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Basic Concepts > 8 Pain and Its Assessment > Flashcards

8 Pain and Its Assessment Flashcards

1
Q

Duration of chronic pain

A

> 3 months (longer than expected healing time)

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2
Q

Detect sensory input to peripheral tissues including the skin, muscles, and joints, and relay that sensory information to the central nervous system

A

Primary sensory neurons

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3
Q

Neurons in the spinal cord that relay information to the thalamus and various midbrain structures

A

Second-order neurons

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4
Q

Pain fibers: Thickly myelinated and fast conducting nerve fibers

A

Low-threshold Aβ fibers

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5
Q

Pain fibers: Unmyelinated or thinly myelinated and slower conducting

A

High-threshold C and Aδ fibers

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6
Q

Stimuli that cause (or at least have the potential to cause) tissue damage

A

Noxious stimuli

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7
Q

Noxious stimuli are sensed by these pain fibers

A

High-threshold C and Aδ afferents called nociceptors

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8
Q

Pain evoked by activation of high-threshold C and Aδ afferents

A

Nociceptive pain

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9
Q

Nociceptive pain normally serves an important protective role by

A

Triggering withdrawal from the noxious stimulus and teaching one to avoid such stimuli in the future, thus minimizing injury in the short and long term

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10
Q

Increases the excitability of nociceptors

A

Peripheral sensitization

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11
Q

Consequences of peripheral sensitization

A

1) Hyperalgesia: a hyperexcitable nociceptor responds more vigorously than normal to a noxious stimulus, resulting in hyperalgesia, or exaggerated pain in response to noxious stimulation
2) Allodynia: reduction of its threshold allows a nociceptor to be activated by weaker-than-normal stimuli, resulting in allodynia, or pain in response to innocuous stimulation
3) a sufficiently large reduction in threshold will cause the nociceptor to become spontaneously active, generating action potentials in the absence of any sensory input and causing spontaneous pain

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12
Q

Biochemicals that sensitize nociceptors

A

Prostaglandins
Tumor necrosis factor-alpha (TNF-α)
Interleukin 1β (IL-1β)
IL-6

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13
Q

Vicious cycle of inflammation caused by release of cytokines from immune cells

A

Neurogenic inflammation

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14
Q

Neurogenic inflammation can be exacerbated by the release of proinflammatory peptides like

A

Calcitonin gene-related peptide (CGRP) and P from activated nociceptors

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15
Q

Causes pain signals to be amplified, but through changes occurring in the central nervous system

A

Central sensitization

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16
Q

Heightened pain sensitivity that is limited to sites of inflammation resulting from sensitized peripheral neurons innervating inflamed areas

A

Primary hyperalgesia

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17
Q

Peripheral vs Central sensitization: causes heightened pain sensitivity that extends beyond sites of inflammation

A

Central

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18
Q

Peripheral vs Central sensitization: causes heightened pain sensitivity that affects only the neurons innervating inflamed areas

A

Peripheral sensitization causing primary hyperalgesia

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19
Q

T/F Peripheral and central sensitization are not mutually exclusive

A

T, the former often contributes to the latter

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20
Q

Factors associated with children and adolescents’ chronic pain (biopsychosocial model of pain)

A

Social factors
Psychological factors
Biological factors
Environmental factors

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21
Q

T/F Susceptibility to such neuroplas- tic changes has a strong genetic and epigenetic component, and the latter can reflect a broad range of environmental factors such as traumatic early life experiences

A

T

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22
Q

Aβ, Aδ, or C fibers: Thickly myelinated

A

Aβ

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23
Q

Aβ, Aδ, or C fibers: Thinly myelinated

A

Aδ and C

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24
Q

Aβ, Aδ, or C fibers: Large diameter

A

Aβ

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25
Q

Aβ, Aδ, or C fibers: Medium diameter

A

Aδ

26
Q

Aβ, Aδ, or C fibers: Small diameter

A

C fibers

27
Q

Aβ, Aδ, or C fibers: Fast conducting

A

Aβ

28
Q

Aβ, Aδ, or C fibers: Medium conducting

A

Aδ

29
Q

Aβ, Aδ, or C fibers: Slow conducting

A

C fibers

30
Q

Aβ, Aδ, or C fibers: Light touch

A

Aβ

31
Q

Aβ, Aδ, or C fibers: Pain

A

Aδ, or C fibers

32
Q

Aβ, Aδ, or C fibers: Temperature

A

Aδ, or C fibers

33
Q

Aβ, Aδ, or C fibers: Itch

A

Aδ, or C fibers

34
Q

Primary afferent fibers

A

Aβ, Aδ, C fibers

35
Q

Last part of the brain where sensory input for pain is processed

A

Prefrontal cortex

36
Q

Sensory afferents and nervous system

A

Primar afferents
Spinal cord
Thalamus
1) Primary somatosensory cortex-Secondary somatosensory cortex
2) Secondary somatosensory cortex
3) Anterior cingulate cortex-Prefrontal cortex or Amygdala
4) Insula
a) Anterior cingulate cortex-prefrontal cortex
b) Amygdala

