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Neurology > Management of Chronic Pain > Flashcards

Flashcards in Management of Chronic Pain Deck (18):
1

what is pain?

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

2

what fibres transmit painful stimulus from skin to spinal cord?

a-delta
c-fibre

3

what is released in spinal cord?

substance P and glutamate released to lamina I and V

4

what in the brain in associated with sensory pain perception?

lamina V projects stimulus to thalamus which signals to somatosensory cortex

5

what in the brain is associated with affective pain perception (attention to pain)?

lamina I projects stimulus to parabrachial which signals to amygdala hypothalamus

6

peripheral tissue injury changes the nervous system in what two ways?

peripheral sensitisation - a reduction in the threshold of peripheral afferent nociceptors

central sensitisation - increased excitability of spinal neurones, rewiring in spinal cord and changes in the brain

7

what are 6 characteristics of chronic regional pain syndrome?

allodynia
hyperalgesia
swelling
colour changes
hair and nail changes
osteopenia

8

what is nociceptive pain?

pain from injury relayed through a normal NS

9

what is neuropathic pain?

pain generated within nervous system

10

what does neuropathic pain feel like?

burning, shooting, tingling, sensitivity

11

what is seen on examination in neuropathic pain?

sensory changes

- allodynia (pain from stimulus that not normally painful eg cotton wool)

- hyperalgesia (more pain than expected from painful stimulus eg pin prick)

12

what are common causes of neuropathic pain?

shingles
post herpetic neuralgia
surgery
trauma
diabetic neuropathy
amputation
many unknown origin

13

how can neuropathic pain be biologically managed?

tricyclic antidepressants - amitriptyline

anticonvulsants - gabapentin

also opioids, NMDA antagonists, sodium channel blockers, capsaicin and GABA agonists

14

what drugs are more often used in children?

topical levomenthol

topical capsaicin

lidocaine patch

tricyclics - amitriptyline

gabapentin or pregabalin

15

what can cause chronic pain in cancer survivor?

post surgical pain
chemo induced peripheral neuropathy
chronic graft vs host disease
radiation induced pain
hormonal therapy and arthralgias

16

other than medication, what else could be used in chronic pain?

TENS
acupuncture
nerve blocks
intrathecal drug delivery systems
spinal cord stimulation

17

what gene could contribute to chronic pain?

SCN9A if absent - no pain
SCN9A if abnormal - increased pain

18

what are potential side effects of opioids?

hormonal (adrenal, libido)
immunomodulation
hyperalgesia (OIH)