2nd Principles > Pain > Flashcards

Pain Flashcards

Unit 2 (70 cards)

Study These Flashcards
1
Q

What is somatic pain?

A

it can be superficial from the skin or deep from the muscles, joints, tendons or bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is visceral pain?

A

either localized (parietal) pain or referred pain from an area surrounding the organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why do we have referred pain?

A

this cutaneous pain is the result of patterns of embryological development and migration of tissues and the convergence of visceral and somatic afferent input into the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three states or phases of pain?

A
  1. acute pain
  2. chronic nociceptive pain
  3. neuropathic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some “red flags” associated with pain?

A

pain that wakes patient up
immunosuppression
severe or progressive neurologic deficit
cold, pale or mottled limb
new bowel or bladder dysfunction
severe abdominal pain or signs of shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the specificity theory of pain?

A

a theory hypothesized by Rene Descartes that suggests that the intensity of pain is directly related to the amount and degree of tissue injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who believed pain is more of an emotional experience rather than a sensory one?

A

Plato

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What theory related to pain helped to explain complexities of pain especially in regards to chronic pain?

A

The gate control theory of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does the gate control theory of pain state?

A

pain transmission is modulated by impulses that are transmitted to the spinal cord and there are separate inhibitory interneurons in the substantia gelatinosa (of the dorsal horn) that act as a gate that regulates transmission to the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give a few examples of inflammatory mediators that are released from surgical incisions that are capable of causing acute pain…

A

bradykinins
prostaglandins
serotonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where are first, second and third order neurons located in the pain transmission pathway?

A

First: from the periphery, terminate in the dorsal horn of the spinal cord
Second: crosses over to the contralateral side of the SC and ascends from the spinothalamic tract to the thalamus
Third: from the thalamus to the somatosensory cortex (postcentral gyrus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A-delta fibers… are they myelinated? How big? How fast?

A

myelinated
large diameter
fast signal transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

C fibers… are they myelinated? How big are they? How fast?

A

NOT myelinated
small diameter
slow signal transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the four elements of pain processing?

A

Transduction
Transmission
Modulation
Perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the difference between signal transduction and transmission?

A

transduction is taking the noxious stimuli and converting it into an action potential
transmission occurs when the action potential is conducted through the nervous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is pain modulated?

A

via afferent neurons in the pain transmission pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where is pain perceived?

A

in the somatosensory cortex and the limbic system (emotional response to pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define allodynia

A

pain from a stimulus that does not normally evoke pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define hyperalgesia

A

an exaggerated response to a normally painful stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What type of pain is characterized by allodynia and hyperalgesia?

A

Neuropathic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is primary hyperalgesia?

A

augmented sensitivity to a painful response or misinterpretation of non-painful stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is secondary hyperalgesia?

A

This occurs as a result of the increased excitability of neurons to glutamate activation of NMDA receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What analgesic can cause hyperalgesia? What can should you give to combat this?

A

Remifentanil, give with Ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the negative symptom of neuropathic pain? Positive symptoms?