37
Q

Under normal conditions, noxious stimulus results in what pain

A

Nociceptive

38
Q

When there is peripheral sensitization, noxious or innocuous stimuli can result in

A

Primary hyperalgesia
Primary allodynia
Spontaneous pain

39
Q

When there is central sensitization, noxious stimuli can result in

A

Secondary hyperalgesia

40
Q

When there is central sensitization, innocuous stimuli can result in

A

Secondary allodynia

41
Q

the more immediate reaction to nociception and is more midbrain based

A

Emotion

42
Q

How cognitions amplify the experience of pain

A

attach meaning to the emotional experience and can trigger additional emotional reactions

43
Q

Cognitive coping strategies that are related to greater pain and emotional distress

A

1) Emotion-focus avoidance (catastrophizing and expressing negative emotions)
2) Cognitive self-instruction (primarily wishful thinking)

44
Q

Cognitive coping strategies that are associated with less pain

A

1) Cognitive refocusing (distraction)
2) Feelings of self-control over pain

45
Q

The first step in the effective management of pain

A

Pain assessment

46
Q

Self-reported measures of pain routinely used as a key outcome in composite measures of JIA

A

None

47
Q

When should pain be assessed among rheuma patients

A

Pain should be assessed in all patients at the first visit and at each subsequent visit

48
Q

The best predictor of whether an individual patient is able to accurately self-report pain

A

Chronological age

49
Q

Most children of this age are able to self-report their current pain when provided with a developmentally appropriate tool

A

5 to 6 years and above

50
Q

Used to assess pain for children younger than 5 years and/or patients with cognitive impairment or communication difficulties

A

An observational pain measure

51
Q

Pain scale: asks children to rate pain intensity on scale of 0 to 10

A

11-point Numerical Rating Scale (NRS-11)

52
Q

Pain scale: includes six faces from “no pain” to “very much pain”

A

Faces Pain Scale-revised (FPS-R)

53
Q

Pain scale: moves a slider along the length of the scale to indicate how much pain they have

A

Color Analog Scale (CAS)

54
Q

2 pain scale measures with low recommendation

A

VAS and NRS-11

55
Q

Pain scale measure recommended for children younger than 6

A

None

56
Q

MC used self-report pain scale intended for use in children 5-18 years and takes 10-15 min

A

Pediatric pain questionnaire (PPQ)

57
Q

A well-validated multidimensional instrument that can aid in the comprehensive assessment of chronic musculoskeletal pain in adolescents (social functioning, physical functioning, depression, general anxiety, pain-specific anxiety, family functioning, and development)

A

Bath Adolescent Pain Questionnaire (BAPQ), which has adolescent and parent versions

58
Q

A web- and mobile-based tool for the visual self-report and electronic tracking of sensory pain where patients can choose from a library of pain-quality icons to express different types of pain, can be assigned a rating of intensity (0 to 10 NRS) and then dragged- and-dropped onto a detailed virtual body map to show pain location

A

Pain-QuILT

59
Q

Observational behavioral measure intended for children 2 months to 8 years that is used routinely for acute pain

A

r-FLACC

60
Q

The r-FLACC behavioral scale uses these indicators to assess pain (FLACC)

A

1) Facial expression
2) Leg movement
3) Activity
4) Cry
5) Consolability

61
Q

Therapeutic strategy for pain that seeks to engage the child as an agent of change in his or her care and is typically delivered weekly by specially trained psychologists over the course of several months

A

cognitive-behavioral therapy (CBT)

62
Q

T/F Evidence suggests that exercise exacerbates arthritis

A

F, an updated Cochrane meta-anal- ysis of existing RCTs found that exercise does not exacerbate arthri- tis; however, this analysis also failed to identify significant evidence of improvements in pain

Basic Concepts (9 decks)

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