Q

What are the two types of peripheral nerves that conduct pain?

A

A-delta fibers and C fibers

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14
Q

What kind of transmission do A-delta fibers perform?

A

Myelinated, fast transmission

Acute, accurately localized, sharp, rapid onset pain

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15
Q

What kind of transmission do C fibers perform?

A

Non-myelinated, slow transmission

Chronic, diffuse, dull, burning, aching pain

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16
Q

Describe the spinal cord pathway of pain

A

Afferent fibers (A-delta or C) –» Spinal cord through dorsal root –» Synapse in Lamina II in dorsal horn grey matter –» ascend via spinothalamioc and spinoreticular tracts –» brain

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17
Q

What is the primary excitatory/facilitory substances in the spinal cord and what are their receptors?

A

Substace P- NK1 receptor

Glutamate- AMPA, NMDA, kainate receptors

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18
Q

What is the primary inhibitory substances in the spinal cord?

A

GABA

endogenous opioids

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19
Q

Where does the spinothalamic tract terminate?

A

In the thalamus and somatosensory cortex

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20
Q

What does the spinothalamic tract transmit?

A

Easily localized, superficial pain

21
Q

How is the spinothalamic tract tested?

A

Brief skin pinch

22
Q

Where does the spinoreticular tract terminate?

A

Reticular formation

23
Q

What does the spinoreticular tract transmit?

A

Deep and visceral pain

24
Q

How is the spinoreticuclar tract tested?

A

Hemostats on the toenail bed to stimulate the periosteum

25
Q

Where is pain information received and inhibitd in the midbrain?

A

Periaqueductal grey matter

Nucleus raphe magnus

26
Q

What do the axons in the PAG and NRM release to inhibit pain?

A

endorphins, serotonin, and NE

27
Q

T/F: the PAG and NRM are the pharmacologic target for pain control.

A

True

28
Q

What nerve mediates pain in the head?

A

Trigeminal nerve (CN V)

29
Q

What are some systemic consequences of unmanaged pain?

A

Mainly stress response (increased sympathetic tone)

Classic manifestation of stress in all organ systems

30
Q

Definition: Allodynia

A

Pain evoked by a stimulus that does not normally cause pain

31
Q

Definition: Hyperalgesia

A

An increased/exaggerated response to a stimulus that is normally painful

32
Q

Where does primary hyperalgesia occur?

A

At the site of injury

33
Q

Where does secondary hyperalgesia occur?

A

Surrounding undamaged tissues

34
Q

Definition: Peripheral sensitization

A

An increase in the activity/excitability and responsiveness of peripheral nerve terminals leading to primary hyperalgesia

35
Q

Definition: Windup

A

Summation of painful stimulation in the spinal cord, mediated by C-fibers

Contributes of central sensitization

36
Q

Definition:

A

An increase in the activity/excitability and responsiveness in the central nerve system (spinal cord) leading to primary and secondary hyperalgesia and allodynia

37
Q

What is the reason for peripheral sensitization?

A

Lowered threshold for nociceptive fibers and activation of additional receptors Due to inflammation

38
Q

Where does windup occur?

A

Dorsal horn neurons

39
Q

Which receptors become active in the dorsal horn with windup?

A

NMDA receptors- available for binding by glutamate to increase pain transmission

40
Q

What does windup contribute to?

A

Central sensitization

41
Q

What is central sensitization due to?

A

Increase in dorsal horn excitability and decrease in inhibition at the spinal cord level (GABA activity)

42
Q

What does central sensitization result in? (4)

A
  1. Hyperalgesia
  2. Allodynia
  3. Spontaneous pain
  4. Pain memory
43
Q

Definition: Analgesia

A

Loss of sensitivity to pain

44
Q

Definition: Multimodal analgesia

A

Use of multiple drugs acting by different mechanisms to produce analgesia

45
Q

Definition: Preemptive analgesia

A

Administration of analgesic therapy before painful stimulation; prevents wind up

46
Q

What drugs block transduction?

A
  1. Topical LAs or cooling
  2. Injected LA
  3. Systemic NSAIDs
47
Q

Which drugs block transmission?

A

LA nerve blockade at peripheral/plexus or eipdural

48
Q

What drugs block/effect modulation?

A
  1. Opioids
  2. Alpha-2 agonists
  3. NSAIDs
  4. NMDA antagonists
49
Q

What drugs effect perception?

A
  1. Opioids
  2. Alpha-2 agonists
  3. General anesthetics

Anesthesiology (27 decks)

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