What anticonvulsants can be taken for neuropathic pain?
Gabapentin, pregabalin, CBZ, lamotrigine
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How does paracetamol work?
Central analgesic effects; activation of cannabinoid receptors, COX-3 inhibition
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What drugs have a high risk of inducing heart problems such as MI?
COX-2 seletive inhibitors particularly Rofecoxib; also piroxicam (a non-selective NSAID)
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What processes are mediated with PGE2 prostaglandins?
duiresis, vasodilation, fever and pain
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What is the difference between COX-1 and COX-2 enxymes?
COX-1 are expressed all over the body, COX-2 and indiced during inflammation
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What can be considered as chronic pain?
duration more than 6 months, persisting after healing, continual inflammation; no warning response,
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What processes are involved in chronic pain?
Nerve fibers grow into the superficial regions of Substntia Gelatinosa and transmit touch signals as pain
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What are the two main mechanisms in neuropathic pain?
Allodynia and hyperalgesia
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How is hyperalgesia manifested?
burning, stabbing, paresthesia, lower pain threshold, reduced inhibition of signals by descending pathway, increased excitability of sodium channels
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What is primary hyperalgesia?
Chemical changes at the site of injury involving sensitization of C fibers; peripheral sensitization
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What is secondary hyperalgesia?
Central sensitization; A fivers adapt to transmit touch around the area of injury as painful signals
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What processes are invilved in inflammatory pain?
Excitation and sensitization of C fibers, neurogenic inflammation, increased substance P transmission, central sensitization
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What are the main mechanisms in neuropathic pain?
Growth of nerve fibers deeper into the spinal cord, expression of subtabce P by A fibers, spontaneous neuronal activity, loss of synaptic contact at the spinal cord
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How does brain perceive pain?
Nerves transmit signals to the dorsal horn of spinal cord -> thalamus -> cortex (Ascending pathway)
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What is descending pathwaty?
inhibitory pathway, where signal travel from midbrain to spinal cord -> periaqueductal gray -> antinocicptive neurons -> dorsal horn
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