Chronic Pain Management Flashcards Preview

Neurology > Chronic Pain Management > Flashcards

Flashcards in Chronic Pain Management Deck (20):
1

what is pain

an unpleasant sensory and emotional experience, associated with actual tissue damage or described in terms of such damage

2

what is the pathway of pain

latertal spinothalamic tracts
a delta/ c fibres
lamina I and V
V- thalamus, somatosensory cortex= sensory
I- parabrachial, amygdala hypothalamus = attention/ affective (creates emotional aspect of pain)

3

how does peripheral tissue injury change the nervous system

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

4

what are the features of chronic regional pain syndrome

allodynia- pain in response to non painful stimulus
hyperalgesia
swelling
blue, white, red skin colour changes
hair and nail changes (both can become hyperkeratotic)
osteopenia

5

what are the main types of pain

nociceptive- from injury via normal nervous syste,
neuropathic- generated within the nervous system

others ic flammatory pain
also mixed pain

6

what does neuropathic pain feel like

burning, shooting, tingling, sensitivity - allodynia and hyperalgesia

7

what is seen on examination in neuropathic pain

sensory changes

8

what are the common causes of neuropathic pain

shingles (post herpetic neuralgia)
surgery
trauma
diabetic neuropathy
amputation

9

what is the drug management for neuropathic pain

tricyclic antidepressants (amitriptyline)
anticonvulsants (gabapentin)
opioids (morphine)
NMDA antagonists (ketamine)
sodium channel blockers (lignocaine)
capsaicin
GABA agonists (baclofen)

10

what drugs are used in childrens neuropathic pain

topical:
-levomenthol
-capsaicin
-lidocaine

tricyclics (amitriptyline)
gabapentin/ pregabalin

11

what are the causes of chronic pain in cancer survivors

post surgical pain
chemotherapy (induces peripheral neuropathies)
chronic graft vs host disease
radiation induced pain syndrome
hormonal therapy and arthralgias

12

what are the non drug methods of pain relief

TENS
acupuncture
nerve blocks
intrathecal drug delivery systems
spinal cord stimulation
physiotherapy
occupational therapy
psychology

13

what drugs are commonly used for chronic pain

Tricyclics
Gabapentin or Pregabalin
Carbamazepine
Duloxetine
Lidocaine (patch)
Opioids
Ketamine (memantine)
Cannabinoids

14

what is progression from acute pain to chronic linked with

child anxiety and parental catastrophising (fear of pain), depression, and sleep quality

15

what is erthromalagia

burning in hand and feet due to dysfunctional v gated sodium channels

16

what are SCN9A diseases

problems in voltage gates sodium channels
mutation- paroxysmal extreme pain disorder
dysfunctional- congenital inability to express pain

17

what type of amputation in more conducive to phantom pain

delayed amputations

18

what happens in brain after amputations

remapping of sensory homunculus

19

what are opioids good and bad for

effective for pain
esp nociceptive pain

less good for neuropathic pain
some pain not opioid sensitive
not good for fibromyalgia
dependence

20

what are the side effects of opioids

hormonal (adrenal, libido)
immunomodulation
hyperalgesia