Pain Management: Nociceptive vs Neuropathic

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Questions and Answers

What characterizes nociceptive pain?

Results from chemical, thermal, or mechanical sources (correct)

Is restricted to deep tissue only

Occurs without identifiable tissue damage

Presents as burning or numbness

Which statement accurately describes acute pain?

Is primarily felt as a burning sensation

Displays signs such as hypertension and tachycardia (correct)

Has no obvious relationship with stimuli

Lasts for more than three months

What type of pain is often difficult to localize and can be described as cramping and deep squeezing?

Visceral pain (correct)

Somatic pain

Neuropathic pain

Similar to allodynia

Which of the following symptoms is common in chronic pain conditions?

Pain lasting or recurring for more than three months Signup and view all the answers

Which defines neuropathic pain?

Involves damage to the central or peripheral nervous system Signup and view all the answers

What is the mechanism of action of baclofen?

Inhibiting transmission at the spinal cord Signup and view all the answers

What are common adverse effects of cyclobenzaprine?

CNS depression Signup and view all the answers

How should capsaicin be applied for effective relief?

Continuous therapy for 2-4 weeks Signup and view all the answers

Which is a potential adverse effect of tizanidine?

Hypotension Signup and view all the answers

What is the formulation of topical lidocaine available for local anesthesia?

Patch, cream, gel, and liquid Signup and view all the answers

Which local anesthetic is commonly used for regional anesthesia?

Bupivacaine Signup and view all the answers

What is a common adverse effect observed with corticosteroids?

Weight gain Signup and view all the answers

What can happen with long-term use of opioid analgesics?

Withdrawal symptoms Signup and view all the answers

How should topical NSAIDs be treated for mild to moderate localized pain?

Topically, applied multiple times a day Signup and view all the answers

Which medication class is used as a non-competitive NMDA receptor antagonist?

Ketamine Signup and view all the answers

Which assessment tool is appropriate for ongoing pain assessment?

Wong Baker Faces Scale Signup and view all the answers

What is the primary goal of therapy for chronic pain?

Improve overall function Signup and view all the answers

Which statement accurately reflects a principle of pain management for mild pain (1-3)?

Administer APAP/NSAID around the clock Signup and view all the answers

What is a key characteristic of NSAIDs compared to acetaminophen?

They provide anti-inflammatory effects Signup and view all the answers

What is the mechanism of action for anticonvulsants like gabapentin?

Inhibit calcium channel activity Signup and view all the answers

For which condition is carbamazepine preferred?

Trigeminal neuralgia Signup and view all the answers

What is a common side effect of tricyclic antidepressants?

Sedation Signup and view all the answers

Which pharmacologic approach is recommended for moderate pain (4-6)?

Opioid and APAP/NSAID together Signup and view all the answers

What is the maximum daily dosage of acetaminophen for adults?

4000 mg Signup and view all the answers

Which of the following is NOT a common side effect of gabapentin?

Severe diarrhea Signup and view all the answers

What is the primary purpose of cognitive behavioral therapy in pain management?

To change pain perception and coping strategies Signup and view all the answers

Which medication is considered a first-line treatment for neuropathic pain?

Antidepressants Signup and view all the answers

What defines the severity of acute pain that would warrant an opioid for management?

Pain rated above a 6 Signup and view all the answers

What should be monitored when prescribing carbamazepine?

CBC for blood disorders Signup and view all the answers

Study Notes

Classification of Pain

Pain is categorized into two main types: nociceptive and neuropathic.
Nociceptive Pain: Involves the body's transfer of information about tissue damage to the CNS.
- Occurs from chemical, thermal, or mechanical sources.
- Types:
  - Somatic Pain:
    - Originates in peripheral tissues; can be superficial or deep.
    - Characterized by sharp, stabbing sensations or dull aches; usually located at a pinpoint site.
  - Visceral Pain:
    - Originates in internal organs.
    - Described as cramping, deep squeezing, or pressure-like, often difficult to localize.
Neuropathic Pain:
- Results from damage or disorders of the nervous system.
- Pain perception occurs without tissue damage due to factors like trauma, infection, or tumors.
- Commonly described as burning, shooting, or pricking sensations; includes allodynia and hyperalgesia.
Pain is also classified as acute or chronic.
- Acute Pain:
  - Sharp, dull, or tingling sensation; linked to identifiable stimuli; short duration.
  - Signs include hypertension, tachycardia, tachypnea; may result in behavioral changes in infants/dementia.
  - Examples: surgical pain, trauma.
- Chronic Pain:
  - Persists for more than three months without a clear link to stimuli; may recur.
  - Associated with comorbid conditions like cancer, fibromyalgia, or arthritis.

