Acute & Chronic Pain Mgmt Definitions

Question 1

Define Allodynia

Answer 1

Perception of an ordinarily nonnoxious stimulus as pain

Question 2

Define Analgesia

Answer 2

Absence of pain perception

Question 3

Define Anesthesia

Answer 3

Absence of all sensation

Question 4

Define Chronic Pain

Answer 4

Pain that persists beyond the usual course of an acute disease or after a reasonable time for healing to occur, typically varies from 1-6 months

Question 5

Define First Order Neurons

Answer 5

The majority of first order neurons send the proximal end of their axons into the spinal cord via the dorsal (sensory) spinal root at each cervical, thoracic, lumbar, and sacral level.

Some unmyelinated afferent C fibers enter the spinal cord via ventral nerve (motor) root.

Once in the dorsal horn, in addition to synapsing with second order neurons, the axons of 1st order neurons may synapse with interneurons, sympathetic neurons, and ventral horn neurons.

Question 6

Cell bodies of 1st order neurons are located:

Answer 6

Facial- geniculate ganglion
Glossopharyngeal- superior and petrosal ganglia
Vagal nerve- jugular ganglion (somatic) and ganglion nodosum (viseral).
Trigeminal- gaussian ganglion

The proximal axonal processes of the first order neurons in these ganglia reach the brainstem nuclei via their respective cranial nerves, where they synapse with second order neurons.

Question 7

Define Hyperalgesia

Answer 7

Increased response to noxious stimulation

Question 8

Define Hyperesthesia

Answer 8

Increased response to mild stimulation

Question 9

Define Hyperpathia

Answer 9

Presence of hyperesthesia, allodynia, and hyperalgesia usually associated with overreaction, and persistence of the sensation after the stimulus

Question 10

Define Lateral Spinothalamic Tract

Answer 10

The lateral spinothalamic (neospinothalamic) tract projects mainly to the ventral posterolateral nucleus of the thalamus and carries discriminative aspects of pain, such as location, intensity, and duration.

Question 11

Define Medial spinothalamic Tract

Answer 11

The medial spinothalamic (paleospinothalamic) tract projects to the medial thalamus and is responsible for mediating the autonomic and unpleasant emotional perceptions of pain.

Question 12

Define Modulation

Answer 12

Occurs peripherally at the nociceptor, in the spinal cord, and in the supraspinal structures. Can either inhibit (suppress) or facilitate (intensify) pain

Question 13

Define Neuralgia

Answer 13

Pain in the distribution of a nerve or a group of nerves

Question 14

Define Neuropathic Pain

Answer 14

Is the result of injury or acquired abnormalities of peripheral or central neural structures.

Question 15

Neuropathic pain tends to be

Answer 15

Tends to be paroxysmal and sometimes lancinating with a burning quality, and is usually accompanied by hyperpathia.

Question 16

Neuropathic Pain is associated with:

Answer 16

It is associated with diabetic neuropathy, causalgia, phantom limbs, postherpetic neuralgia, stroke, spinal cord injury, and multiple sclerosis.

Question 17

Neuropathic Pain is difficult to treat and :

Answer 17

Is difficult to treat and multiple therapeutic modalities may be needed

Like:

• anticonvulsants like gabapentin and pregabalin,
• antidepressants like TCAs or SNRIs,
• antiarrhythmics like mexiletine,
• alpha 2 agonists like clonidine,
• topical agents like lidocaine or capsaicin, and
• analgesics like NSAIDs and opioids

Question 18

Define Nociceptive Pain

Answer 18

Caused by activation or sensitization of peripheral nociceptors, specialized receptors that transduce noxious stimuli.

Question 19

Define Parasthesia

Answer 19

Abnormal sensation perceived without an apparent stimulus

Question 20

Define Perception

Answer 20

Is the final common pathway, which results from the integration of painful input into the somatosensory and limbic cortices.

Generally speaking, traditional analgesic therapies have only targeted pain perception.

Question 21

Define Radiculopathy

Answer 21

Functional abnormality of one or more nerve roots

Question 22

Second Order Neurons are located

Answer 22

Second order neurons are located in the gray matter of the ipsilateral dorsal horn where they synapse with the first order neurons through interneurons.

Question 23

Second order Neurons care signals from

Answer 23

the spinal cord to the thalamus

Question 24

Second order neurons are either

Answer 24

1. nociceptive-specific or

2. wide dynamic range neurons.

Question 25

Nociceptive-specific neurons serve only (second order neurones)

Answer 25

noxious stimuli and are arranged in somatotopically in lamina I and have discrete somatic receptive fields. They only respond to high threshold noxious stimuli.

Question 26

Wide dynamic neurons (second order) receive

Answer 26

noxious and non noxious afferent input from A- gamma, delta, and C fibers. They are the most prevalent cell type in the dorsal horn, but they are most abundant in lamina V.

Question 27

The most prevalent cell type in the dorsal horn is:

Answer 27

second order / wide dynamic neurons

• most abundant in lamina V

Question 28

define Somatic Pain

Answer 28

Classified as superficial or deep pain due to nociceptive input arising from skin, subcutaneous tissues, and mucous membranes. Characteristically its well localized and described as a sharp, pricking, throbbing or burning sensation

Question 29

Third Order Neurons

Answer 29

Location of perception and discrete pain

Located in the thalamus and send fiber to the somatosensory areas I and II in the postcentral gyrus of the parietal cortex and the superior wall of the sylvian fissure.

Question 30

Third order neurons are located in the

Answer 30

Located in the thalamus and send fiber to the somatosensory areas I and II in the postcentral gyrus of the parietal cortex and the superior wall of the sylvian fissure.

Question 31

Define Transduction

Answer 31

Is the event whereby noxious thermal, chemical, or mechanical stimuli are converted into an action potential.

Question 32

Define Transmission

Answer 32

Occurs when the action potential is conducted through the nervous system via the first, second, and third-order neurons which have cell bodies located in the dorsal root ganglion, dorsal horn, and thalamus, respectively.

Question 33

Define Visceral Pain

Answer 33

Visceral acute pain is due to a disease process or abnormal function involving an internal organ or its covering.

Question 34

Four Subtypes of Visceral Pain:

Answer 34

Four subtypes:

1. True localized visceral pain (dull, diffuse, midline)
2. Localized parietal pain (sharp, stabbing)
3. Referred parietal pain
4. Referred Visceral pain

Question 35

True visceral pain is associated with

Answer 35

abnormal sympathetic or parasympathetic activity causing nausea, vomiting, sweating, and changes in BP and HR.