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Case 1 > Acute Pain + Analgesia 1 > Flashcards

Acute Pain + Analgesia 1 Flashcards

1
Q

What is the definition of pain?

A

Unpleasant sensory + emotional experience associated with actual or potential tissue damage

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2
Q

What is activity induced by noxious stimuli?

A
  • NOT pain = always a psychological stage

- Pain in absence of tissue damage should be accepted pan

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3
Q

Describe the classification of pain

A

Duration (acute + chronic)
Nature:
1. Noiceptive - somatic + visceral
2. Non-noiceptive - neuropathic + sympathetic

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4
Q

Describe acute pain

A
  • recent onset, limited duration
  • activation of nociceptive sensory neutrons
  • transient
  • specific injury produces tissue damage
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5
Q

Describe chronic pain

A
  • persists after expected healing time or absence of injury
  • lasting 3+ months
  • no identified cause
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6
Q

Describe nociceptive pain

A
  • obvious tissue injury/illness
    a. k.a physiological or inflam pain
  • protective function
  • sharp/dull
  • well localised
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7
Q

Describe neuropathic pain

A
  • tissue injury not obvious
  • NS damage/abnormality
  • does not have protective function
  • burning, shooting/numbness, pins and needles
  • well localised
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8
Q

Explain plasticity in peripheral and central pain systems

A

Plasticity = response to activity, inflam + neural injury which can lead to…

  • Central sensitisation = increases membrane excitability + synaptic efficacy + reduces inhibition
  • Hypersensitivity to stimuli
  • Chronic stimulation of nociceptors
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9
Q

What is the difference between nociception and pain?

A 
Nociception = process through which potentially damaging stimuli detected 
Pain = how we feel
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10
Q

Describe the process of nociception

A
  • Thermal, chemical + mechanical stimuli capable of causing tissue damage activate nociceptors to transmit signals via glutamate -> CNS
  • Activation modulated by inflam influences in local EC enviro (prostaglandins, histamine + bradykinin)
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11
Q

What are the 4 main phases of nociception?

A
  1. Transduction - exposure to noxious stimuli = AP
  2. Transmission - travels along fibres to dorsal horn -> brain -> thalamus = translates nociception to pain
  3. Perception - experience discomfort…
  4. Modulation - response to pain
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12
Q

What are the 3 types of afferent nerve fibres?

A
  1. A-delta
  2. C fibres
  3. A-beta fibres
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13
Q

What is the role of A-delta fibres?

A
  • fast
  • myelinated
  • respond to heat, pressure + 1st sharp pain sensation
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14
Q

What is the role of C fibres?

A
  • slow
  • unmyelinated
  • respond to thermal, mechanical + chemical stimuli
  • 2nd throbbing pain sensation
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15
Q

What is the role of A-beta fibres?

A
  • respond to non-noxious stimuli

- detect light touch, vibrations

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16
Q

Describe the ascending pain pathways

A
  • Enter CNS at substantial gelatinosa of dorsal horn
    = receives input from A delta or C fibres which synapse with 2nd nerve
  • Also receives inputs from A-beta
  • 2nd nerve travels up opposite side of spinal cord
  • Ascends in contralateral spinothalamic tract
17
Q

Where does pain perception occur?

A

Cortex

Thalamus = second relay structure

18
Q

Describe the descending pain pathway

A
  • Brain -> dorsal horn

- Usually decrease pain signal

19
Q

Where does chronic noxious stimulation occur?

A
  • Peripherally - misfiring by neural stimulus, amplifying signal to brain
  • Centrally - firing of neutrons in spinal cord or brain in absence of stimulus
20
Q

What is hyperalgesia?

A
  • Peripheral sensitisation

- Localised inflam = hyper-excitability of peripheral nociceptors

21
Q

What is allodynia?

A
  • Central sensitisation

- Pain to normally painless stimulus: enables non-noiciceptive A-beta fibres to evoke pain

22
Q

Explain the Gate control theory

A
  • Excitation along A-delta + C-fibres opens gate

- Excitation alone A-beta fibres closes gate

23
Q

On what principle does TENS work?

A

Mild mechanical stim. (rubbing) can activate inhibitory A-beta fibres = inhibiting nociceptive signals along spinothalamic interneuron
i.e. closes gate

24
Q

What is the neuromatrix theory?

A

Pain arises from neural network with sensory, affective + cognitive components

Sensory = basic sensory info (location, qualities)
Affective = emotional + motivation reactions to pain (fight+flight)
Cognitive = meaning of sensory experience
25
Q

What does cortical processing of pain consist of?

A

Medial + lateral pain systems originating from medial + lateral thalamic nuclei

26
Q

What does the medial pain system consist of and what is its role?

A

= medial thalamic nuclei, ACC + insula

- mediates affective-cognitive-evaluative aspects of pain

27
Q

What does the lateral pain system consist of and what is its role?

A

= primary + secondary somatosensory cortices, lateral thalamic nuclei
- mediates sensory/discriminative aspects of pain

Case 1 (9 decks)

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