Assessment of Pain

Importance of thorough history and physical exams to identify underlying factors.
Characterization tools include OLDCARTS, SOCRATES, SCHOLAR-MAC, and PQRSTU.
- OLDCARTS: Onset, Location, Duration, Characteristics, Alleviating/Aggravating factors, Radiating/Relieving factors, Timing, Severity.
- SOCRATES: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors, Severity.
- SCHOLAR-MAC: Symptoms, Characteristics, History, Onset, Location, Aggravating, Remitting, Medication, Allergies, Conditions.
- PQRSTU: Provoking/Palliating factors, Quality of pain, Region/Radiation, Severity, Timing, Understanding.
Ongoing assessments include Wong-Baker Faces Scale, Brief Pain Inventory, and Numeric Rating Scale.

Goals of Therapy

Objectives vary based on pain type:
- Acute Pain: Focus on recovery and prevention of chronic pain.
- Chronic Pain: Aim to improve function, decrease pain perception, and enhance quality of life.

Nonpharmacologic Therapy

Approaches include exercise, physical therapy, dietary changes, weight loss, cognitive-behavioral therapy, tai chi, yoga, and acupuncture.

Principles of Pain Management

Mild Pain (1-3):
- Treated with Acetaminophen (APAP) or NSAIDs.
- Regular dosing around the clock (ATC) is encouraged.
Moderate Pain (4-6):
- Combination of opioids with APAP/NSAIDs.
- ATC and PRN dosing practices employed.
Severe Pain (7-10):
- Opioids considered ATC; frequent reassessment for titration.

Pharmacologic Therapy

Non-Opioid Analgesics:
- Includes APAP for mild to moderate pain and NSAIDs for inflammatory conditions.
Co-Analgesics/Adjuvants:
- Anticonvulsants and antidepressants used to enhance pain management.
Opioids:
- Morphine and its analogs are primary agents in severe cases.

Non-Opioid Analgesics for Nociceptive Pain

Acetaminophen:
- Effective against mild to moderate pain; contraindicated in severe hepatic impairment.
NSAIDs:
- Provide analgesic and anti-inflammatory effects; contraindications include active GI bleeding and renal impairment.

Co-Analgesics/Adjuvants

Anticonvulsants:
- Gabapentin and pregabalin effective for neuropathic pain; renal dose adjustments necessary.
Antidepressants:
- Enhance pain inhibition by inhibiting serotonin and norepinephrine reuptake; effective at lower doses than those used for depression.

Skeletal Muscle Relaxants

Treat muscle spasms and spasticity; should be used cautiously and for limited durations.
Side effects often include CNS depression and withdrawal symptoms.

Topical Agents

Used to address localized pain with reduced systemic exposure.
- Capsaicin: Effective for neuropathic pain; requires consistent use for efficacy.
- Topical NSAIDs: Useful for localized pain like arthritis or sprains; low absorption risk.

Regional Anesthesia

Involves local anesthetics for pain management in various forms (injections).

Miscellaneous Agents

Corticosteroids: Used for inflammation and pain related to diseases; potential side effects including weight gain and osteoporosis.
Cannabinoids: Indicated for chronic pain.
Ketamine: Provides analgesic/anesthetic effects with potential CNS and psychiatric adverse events.

Opioid Analgesics

Oral opioids have a delayed onset; morphine serves as the standard for comparison against other opioids.
Special consideration needed for patients with renal impairment concerning morphine metabolites.

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Description

This quiz examines the classification of pain, focusing on nociceptive and neuropathic categories. It delves into the characteristics and types of nociceptive pain, including somatic pain with its distinct features. Enhance your understanding of how pain is communicated from damaged tissues to the central nervous system.