MODULE 1 Topic: Pain & Neuropathic Pain Basics Date: June 1, 2023 STANDARD QUESTIONS & ANSWERS Q. 1. What is pain? Answer, Pain is an unpleasant sensation and associated negative feelings which we get when there is actual or likely damage to any body part. What are its basic features? Answer. It is protective in nature - acts as a warning signal against disturbance in the body. Itis felt only by the sufferer — how severe the pain is can’t be felt or measured by others. Pain can be acute (lasting maximum of 1 month), subacute (lasting 1-6 months) or chronic (lasting more than 6 months). Q. 2. What are the major types of clinical pain? Answer. (2) Nociceptive pain, (2) neuropathic pain, and (3) mixed-origin pain. Q. 3. What are the important features of nociceptive pain? Answer. It is the usual pain one gets if suffering from conditions like joint pain (or arthritis), sprain, bone fracture, surgical wound, or injury to a part of body, etc. This pain results from inflammation of tissues without the sensory nerves having been affected in any way. Itgenerally stops after the damaged tissue has healed. This type of pain responds well to routinely used pain killers and ant opioids, and steroid drugs. flammatory drugs, e.g., NSAIDs, Q. 4, What are the important features of neuropathic pain? Answer. This type of pain results specifically from some damage to the sensory nerves Itis often chronic (continuous or off-and-on) and very distressing in nature.Itcan be felt as burning, stabbing, shooting, numbness, coldness, electric shock-like or itchiness. ‘Abnormal sensations like paresthesias and dysesthesias may be present. Often itis difficult to treat - does not respond well to routine pain-relieving drugs like the NSAIDs. Q. 5. What abnormality in pain transmission and its modulation accounts for neuropathic pain? Answer. In neuropathic pain, the ascending pain transmission pathway is abnormally active and the descending pain modulation pathway is abnormally inactive. Q. 6. What are the important features of a mixed-origin pain? Answer. A mixed-origin pain condition like low back pain has certain symptoms typical of nociceptive pain and certain others typical of neuropathic pain. Q. 7. Name the types of painful neuropathy conditions with a few examples. Answer, Peripheral (affected sensory nerve is outside the brain or spinal cord) neuropathy conditions: (1) diabetic neuropathy, and (2) post-herpetic neuralgia. Central (affected sensory nerve is within the brain or spinal cord) neuropathy conditions: (1) post-stroke neuropathic pain, and (2) spinal cord injury-associated neuropathic pain. Q. 8. What are the major issues with regard to the management of neuropathic pain? Answer. Neuropathic pain generally has many harmful effects on a sufferer — it lowers mood and the quality of life, decreases the ability to perform daily activities and professional work, and disturbs sleep. Treatment is mostly long-term and significantly increases financial burden. Treatment is often less than satisfactory because the pain is not sufficiently relieved and/or too much side effects develop. Q.9. Which are the first-line drugs recommended for the treatment of neuropathic pain? Answer. (1) Gabapentin and pregabalin (anticonvulsants) (2) Duloxetine and venlafaxine (SNRI antidepressants) (3) Tricyclic antidepressants (nortriptyline, amitriptyline) ‘These drugs are given by mouth and long-term treatment (several months) is generally necessary. Q. 10. What is the logic behind using drug combinations for the treatment of neuropathic pain?Answer. of neuropathic pain Re a single drug like pregabalin or duloxetine alone is often insufficient in their standard recommended doses and increasing their dose further can cause disproportionate increase in their side effect burden and without better pain control. But giving two or more drugs together, which are known to be effective for the treatment of neuropathic pain and work by different mechanisms, can be more effective in controlling the pain, often in lesser doses, without increased burden of their side effects and with better patient acceptance. @e@eee