Flashcards in Chronic Pain Management Deck (20)
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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
