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47 Pain Flashcards

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1
Q

Physiology of Pain

A

symptoms of an underlying problem

-nociception involves the physiologic mechanisms of pain processing

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2
Q

Physiology of Pain

4 stages

A

1 Transduction
2 Transmission
3 Perception
4 Modulation

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3
Q

nociceptors

A

free nerve endings

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4
Q

Transduction

A
  • process of converting painful stimuli to neuronal action potentials at sensory level
  • nociceptors transduce noxious stimuli into action potentials
  • chem mediators alter the membrane potential of the pain receptor
  • NSAIDs prevent prosaglandin production by inhibiting the action of cyclooxygenase
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5
Q

cyclooxygenase

A

enzyme that normally converts arachidonic acid to prostaglandin

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6
Q

Transmission

A

stim nociceptors transmit impulses to the CNS by means of specialized sensory fibers

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7
Q

primary sensory fibers

A

Ao

C

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8
Q

Ao sensory fiber

A

myelinated fibers involved in transmission of sharp, stinging, + highly localized pain

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9
Q

C sensory fiber

A

small, unmyelinated fibers involved in transmission of dull, aching, + poorly localized pain that lingers

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10
Q

2 division of Anterolateral Tract

A

1 Neospinothalamic Tract

2 Paleospinothalamic Tract

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11
Q

Neospinothalamic Tract

A

carries Ao fiber input

-projects to thalamus then sensory cortex

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12
Q

Paleospinothalamic Tract

A

carries C fibers input

-projects diffusely to the reticular formation, mesencephalon, + thalamus

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13
Q

______ cause conscious perception of pain

A

lower brain centers

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14
Q

many neurotransmitters + neuropeptides involved in synaptic transmission at the spinal cord level

A
  • substance P, glutamate, GABA, cholecystokinin, + calcitonin gene-related peptide
  • glutamate may stimulate “wind up” phenomenon that can lead to chronic pain
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15
Q

brain can localize a pain sensation to a particular part of the body because…

A

nociceptor pathways are kept in specific anatomic order in the cord (sensory dermatome) + somatosensory cortex

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16
Q

Modulation

A

complex mechanism whereby synaptic transmission of pain signals is altered
-modulated w/in brain/spinal cord by endogenous opioids (enkephalins, endorphins)

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17
Q

mediators of presynaptic inhibition

A

opiods like endorphins + morphine

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18
Q

rostral pons

A

secrete NORepinephrine

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19
Q

periaqueductal grap [PAG]

A

has high concentration of endogenous opioids

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20
Q

Raphe Magnus

A

receives input fr PAG + Rostral Pons

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21
Q

Opioids + receptor types

A

have different effects depending on the types of receptors they activate

4 types:
Mu, Kappa, Sigma, Delta

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22
Q

____ + ____ receptors have analgesic activities

A

Mu (brain) + Kappa (spinal cord)

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23
Q

Gate Control Theory

A

impulse carried by large myelinated cutaneous fibers (AB) could “close the gate” on nociceptor impulses
–pain signals would be blocked in spinal cord + not allowed to progress to brain

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24
Q

rubbing, pressing, + shaking of the painful area may….

