4. Pain and Chronic Wounds / Treating People with Chronic Pain

Question 1

What are the three components of pain?

Answer 1

1. Sensory / Discriminative (input)
2. Cognitive / evaluative (processing)
   - Pain modulation
3. Motivational / affective (output)

(no actual way to objectify pain)

Question 2

When is pain a problem?

Answer 2

When it decreases function or impedes Quality of Life (but pain can be helpful)

Question 3

What are the symptoms of a Venous Leg Ulcer?

Answer 3

80% report pain
Dull aching
Heaviness
Burning
Itching

Question 4

What are the symptoms of arterial ulcers?

Answer 4

Claudication
Ischemic pain / rest pain
Ache
Cramping
Numbness

Question 5

What are the symptoms of diabetic foot ulcers?

Answer 5

50-75% report pain
Neuropathic pain
Burning
tingling
Sharp / shooting
(may feel nothing w/ touch)

Question 6

What are the symptoms of pressure ulcers?

Answer 6

59-88% report pan
Burning
Stabbing
Stinging
Tugging
Throbbing
Sharp

Question 7

What constitutes wound pain?

Answer 7

Spontaneous pain
Activity-related pain
Dressing changes (80% report)
Compression wraps
Procedures / debridement

Question 8

How does pain affect healing?

Answer 8

Lack of sleep --> physiologic stress --> poor healing
Lack of activity / mobility
LAck of socialization
Decreased access to care
Decreased QoL / mood

Question 9

What are the different nociceptors of pain?

Answer 9

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)

Question 10

What are the two primary afferent fibers?

Answer 10

A-Delta and C-fibers

Question 11

What are the characteristics of A-Delta Fibers?

Answer 11

Sensitive to mechanical stimulus when tissue is injured

• Myelinated & fast
• Perceived as sharp, localized pain
• Neurotransmitter is L-Glutamate!!!

Question 12

What are the characteristics of C-Fibers?

Answer 12

Sensitive to mechanical, chemical, and temperature!!!-Unmyelinated and slow

• Perceived as dull, diffuse pain
• Neurotransmitters are Substance-P and Calcitonin Gene Related peptide

Question 13

Where do primary afferents synapse with secondary afferents?

Answer 13

In the dorsal horn

Question 14

What are two ascending pathways?

Answer 14

Spinothalamic and Spinoreticular

Question 15

What are the characteristics of the descending pathways?

Answer 15

Descending pain inhibition systems originate in the periaqudeductal gray area

• Rely on endogenous opioids and serotonin
• Synapse in dorsal horn
• Inhibit pain

Question 16

What is Hyperalgesia?

Answer 16

Disproportionate pain to a typically noxious stimulus (overreacting to pain)

• Primary
• Secondary

Question 17

What is Allodynia?

Answer 17

Pain in response to a stimulus that is NOT typically deemed painful

Question 18

What is peripheral sensitization?

Answer 18

Increased sensitivity and/or firing of the nociceptors (“sunburn of the nerves”)

Question 19

What is central sensitization?

Answer 19

Increased real-estate devoted to pain processing

Question 20

What is acute pain?

Answer 20

Less than 3 months

characerized by tissue damage

Question 21

What is persistent pain?

Answer 21

Ongoing / recurrent / episodic

Question 22

What is chronic pain?

Answer 22

Longer than expected healing time (longer than 3-6 months). Great than expected given injury / tissue damage

Question 23

What is Chronic pain syndrome?

Answer 23

Pain that affects elements of life

Phantom pain: less likely in tramatic amputee but more likely in chronic pain person (used to pain)

Question 24

Should wound healing be in a dry or moist environment?

Answer 24

MOIST!

Question 25

Is chronic pain a diagnosis?

Answer 25

Yes

Question 26

What are some characteristics of chronic pain

Answer 26

Uses biopsychosocial model (hard to explain when you lack the experience)

Central sensititzation (more areas of brain alerted - 7 alarm fire)

Question 27

What model does acute pain use?

Answer 27

Nociceptive model (chronic uses biopsychosocial)