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Flashcards in Chronic Pain Deck (15):
1

What laminae in the spinal cord are involved in chronic pain?

Lamina 1
Lamina 5

2

Which neuronal fibres are involved in pain transmission?

A-delta
C-fibre

3

Which neurotransmitters are involved in pain transmission?

Substance P
Glutamate

4

Which areas of the brain are involved in the emotional side of pain?

Amygdala and hypothalamus

5

What are the 2 mechanisms to pain after an injury?

Peripheral sensitisation; a reduction in the threshold of peripheral afferent nociceptors
Central sensitisation; increased excitability of spinal neurones, rewiring in the spinal cord, changes in the brain

6

What are the symptoms of chronic regional pain syndrome?

Allodynia
Hyperalgesia
Swelling
Blue, red, white skin
Hair and nail changes
Osteopenia

7

What is nociceptive pain?

Pain from injury relayed through a normal nervous system

8

What is neuropathic pain?

Pain generated within the nervous system

9

How is neuropathic pain diagnosed?

History
Description; burning, shooting, tingling, sensitivity
Exam; sensory changes
Allodyina
Hyperalgeisa

10

What are common causes of neuropathic pain?

Shingles, post herpetic neuralgia
Surgery
Trauma
Diabetic neuropathy
Phantom limb

11

Management of neuropathic pain

Tricyclic antidepressants
Anticonvulsants
Opioids
NMDA antagonists; ketamine
Na+ channel blockers; lignocaine
Capsaicin
GABA agonists; baclofen

12

What is the mode of action of capsaicin?

Depletion of substance P

13

What is the mode of action of tricyclics?

Inhibits amine reuptake and so enhances inhibition from the brainstem to the spinal cord

14

What is the mode of action of gabapentin/pregabalin?

GABA analogues blocking voltage dependent calcium channels

15

What are common side effects of opioid overuse?

Hormonal; adrenal, libido
Immunomodulation
Hyperalgesia; opioid induced hyperalgesia