Science Quiz / Lehman Pain Management

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Can you name the Lehman Pain Management ?

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__% of physician visits are pain related. About 1/3 of people suffer from some kind of chronic pain.
The transduction of an external stimulus into a neural impulse.
An unpleasant sensory and emotional experience. The sensation + the perception.
This is really what we’re treating. More than stimulus – transduction – perception.
Acute or Chronic: Associated with tissue damage. Increased autonomic nervous activity. Resolves with healing of injury. Serves an adaptive function
Acute or Chronic: Extends beyond expected time of healing of injury. No adaptive function, rather it degrades health and function, causes further morbidity
Disruptions in sleep, eating, mobility, self image, participation in activities that bring JOY are _____ of pain.
_____ pain: perception of nociceptive input in terms of tissue damage, either somatic or visceral, mediated by an intact nervous system. Somatic or Visceral
_____ pain: arises from abnormal neural activity due to either damage or dysfunction of the nervous system. Electrical, burning, shooting
_____ pain: sensation of physical pain that is rooted in psychological conflict.
Name a cause of peripheral neuropathic pain.
There are ALWAYS psychological components to the experience of pain, whether as a _____ or a consequence.
Physical pain that is caused, increased or prolonged by mental, emotional or behavioral factors. Common symptoms are headache, back pain, abdominal pain.
Presence of physical symptoms suggesting a medical condition despite the lack of any organic or physical findings. The symptoms cause clinically significant distress or impairment
Multiple symptoms and a belief that one is sickly. High utilization of medical resources. Presentations often overly dramatic, but vague, imprecise or inconsistent history.
Pain, numbness and weakness is the triad. In up to 30% of cases, patients do eventually develop a diagnosable physical disorder.
Pain associated with a potentially life-limiting, progressive disease -Cancer, AIDS, End stage organ failure
Visceral afferent nociceptors converge on the same pain-projection neurons as the afferents from the ______ structures in which the pain is perceived. The brain projects the sensat
Perception of more pain in response to a noxious stimulus than would normally be evoked by that stimulus
Abnormal sensation in the distribution of a nerve. May be spontaneous or evoked. Ex: light tapping over the wrist of a patient with carpal tunnel syndrome evokes electrical shocks
____ order neurons in the brain generate the experience of pain.
Descending neurons can ___ the pain response neurons in the dorsal horn.
The “inflammatory soup” sensitizes hollow viscera (normally only painful when distended) to ________ stimulation (heel jar).
Spontaneous pain and sympathetic dysfunction following injury is called ______ regional pain syndrome
Name a red flag for pain.
Depression in up to __% of chronic pain patients.
This can look like vegetative disturbances, excessive self-devaluation, pessimism, cognitive processing inefficiencies, crying spells, anhedonia, irritability.
_____ sign: Tenderness exaggerated/inconsistent Simulation tests Distractability Regional distribution inconsistent w/ anatomy Overreaction
Undertreating Pain. 50% of ED visits undertreated. On the basis of neglect, WHO urge every nation to establish a pain relief policy.
The correct dose of ______ is the dose that relieves the pain.
absence of pain in response to stimulation that would normally be painful. Or, a decrease in pain/increase in pain threshold, which results when analgesics such as opioids are used
Drugs used in pain management that may or may not have intrinsic analgesic properties. Examples: Sodium channel blockers (Anticonvulsants and antiarrhythmics), mood stabilizers, anThey provide pain relief in certain pain syndromes or potentiate the common analgesics.
When using anticonvulsant as co-analgesic, we are not Not shooting for “therapeutic” _____ levels, rather titrate to pain relief and side effects.
Helpful for opioid-induced nausea, and especially useful because it potentiates the analgesic effects, possibly by blocking histamine mediated activation of C fibers
Babies exposed to opioids close to delivery may have respiratory _____
Babies exposed to Chronic Opioid Therapy (COT) during pregnancy will go through excruciating ____.
Babies exposed to NSAIDS late in pregnancy may have constriction of the ______ _______
Derived from the opium poppy.
Natural and synthetic derivatives, including opium.
Name one of the 4 A's for COT follow-up.
Physical symptoms develop with abrupt withdrawal of the substance (or administration of an antagonist). Symptoms include intense cravings, depression/anxiety, myalgias and spasms,
Continued use despite harm.
Pattern of drug-seeking behavior of patients with pain receiving inadequate pain management that can be mistaken for addiction (concerns about availability, ‘clock watching’, u

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