4. Pain and Chronic Wounds / Treating People with Chronic Pain Flashcards
What are the three components of pain?
- Sensory / Discriminative (input)
- Cognitive / evaluative (processing)
- Pain modulation - Motivational / affective (output)
(no actual way to objectify pain)
When is pain a problem?
When it decreases function or impedes Quality of Life (but pain can be helpful)
What are the symptoms of a Venous Leg Ulcer?
80% report pain Dull aching Heaviness Burning Itching
What are the symptoms of arterial ulcers?
Claudication Ischemic pain / rest pain Ache Cramping Numbness
What are the symptoms of diabetic foot ulcers?
50-75% report pain Neuropathic pain Burning tingling Sharp / shooting (may feel nothing w/ touch)
What are the symptoms of pressure ulcers?
59-88% report pan Burning Stabbing Stinging Tugging Throbbing Sharp
What constitutes wound pain?
Spontaneous pain Activity-related pain Dressing changes (80% report) Compression wraps Procedures / debridement
How does pain affect healing?
Lack of sleep --> physiologic stress --> poor healing Lack of activity / mobility LAck of socialization Decreased access to care Decreased QoL / mood
What are the different nociceptors of pain?
Cutaneous (dermis - temp, mech, chem)
Skeletal muscle
Joint (capsular, ligamentous, bone … NOT CARTILAGE; pressure and movement)
Visceral (no distinction between mechanoreceptors and nociceptors; share the somatosensory pathways / ascending tracts)
What are the two primary afferent fibers?
A-Delta and C-fibers
What are the characteristics of A-Delta Fibers?
Sensitive to mechanical stimulus when tissue is injured
- Myelinated & fast
- Perceived as sharp, localized pain
- Neurotransmitter is L-Glutamate!!!
What are the characteristics of C-Fibers?
Sensitive to mechanical, chemical, and temperature!!!-Unmyelinated and slow
- Perceived as dull, diffuse pain
- Neurotransmitters are Substance-P and Calcitonin Gene Related peptide
Where do primary afferents synapse with secondary afferents?
In the dorsal horn
What are two ascending pathways?
Spinothalamic and Spinoreticular
What are the characteristics of the descending pathways?
Descending pain inhibition systems originate in the periaqudeductal gray area
- Rely on endogenous opioids and serotonin
- Synapse in dorsal horn
- Inhibit pain
What is Hyperalgesia?
Disproportionate pain to a typically noxious stimulus (overreacting to pain)
- Primary
- Secondary
What is Allodynia?
Pain in response to a stimulus that is NOT typically deemed painful
What is peripheral sensitization?
Increased sensitivity and/or firing of the nociceptors (“sunburn of the nerves”)
What is central sensitization?
Increased real-estate devoted to pain processing
What is acute pain?
Less than 3 months
characerized by tissue damage
What is persistent pain?
Ongoing / recurrent / episodic
What is chronic pain?
Longer than expected healing time (longer than 3-6 months). Great than expected given injury / tissue damage
What is Chronic pain syndrome?
Pain that affects elements of life
Phantom pain: less likely in tramatic amputee but more likely in chronic pain person (used to pain)
Should wound healing be in a dry or moist environment?
MOIST!
Is chronic pain a diagnosis?
Yes
What are some characteristics of chronic pain
Uses biopsychosocial model (hard to explain when you lack the experience)
Central sensititzation (more areas of brain alerted - 7 alarm fire)
What model does acute pain use?
Nociceptive model (chronic uses biopsychosocial)
