ABA Pain Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

A-delta fiber

Thinly myelinated primary afferent conducting sharp, fast, well-localized first pain at roughly 5 to 30 m/s. It terminates mainly in laminae I and V of the dorsal horn.

C fiber

Unmyelinated primary afferent carrying dull, burning second pain at 0.5 to 2 m/s; it ends in superficial dorsal horn laminae I and II and releases glutamate and substance P.

Wide dynamic range neuron

Dorsal horn lamina V neuron receiving convergent input from nociceptors and low-threshold mechanoreceptors; its large receptive field helps explain referred pain and secondary hyperalgesia.

Mu opioid receptor

Gi-coupled receptor whose activation inhibits adenylyl cyclase, opens potassium channels, and closes voltage-gated calcium channels, reducing neurotransmitter release and producing analgesia with respiratory depression.

Central sensitization

Activity-dependent increase in dorsal horn neuron excitability that requires NMDA receptor activation and glial signaling, producing hyperalgesia, allodynia, and expanded receptive fields after tissue injury.

DN4 questionnaire

Ten-item clinician-administered screening tool for neuropathic pain; a total score of 4 or more out of 10 suggests a neuropathic component and warrants further diagnostic evaluation.

painDETECT

Seven-item patient questionnaire screening for neuropathic pain: scores of 12 or less make a neuropathic component unlikely, 13 to 18 are unclear, and 19 or higher are likely.

PEG scale

Three-item measure scoring Pain intensity, Enjoyment of life, and General activity from 0 to 10; the averaged score tracks both pain severity and functional interference over time.

Abbey Pain Scale

Six-item observational tool for patients with advanced dementia who cannot self-report pain; scores of 3 to 7 indicate mild, 8 to 13 moderate, and 14 or higher severe pain.

Back pain red flags

Findings requiring urgent workup: bowel or bladder dysfunction, saddle anesthesia, progressive motor deficit, fever, unexplained weight loss, cancer history, or pain unrelieved by rest.

Morphine milligram equivalents

Standardized potency conversion used to total a daily opioid dose: 30 mg oral morphine equals 20 mg oxycodone, 7.5 mg hydromorphone, or 30 mg hydrocodone.

Acetaminophen ceiling dose

Maximum adult dose is generally 3 to 4 g per day; reduce to about 2 g per day with hepatic impairment, chronic heavy alcohol use, malnutrition, or low body weight.

Tramadol

Weak mu agonist that also inhibits serotonin and norepinephrine reuptake; it lowers seizure threshold and can precipitate serotonin syndrome when combined with SSRIs, SNRIs, or MAOIs.

Duloxetine

Serotonin-norepinephrine reuptake inhibitor approved for diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain; the usual dose is 60 mg once daily.

Lidocaine 5% patch

Topically applied patch approved for postherpetic neuralgia; apply to intact skin for up to 12 hours per day using no more than three patches simultaneously.

Medial branch block

Diagnostic injection of local anesthetic onto the medial branches innervating a facet joint; at least 50 percent relief at two levels supports proceeding to radiofrequency ablation.

Stellate ganglion block

Cervical sympathetic block performed at the C6 level; a successful block produces Horner syndrome with ptosis, miosis, and anhidrosis, though these signs are not required for efficacy.

Celiac plexus block

Sympathetic block targeting the celiac ganglia for upper abdominal visceral cancer pain, particularly pancreatic cancer; it is usually performed with fluoroscopic or CT guidance.

Ziconotide

Non-opioid intrathecal analgesic that blocks N-type voltage-gated calcium channels; slow titration is required because of psychiatric and cognitive adverse effects, and it is approved for severe chronic pain.

Spinal cord stimulation

Neuromodulation delivering electrical pulses to the dorsal columns through epidural leads; best evidence is in failed back surgery syndrome and complex regional pain syndrome, usually after a successful trial.

Fear-avoidance model

Explains chronic disability as a cycle in which catastrophic appraisal of pain produces fear, avoidance, disuse, and depression, which in turn further worsen pain and function.

Graded exposure

Rehabilitation approach in which feared movements and activities are reintroduced in hierarchical, progressively challenging steps to extinguish pain-related fear and reduce avoidance behavior.

Pacing

Activity strategy that alternates planned rest and activity before pain escalates, using time-contingent rather than pain-contingent schedules to prevent boom-and-bust cycles.

Pain Catastrophizing Scale

Thirteen-item self-report measuring rumination, magnification, and helplessness about pain; a total score of 30 or higher indicates clinically relevant catastrophizing.

Biopsychosocial model

Frames pain and disability as the product of interacting biological, psychological, and social factors; it is the conceptual basis for interdisciplinary and multidisciplinary pain treatment.

Interdisciplinary pain program

Team of clinicians from different disciplines who communicate regularly, share a single treatment plan, and deliver coordinated physical, psychological, and vocational rehabilitation for chronic pain.

IMMPACT outcome domains

Consensus core outcomes for chronic pain trials: pain intensity, physical functioning, emotional functioning, global improvement, satisfaction, symptoms, and adverse events.

Functional restoration

Interdisciplinary program combining progressive physical conditioning, cognitive-behavioral intervention, and vocational rehabilitation; the strongest evidence is in chronic low back pain for function and work status.

Naloxone co-prescribing

Recommended for patients taking 50 morphine milligram equivalents or more daily, those on concurrent benzodiazepines, or those with substance use disorder history; it provides rescue from accidental overdose.

Prescription drug monitoring program

State database of controlled substance prescriptions; checking it before initiating or escalating opioids reveals multiple prescribers, early refills, and concurrent sedative prescriptions.

Procedural time-out

Brief pause before a procedure in which the team verifies patient identity, site, procedure, consent, allergies, and anticoagulation status aloud before starting.

CDC 2022 opioid guideline

Recommends individualized, function-focused opioid prescribing, non-opioid options first, no abrupt discontinuation of long-term opioids, and no hard morphine milligram equivalent thresholds.