A

reduce pain

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25
2 major subtypes of Pain
1 Physiologic Pain | 2 Pathologic Pain
26
Physiologic Pain
tissue injury has occurred
27
Pathologic Pain
occurs after tissue injury, but long-term changes occur both w/inthe peripheral + CNS -changes occur along somatosensory pathways fr the periphery to the cortex
28
Acute Pain
results fr tissue injury | -resolved when injury heals
29
Acute Pain | s/s
INCR hrt rt, resp rt, bp - pallor - sweat - cry/moan - pacing - grimacing
30
Acute Pain | treatment
short term therapy w NONOPIOID + OPIOID meds - provide adequate pain relief - may prevent some types of chronic pain
31
Headache | classifications
``` classified according to etiologic factors: 1 Migraine 2 Tension 3 Cluster 4 Sinus ```
32
Migraine
results fr dysfunction of brainstem areas involved w modulation of craniovascular afferent fibers
33
Migraine | s/s
- unilateral throbbing - n/v - photophobia - phonophobia - lacrimation
34
Chronic Pain
- may be assoc w disease process - last longer than expected healing time - -------more than 6 mth
35
Chronic Pain | s/s
generally not assoc w s/s of sympathetic activity | -psychological like loss of job, irritability
36
Fibromyalgia Syndrome
disordered pain mechanism in CNS - widespread pain affecting all 4 extremities - hyperalgesia - trigger or tender points
37
Fibromyalgia Syndrome | etiology/risk factors
unknown etiology; risk factors may be trauma, sex abuse, stress
38
Hyperalgesia
is a condition in which you experience an enhanced sensitivity to pain
39
Fibromyalgia Syndrome | s/s
-widespread pain affecting all 4 extremities -hyperalgesia -trigger or tender points -sleep distrub/insomnia difficulty concentrating -fatigue -ibs -allodynia
40
Allodynia
the experience of pain from stimuli that isn't normally painful. -People with migraine will often describe this experience by saying, “My hair hurts.”
41
Cancer Related Pain
may result fr infiltration of organs, compression of structures by expanding tumor, or result of cancer treatments
42
Cancer Related Pain | s/s
mix of sympathetic NS activation + behavioral changes
43
Neuropathic Pain
results fr tissue injury in which the nerves themselves become damaged or dysfunctional - may result fr altered central processing of nociceptive input - -----releasing norepinephrine into nociceptors
44
Diabetic Neuropathy
cause by damage to lrg peripheral nerves by inflammation + demyelination -patient education for foot care + glucose control is critical for reducing further complications
45
Postherpetic Neuralgia
reactivation of latent herpes virus thats been dormant in nerve roots -herpes zoster is characterized by burning pain that follows a dermatomal pathway + accompanied by a blistering rash
46
Ischemic Pain
fr sudden/profound loss of blood flow to tissues
47
Ischemic Pain | mgmt
mgmt aimed at improving blood flow + reducing tissue hypoxia | -removing clot if needed
48
Chronic Ischemic Pain is assoc w...
atherosclerosis
49
Referred Pain
perceived in an area other than the site of injury ex. myocardial infarc felt in jaw or left arm; shoulder pain after pelvic procedure bc pain is referred to other structures of SAME dermatome
50
sympathetic NS activation during ACUTE pain can lead to....
INCR hr rt, resp rt, bp, BLOOD GLUCOSE - dilated pupils - sweat - pallow - DECR gastrointestinal motility - hypomotility of bladder
51
pain mgmt interventions can be directed at 3 points:
1 INTERRUPT peripheral transmission of nociception 2 MODULATE pain transmission at spinal cord 3 ALTER PERCEPTION + INTEGRATION of nociceptive impulses in brain
52
INTERRUPT peripheral transmission of nociception
often 1st step in controlling pain - application of heat/cold alters bf + reduce swelling - NSAIDs decr prostaglandin - ---interrupts periph transmission
53
NSAIDs | side effects
- gastrointestinal bleeding - decr platelet aggregation - renal insufficiency
54
MODULATE pain transmission at spinal cord
cutaneous stim activated large sensory fibers that can block central progression of nociceptive transmission at interneurons
55
MODULATE pain transmission at spinal cord | examples
- TENS: transcutaneous electrical nerve stim - massage - acupuncture - heat/cold - therapeutic touch - epidural + intrathecal analgesia - dorsal column stimulator
56
ALTER PERCEPTION + INTEGRATION of nociceptive impulses in brain
opioids work at specific receptor sites located thruout body but concentrated in brain -opioid analgesic have similar mechanism but vary widely in potency
57
Opioid Analgesic for alteration of perception + integration in brain side effects, tolerance
side effects: n/v, resp depression, constipation tolerance: need for incr dosage to achieve same effect addiction: withdrawal symptoms if abrupt cessation - -behavioral pattern of craving + preoccupation w obtaining drug - -not an expected response to opioid therapy
58
Opioid Analgesic for alteration of perception + integration in brain types of meds
MILD: nonopioids: NSAIDs or acetaminophen MOD: low potency opioids: codeine SEVERE: potent opioid: morphine/fentanyl
59
Opioid Analgesic for alteration of perception + integration in brain DISTRACTION
less able to integrate pain experience when other competition is present
60
Opioid Analgesic for alteration of perception + integration in brain IMAGERY
alters perception of painful stim in high brain centers | ---produces relaxation + analgesia
61
Opioid Analgesic for alteration of perception + integration in brain RELAXATION
conditioned response | ---incr bf
62
Opioid Analgesic for alteration of perception + integration in brain BIOFEEDBACK
INCR endorphins | ---conditioned response

Pathophysiology (32 decks)

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