Acute Pain Basics - Exam 2 Flashcards
What are examples of superficial somatic pain?
- skin
- subQ tissue
- mucous membranes
What are examples of Deep Somatic Pain?
- muscles
- tendons
- joints
- bones
What is Parietal Visceral pain?
- pain localized to the area around the organ
- ex: acute appendicitis pain
What is referred visceral pain?
- cutaneous pain
- comes from patterns of embryological development & migration of tissues
- convergence of visceral & somatic afferent input to CNS
What are 4 goals of pain control?
- pt comfort
- attenuate adverse physiologic responses to pain
- prevent chronic pain syndrome
- control anxiety & agitation
What 2 main things can be done to reach the pain goals?
- preemptive/preventative analgesia
- multimodal approach (diff. receptors)
What are the 3 phases of pain?
- acute pain
- chronic nociceptive pain
- neuropathic pain (DM)
not exclusive
What are some examples of disease states that cause pain?
- Degenerative joint and disc disease
- spinal stenosis
- DM
- CVD
- osteoporosis
- cancer
- heart disease
- polymyalgia rheumatica
- wounds
- PAD
- end of life
What are 3 things that cause pain r/t immobility?
- loss of functional status (dementia, stroke, DJD, fx, amputation)
- neuropathy
- PVD (edema/pain)
What are 6 red flags of pain?
- new loss of bowel/bladder
- pain that wakes pt up
- immunosuppression (malignancy)
- severe/progressive neuro deficit
- cold, pale, mottled, cyanotic limb
- severe abd. pain/shock peritonitis
The Specificity theory states that pain has —-
Who proposed this theory?
its own pathway not involving any other senses
Rene Descartes (French philospher)
Who introduced the intensity theory of pain?
What does the theory state?
- Plato
pain is an emotional experience not a sensory one
Who proposed the Gate Control Theory of Pain?
What is the idea of theory?
- Ronald Melzack and Patric Wall (1965)
pain transmission is modulated by balance of impulses transmitted to spinal cord
* inhibitory interneurons in substantia gelatinosa & cells function as a gate
* regulating transmission of impulses to CNS
What is the physiologic pathway of pain?
1. initial insult:
2. activates:
3. releases:
- initial insult: thermal, mechanical, & chemical tissue damage
- activates: afferent nerve endings of myelinated a-delta and unmyelinated C fibers
- releases: histamine & inflamm. mediators
What are the nerve fibers involved in acute pain?
- a-delta
- C fibers
what are the inflammatory mediators released in response to pain?
- peptides: bradykinin, substance P
- lipids: PGs
- neurotransmitters: serotonin, Ach
1st order neurons:
periphery to spinal cord
* tissue receptors of skin & proprioceptors (muscle, joints, tendons)
* synapse in spinal cord w/ 2nd order
2nd order neurons:
spinal cord to thalamus
* 1st order neurons in dorsal horn
* crosses to contralateral side of spinal cord
* ascends in spinothalamic tract
3rd order neurons:
thalamus to post-central gyrus in cerebral cortex
* 2nd order neurons in thalamus
* ascends through internal capsule
* post-central gyrus
Neuropathic Pain
What is allodynia?
pain response to something that is normally not painful
ex: DM neuropathy
Neuropathic Pain
What is hyperalgesia?
exaggerated response to a normally painful stimulus
* release of local inflammatory mediators that can produce augmented sensitivity to stimuli
