Pain

Question 1

What is pain?

Answer 1

An unpleasant sensory and emotional experience, associated with actual tissue damage

Question 2

What is the pathway for pain?

Answer 2

1-Pain stimulus
2- a-delta and c-fibre
3-Synapse in spinal cord
4-Substance P and glutamate released
5-Goes to the thalamus and somatosensory cortex
6-However, travels there via amygdala which “alarms” your brain

Question 3

All pain serves a protective function TRUE/FALSE

Answer 3

FALSE
acute pain serves a protective function
In chronic pain it no longer serves a useful purpose

Question 4

What is nociceptive pain?

Answer 4

Appropriate physiological response to a painful stimulus via the intact nervous system

Question 5

What is neuropathic pain?

Answer 5

Inappropriate response caused by a dysfunction in the nervous system

Question 6

TRUE/FALSE

Chronic pain is associated with morphological changes in the CNS

Answer 6

TRUE

Question 7

What are symptoms of neuropathic pain?

Answer 7

Shooting/burning sensations
Tingling/numbness
Allodynia
Hyperalgesia

Question 8

What is allodynia?

Answer 8

Pain produced in response to a not normally painful stimulus e.g. light touch, cotton wool

Question 9

What is 1st line to treat trigeminal neuralgia?

Answer 9

Carbamazepine

Question 10

What are the 3 drugs that can be used for neuropathic pain?

Answer 10

Amitriptyline
Duloxetine
Gabapentin/pregabalin

Question 11

What is complex regional pain?

Answer 11

Chronic condition, causes neuropathic pain, usually after surgery/minor injury, usually affecting arm/leg

Progressive disproportionate pain, swelling, skin changes and motor dysfunction (tremor or dystonia)

Question 12

Management of complex regional pain

Answer 12

Physiotherapy and amitriptyline

Question 13

Neuropathic pain occurs most commonly due to lesions where?

Answer 13

Thalamic

Question 14

What does post stroke pain look like?

Answer 14

Mild, rapidly improving hemiplegia with initial paraesthesia
followed in weeks-months by allodynia

Question 15

What type of pain do NSAIDs act on?

Answer 15

Nocioceptive

Question 16

What are the classic NSAID S/E?

Answer 16

GI irritation/bleeding
Renal toxicity
Potential drug-drug
Cardiovascular S/E

Question 17

What is the efficacy of non-opioid analgesia e.g. paracetamol?

Answer 17

Analgesic and antipyretic effects

Non inflammatory action

Question 18

Name 2 weak and 2 strong opioids

Answer 18

Weak–> Tramadol and codeine

Strong–> Morphine and Oxycodone

Question 19

What are opined analgesics mainly effective in?

Answer 19

Nociceptive pain

less effective in chronic states

Question 20

How do opioids work?

Answer 20

Activate the endogenous analgesic system

Question 21

What are side effects of chronic use of opiod analgesics?

Answer 21

Opiod induced hyperalgesia (can end up with more pain)
Libido issues
Immune modulatory issues

Question 22

What are TCA’s effective in?

Answer 22

Neuropathic pain
Complex regional pain syndrome
Tension headaches

Question 23

What are some classic S/E of TCAs?

Answer 23

Constipation
Dry mouth
Somnelence
Abnormalities in HR and rhythm
Insomnia
Increased appetite

Question 24

ARE THE RUMOURS TRUE?

SNRIs are better analgesics than SSRIs

Answer 24

GIRL THEY ARE TRUEEE

Question 25

What are antidepressants mode of action?

Answer 25

Selectively inhibit reuptake of noradrenaline or serotonin or both

Question 26

What is the mode of action of gabapentin?

Answer 26

Binds to presynaptic voltage-gated dependent calcium channels

Question 27

What is the mode of action of pregabalin?

Answer 27

Interacts with special N-type calcium channels

Question 28

Carbamazepine mode of action?

Answer 28

Blocks Na+ and Ca2+ channels

Question 29

How do topical analgesics work?

Answer 29

Reduce pain impulses transmitted by the delta fibres and c fibres