Pain Management 2

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Pain Management 2
2012-11-28 16:28:07
Clinical Practice ll

Clinical Practice ll
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  1. Pain pathway is a chain of _____ neurons.
  2. neuronal the neurons in the pain pathway?
    • first order neuron
    • second order neuron
    • third order neuron
  3. Where does the first order neuron originate?  Where does it carry the signal?
    • Originates in the periphery 
    • carries signal to the spinal cord
  4. Where does the second order neuron carry the signal?
    Carries the signal up the spinal cord
  5. Where does the third order neuron carry the signal?
    Carries the signal to the cerebral cortex
  6. What does the more complex level of pain pathway involve?
    Involves a network of branches and communication with other neurons (afferent, sensory) which modulate, or modify the transmission of painful stimuli
  7. Decribe the anatomy of a pain neuron.
    • Cell bodies - located in dorsal root ganglia 
    • nociceptors
    • fibers or axons
  8. What are nociceptors?
    Specialized nerve endings that detect painful stimuli 
  9. What do nociceptors signal?
    Actual or potential tissue injury
  10. What are the differen types of pain axons?
    • A - delta fibers
    • C - fibers
  11. Where are fibers or axons located?
    • Skin
    • peritoneum
    • pleura
    • periosteum
    • joint capsule
    • blood vessels
    • muscles
    • tendons
    • viscera
  12. What do A-delta fibers look like?
    • Large diameter
    • thinly myelinated axons
  13. A-delta fibers conduct impulses very _____.
  14. A-delta is considered the _____.
    first pain
  15. What do C-fibers look like?
    • Smaller
    • unmyelinated axons 
  16. How does the C-fibers transmit?
    Much slower 
  17. C-fibers are considered the _____.
    Second pain
  18. Where do the neurons interact?
    At synapses in spinal cord or brain
  19. What does nociceptions include?
    Transduction, transmission, modulation, and perception by the brain of pain 
  20. What is transduction?
    The translation of noxious stimuli into electrical activity at the peripheral nociceptor
  21. What is transmission?
    The propagation of nerve impulses through the peripheral nervous system 
  22. What is modulation?  Where does it occur?
    • Modification of pain impulses (inhibit or excite)
    • occurs in the dorsal horn of the spinal cord
  23. What is perception?  Where does it occur?
    • Conscious pain is experienced by the patient
    • occurs in cerebral cortex
  24. What are the different strategies of pain management?
    • Preemptive analgesia
    • multimodal analgesia
    • postoperative analgesia
  25. It is easier to _____ pain than to _____ pain.
    • Prevent
    • control
  26. What is the purpose of preemptive analgesia?  When do we use it?
    • Cannot eliminate post op pain but can help prevent peripheral and CNS sensitization during surgery 
    • makes patient easier to handle
    • decreases anesthetic requirements during surgery
  27. What's another term for multimodal analgesia?
    Balanced analgesia
  28. What is multimodal analgesia?
    Simultaneous administration of two or more analgesic drug classes or techniques
  29. Combination multimodal analgesia often have what?  What does this do?
    • Combinations often have additive or synergistic effects
    • doses can be lowered and minimizes risk of side effects
  30. What are the different mechanisms that the inhibition of nociception that can be achieved at the different points of the pain pathway?
    • Transduction
    • transmission
    • modulation
    • perception
  31. What does transduction do in the multimodal analgesia?  Which pain meds do this?
    • Inhibits peripheral sensitization of nociceptors
    • local anesthetics, opioids, NSAIDS, corticosteroid 
  32. What is transmission in multimodal analgesia?  Which pain meds do this?
    • Inhibits impulse conduction
    • local anesthetics, alpha 2 agonists 
  33. What does modulation do in multimodal analgesia?  Which drugs do this?
    • Inhibits center all sensitization 
    • local anesthetics, opioids, alpha 2 agonists, tricyclic antidepressants, cholinesterase inhibitiors, dissociative anesthetics, NSAIDS, anticonvulsants
  34. What does perception do in multimodal analgesia and which drugs do this?
    • Inhibit perception 
    • general anesthetics, opioids, alpha 2 agonists, benzodiazepines, phenothiazines