A

negative: numbness
positive: burning, shooting pain, or dull aching pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is one benefit of opioids versus non-opioids?
no ceiling effects increased doses of non-opioids can have adverse effects
26
What are the benefits of non-opioids over opioids?
less likely to cause addiction, dependence no tolerance don't act centrally (no respiratory depression) anti-inflammatory
27
What response is elicited from Mu receptor activation?
analgesia, respiratory depression, euphoria, reduced GI motility
28
What responses are elicited from Kappa receptors?
analgesia, dysphoria, delusion/delirium, miosis, respiratory depression
29
what response is elicited from Delta receptors?
analgesia
30
How do opioids work?
by binding to 4 different endogenous opioid receptors (Mu1, Mu2, Kappa, Delta) and reduce the perception of pain
31
What are some benefits of codeine over morphine?
better absorbed orally
32
Why do we avoid using codeine in children less than 12?
they lack the enzyme to break down the drug and can experience side effects with no analgesia
33
What is tramadol? Is it highly protein bound?
A synthetic opioid that targets mu, kappa and delta receptors. Only 20% protein bound.
34
When is tramadol contraindicated?
in patients with seizure disorders
35
What is the oral requirement for dosing morphine as opposed to IV dosing?
PO: 3x IV dose
36
What is a major complication of morphine?
causes histamine release which can lead to hypotension (caution if patient is already hypotensive)
37
What are a few good things about oxycodone?
Onset is less than 1 hour and patients can experience pain relief for 6-12hr (good at getting patients to a steady state of pain relief)
38
What receptors does Oxycodone work on?
Mu and Kappa receptors
39
What is Methadone?
a synthetic broad-spectrum opioid (mixed agonist and antagonist) good for weaning people off more potent and addictive opioids (long duration of action)
40
What receptors does Methadone target?
it is a weak non-competitive NMDA receptor antagonist affinity for Mu receptors
41
Methadone metabolism can be increased by CYP450 inducers like....
carbamazepine, antiretrovirals and grapefruit juice
42
How long does it take to get to an appropriate dose for methadone?
5-10 days
43
Why do we like Fentanyl in anesthesia?
fast onset, potent, short half-life, available in multiple forms
44
What is a standard dose of Hydromorphone (Dilaudid)?
0.5 -1mg at a time (IV)
45
What is a standard dose of methadone?
10mg PO
46
What is hydrocodone?
a semi-synthetic opioid (codeine derivative). Almost always combined with acetaminophen (Norco, Vicodin)
47
What are the two most highly abused opioids?
oxycodone and hydrocodone
48
What is different about hydrocodone from oxycodone?
it has a shorter half life (less long acting pain relief than Oxy)
49
Which opioid's effects are potentiated by magnesium and calcium channel blockers?
Hydrocodone
50
What is Buprenorphine? What receptors does it work on?
a semi-synthetic agonist-antagonist opioid that works on mu (agonist) and kappa (antagonist) receptors. Also a weak delta receptor agonist. (Less severe side effects)
51
What is the half-life of buprenorphine?
half-life: 1-3 days
52
Why is buprenorphine a good medication for weaning people off opioids?
Targets multiple receptors for pain but does not produce a high. Can be administered multiple different routes (transdermal, transmucosal, oral)
53
What are some ways we as providers can avoid excessive side effects associated with opioid use?
Choosing medications that hit multiple receptors or do more than one thing rotate opioids use other pharmacologic and non-pharmacologic interventions
54
List a few adjuvant medications we can prescribe for pain relief (drug classes and examples)
antidepressants (TCA's for nerve pain) anticonvulsants (like Gabapentin) skeletal muscle relaxants topical cream
55
Name a few non-pharmacologic solutions for pain relief...
PT relaxation techniques hypnosis acupuncture nerve blocks heat/cold psychotherapy stretching/yoga
56
How quickly can tolerance build up to analgesia with opioids?
After a single dose (desensitization)
57
What are some common unwanted side effects of opioids?
N/V, dizziness, urinary retention, constipation, exacerbation of OSA, dysphoria
58
Opioids decrease ventilation two ways... how?
1. They act on mu and delta receptors in the respiratory control centers of the CNS and decrease their responsiveness to rising CO2 levels and decreasing O2 levels 2. They also activate laryngeal adductor muscles and depress laryngeal abductor muscles leading to an upper airway obstruction
59
How does chronic opioid use lead to opioid induced hyperalgesia?
Chronic opioid consumption produces central sensitization and activate mu receptors which increases effectiveness of glutaminergic synapses at NMDA receptors
60
What's beneficial about using ketamine in opioid free analgesia?
It is an NMDA receptor agonist that decreases the need for opioids post-operatively. Also has anti-hyperalgesic, anti-allydonic and anti-tolerance effects and less PONV
61
How do gabapentoids such as pregabalin and gabapentin work on pain?
acts on Calcium channels to inhibit neuronal calcium influx which reduces the release of excitatory NT's like glutamate, substance P, and calcitonin which suppresses excitability after tissue damage.
62
What dose of gabapentin results in an analgesic ceiling effect?
600 mg
63
How does IV Lidocaine work for post-operative pain?
is a Na channel blocker that inhibits spontaneous impulses generated from injured nerve fibers. Also has anti-inflammatory properties.
64
What type of surgery is IV Lidocaine most useful for? Why?
Abdominal surgeries. Can reduce opioid-related unwanted side effects and postoperative ileus. Can prevent post-op abdominal pain up to 72hr
65
How does Magnesium work to decrease pain?
Mag Sulfate is a non-competitive NMDA antagonist by blocking more Ca and Na ions from entering NMDA receptors this prevents depolarization and transmission of pain signals
66
What are the typical loading dose and maintenance doses of Magnesium Sulfate?
Loading dose: 30-50 mg/kg Maintenance dose: 6-20 mg/kg/hr until end of surgery
67
How do alpha-2 agonists, like dexmedetomidine and clonidine, help to decrease post-operative opioid use?
alpha-2 receptors are present on both pre and post-synaptic neurons in the CNS and PNS. They are very dense in the locus coeruleus of the brainstem which is an important site of pain modulation. They are also present in the substantia gelatinosa of the dorsal horn and inhibit nociceptive neurotransmission.
68
What is a loading dose and maintenance dose for dexmedetomidine for analgesia?
loading dose: 0.5 mcg/kg over 10 min maintenance dose: 0.1-0.3 mcg/kg/hr
69
How much more specific is dexmedetomidine for alpha-2 receptors than clonidine?
8x more specific
70
How might beta blockers like Esmolol decrease opioid use in the perioperative period?
Esmolol decreases the HR and thereby decreases CO and hepatic blood flow, this slows down the metabolism of opioids.
2nd Principles
flashcards
Decks in class (14)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions