06-01: Pain Flashcards
Definition of Pain
- An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
- Warning sign for potential tissue damage
Categories of Pain (2)
- Acute
- Chronic
Acute Pain
- Lasts less than 6 weeks
- Lasts as long as noxious stimulus exists
- Sub-acute pain lasts between 7-12 weeks
Chronic Pain
- Lasts beyond time of healing: > 12 weeks
- Activation of abnormal neurological responses
- Lasts after stimulus ceases
- Associated with physical, psychological, social dysfunction
Healing process of pain (12 weeks)
- Full 12 weeks to heal
- 50% at 2 weeks
- 80% at 6 weeks
- 100% at 12 weeks
Types of pain (4)
- Referred
- Trigger Points
- Radiating Pain
- Sclerotomes
Referred Pain
- Experience pain in one area, but the injury is in another area
- Can refer joint-to-joint
- Most common joint-to-joint: hip-to-knee
- Can refer from peripheral nerve to its distal intervention (Radiating pain)
- Can refer from an organ to outside tissues
Trigger Points
Hyperirritable area of muscle that, when activated, becomes painful and may refer pain to areas that follow a specific pattern associated with a particular point.
Radiating Pain
- Pain caused by irritation of nerves and nerve roots
- Ex: Sciatic Nerve: Pain from sciatica radiates from the buttock down the leg and can travel as far as the feet and toes
Sclerotomes
- Deep somatic pain
- A segment of bone that is innervated by a spinal segment
- Similar to dermatomes
Pain Assessment (4)
- Visual Analogue Scale
- Numeric Scale
- Pain Charts
- Questionnaires (Ostwestry, McGill, Dallas, Rowland Morris LBP)
Goals of Therapy
- Directed toward reducing pain
- Pain can inhibit pt’s ability to function, prevent participation in therex, cause other complications
- PTs/PTAs encourage body to heal using movement (therex)
- Modatlities can assist in reducing pain; allows a quicker return to function
Pain Descriptors
- Gives better idea of what causes pain: jt, tissue, muscle
- Ex: sharp, dull, throbbing, stinging, achting, burning, localized, generalized
Sensory Receptors
Sensory nerve ending designed to detect various stimuli
Meissner’s Corpuscles
Light Touch
Pacinian Corpuscles
Deep Pressure
Merkel’s Corpuscles
Slow response to deep pressure (ex: hair follicle activity controls as depressed, pushed on)
Ruffini Corpuscles
Skin - touch, tension, heat
Can detect change in posiiton (joint)
Krause’s End Bulbs
React to decrease in temperature and touch
Nociceptors
Respond to noxious stimuli, tissue damage
Endogenous Opioids
- Opiate-like neuroactive peptide substances made by the body
- Produced and released when we experience pain
- Released by nerves traveling from brain to spinal cord
- Have analgesic properties
- Block the passage of noxious stiimuli
- Reduces sense of pain
Types of Endongenous Opioids (2)
- Endorphins and Enkephalins
- Enkephalins inhibit depolarization of nociceptor nerve fibers
Neural transmission of pain
Sensory receptors –> Afferent fibers (towards brain) –> Dorsal horn of spinal cord –> Brain –> Efferent fibers (away from brain) –> Motor response
Neurotransmitters
Substances that pass info from one neuron to another
Gate Theory of Pain: Ascending
- Stimulus –> Dorsal horn of spinal cord –> Pain message encounters “nerve gate”
- Stimulates fibers so pain fibers blocked; can potentially shut gate
- Short term (as long as stimulus exists)
Open Gate (Gate Theory)
Pain message gets through –> pain is received
Closed Gate (Gate Theory)
Pain message doesn’t reach brain –> no pain is received
Gate Theory (Thin, Thick fibers)
- Pain travels over smaller, thin fibers (“C” fibers)
- Touch, pressure, vibration, movement travels over large thick fibers (A Beta Fibers) - stimulate sensation to inhibit feeling of pain
- Both fibers act on the inhibitory neuron - thin inhibits, thick stimulates
- Movement also stimulates enkephalin release
