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Pathophysiology > 47 Pain > Flashcards

47 Pain Flashcards

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
Q

2 major subtypes of Pain

A

1 Physiologic Pain

2 Pathologic Pain

26
Q

Physiologic Pain

A

tissue injury has occurred

27
Q

Pathologic Pain

A

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
Q

Acute Pain

A

results fr tissue injury

-resolved when injury heals

29
Q

Acute Pain

s/s

A

INCR hrt rt, resp rt, bp

  • pallor
  • sweat
  • cry/moan
  • pacing
  • grimacing
30
Q

Acute Pain

treatment

A

short term therapy w NONOPIOID + OPIOID meds

  • provide adequate pain relief
  • may prevent some types of chronic pain
31
Q

Headache

classifications

A 
classified according to etiologic factors:
1 Migraine
2 Tension
3 Cluster
4 Sinus
32
Q

Migraine

A

results fr dysfunction of brainstem areas involved w modulation of craniovascular afferent fibers

33
Q

Migraine

s/s

A
  • unilateral throbbing
  • n/v
  • photophobia
  • phonophobia
  • lacrimation
34
Q

Chronic Pain

A
  • may be assoc w disease process
  • last longer than expected healing time
  • ——-more than 6 mth
35
Q

Chronic Pain

s/s

A

generally not assoc w s/s of sympathetic activity

-psychological like loss of job, irritability

36
Q

Fibromyalgia Syndrome

A

disordered pain mechanism in CNS

  • widespread pain affecting all 4 extremities
  • hyperalgesia
  • trigger or tender points
37
Q

Fibromyalgia Syndrome

etiology/risk factors

A

unknown etiology; risk factors may be trauma, sex abuse, stress

38
Q

Hyperalgesia

A

is a condition in which you experience an enhanced sensitivity to pain

39
Q

Fibromyalgia Syndrome

s/s

A

-widespread pain affecting all 4 extremities
-hyperalgesia
-trigger or tender points
-sleep distrub/insomnia
difficulty concentrating
-fatigue
-ibs
-allodynia

40
Q

Allodynia

A

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
Q

Cancer Related Pain

A

may result fr infiltration of organs,
compression of structures by expanding tumor,
or result of cancer treatments

42
Q

Cancer Related Pain

s/s

A

mix of sympathetic NS activation + behavioral changes

43
Q

Neuropathic Pain

A

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
Q

Diabetic Neuropathy

A

cause by damage to lrg peripheral nerves by inflammation + demyelination
-patient education for foot care + glucose control is critical for reducing further complications

45
Q

Postherpetic Neuralgia

A

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
Q

Ischemic Pain

A

fr sudden/profound loss of blood flow to tissues

47
Q

Ischemic Pain

mgmt

A

mgmt aimed at improving blood flow + reducing tissue hypoxia

-removing clot if needed

48
Q

Chronic Ischemic Pain is assoc w…

A

atherosclerosis

49
Q

Referred Pain

A

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
Q

sympathetic NS activation during ACUTE pain can lead to….

A

INCR hr rt, resp rt, bp, BLOOD GLUCOSE

  • dilated pupils
  • sweat
  • pallow
  • DECR gastrointestinal motility
  • hypomotility of bladder
51
Q

pain mgmt interventions can be directed at 3 points:

A

1 INTERRUPT peripheral transmission of nociception
2 MODULATE pain transmission at spinal cord
3 ALTER PERCEPTION + INTEGRATION of nociceptive impulses in brain

52
Q

INTERRUPT peripheral transmission of nociception

A

often 1st step in controlling pain

  • application of heat/cold alters bf + reduce swelling
  • NSAIDs decr prostaglandin
  • —interrupts periph transmission
53
Q

NSAIDs

side effects

A
  • gastrointestinal bleeding
  • decr platelet aggregation
  • renal insufficiency
54
Q

MODULATE pain transmission at spinal cord

A

cutaneous stim activated large sensory fibers that can block central progression of nociceptive transmission at interneurons

55
Q

MODULATE pain transmission at spinal cord

examples

A
  • TENS: transcutaneous electrical nerve stim
  • massage
  • acupuncture
  • heat/cold
  • therapeutic touch
  • epidural + intrathecal analgesia
  • dorsal column stimulator
56
Q

ALTER PERCEPTION + INTEGRATION of nociceptive impulses in brain

A

opioids work at specific receptor sites located thruout body but concentrated in brain
-opioid analgesic have similar mechanism but vary widely in potency

57
Q

Opioid Analgesic for alteration of perception + integration in brain
side effects, tolerance

A

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
Q

Opioid Analgesic for alteration of perception + integration in brain
types of meds

A

MILD: nonopioids: NSAIDs or acetaminophen
MOD: low potency opioids: codeine
SEVERE: potent opioid: morphine/fentanyl

59
Q

Opioid Analgesic for alteration of perception + integration in brain
DISTRACTION

A

less able to integrate pain experience when other competition is present

60
Q

Opioid Analgesic for alteration of perception + integration in brain
IMAGERY

A

alters perception of painful stim in high brain centers

—produces relaxation + analgesia

61
Q

Opioid Analgesic for alteration of perception + integration in brain
RELAXATION

A

conditioned response

—incr bf

62
Q

Opioid Analgesic for alteration of perception + integration in brain
BIOFEEDBACK

A

INCR endorphins

—conditioned response

Pathophysiology (32 decks)

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