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EXCI 360 > Ch. 10: Pain > Flashcards

Ch. 10: Pain Flashcards

1
Q

Is pain uni- or multidimensional (3)?

A

MULTIDIMENSIONAL:

  • SENSORY
  • AFFECTIVE (EMOTIONAL)
  • AUTONOMIC
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2
Q

Can pain be measured?

A

YES. By using pain scales like: the Visual analogue scale and the McGill Pain Questionnaire

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3
Q

Can pain be beneficial for the body?

A

YES. Localization compensation mechanisms(?)

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4
Q

What is the difference between nociceptive sensation and painful sensation?

A

NOCICEPTIVE: Before signal reaches awareness / the path from injury to where the signal is intercepted and interpreted

PAINFUL: Once the signal has been interpreted in the brain.

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5
Q

True or False: Pain is directly related to the AMOUNT of damage.

A

FALSE.

Pain is not always directly related to the AMOUNT of damage but the TYPE OF DAMAGE

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6
Q

What is the DEFINITION of pain according to MOSBY’s Medical Dictionary?

A

An UNPLEASANT SENSATION caused by noxious stimulation of the sensory nerve endings.

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7
Q

Is pain considered subjective or objective?

A

It is a SUBJECTIVE feeling and an INDIVIDUAL response to the cause.

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8
Q

Can pain be influenced (2)?

A

Pain can be influenced by several factors like

  • Emotional state
  • Cultural background
  • Etc.
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9
Q

What are some characteristics of different types of pain (around 10)?

A
  1. Mild
  2. Severe
  3. Chronic
  4. Acute
  5. Lancinating
  6. Burning
  7. Dull
  8. Sharp
  9. Precisely localized
  10. Poorly localized
  11. Referred
  12. Etc.…
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10
Q

What is the term for pain receptors?

A

NOCICEPTORS

Latin nocere = “to hurt”

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11
Q

Through what fibers is the pain signal transmitted (2)?

A

A-delta fibers and C fibers

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12
Q

True or False: Thermoreceptor axons fire action potentials at a higher rate than at lower temperatures.

A

FALSE:
Thermoreceptors fire AP’s at the same rate as at lower temperatures. The number and frequency of action potential discharge in the nociceptive axon will continue to increase.

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13
Q

What is the approximate threshold for pain ?

A

43° is the approximate threshold for pain

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14
Q

Through what fiber is the “FIRST pain” transmitted, and what TYPE of pain is it responsible for?

A

First pain is transmitted through A-Delta fibers and are responsible for the (first/ initial) sharp pain (EARLY PERCEPTION OF PAIN)

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15
Q

Through what fiber is the “SECOND pain” transmitted, and what TYPE of pain is it responsible for?

A

Second pain is transmitted through the C fibers and is responsible for DULL, BURNING and LONG-LASTING sensations (LATER PERCEPTION OF PAIN)

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16
Q

TRUE OR FALSE

The A- delta fibers are myelinated and therefore transmit pain slower than the unmyelinated C-fibers.

A

FALSE:

The A- delta fibers are myelinated and therefore transmit pain FASTER than the unmyelinated C fibers.

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17
Q

What is the anterolateral system?

A

The neural pathway that conveys pain and temperature information to higher centers.

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18
Q

In the anterolateral system, primary afferents in the dorsal root ganglia send their axons via what to terminate where?

A

Primary afferents in the DORSAL ROOT GANGLIA –> axons via DORSAL ROOTS –> terminate in DORSAL HORN of the spinal cord.

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19
Q

What is the name of the tract the afferents branch and course through before giving rise to collateral branches that terminate in the dorsal horn?

A

Lissauer’s tract.

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20
Q

What “order” neurons are in the dorsal horn and where are they sending axons?

A

Second order neurons in the dorsal horn send their axons across the midline to ascend to HIGHER levels in the ANTEROLATERAL COLUMN of the spinal cord.

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21
Q

Where do c-fiber afferents terminate within the dorsal horn?

A

REXED’s LAMINAE I and II of the dorsal horn.

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22
Q

Where do A-delta fibers terminate within the dorsal horn?

A

In LAMINAE I and V

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23
Q

What axons cross the midline in laminae I and V and where are they travelling?

A

The axons of Second-Order neurons in laminae I and V cross the midline and ascend to higher centers

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24
Q

What is the definition of referred pain (5 examples)?

A

Pain at a site other than its actual source. Pain that arises from damage to visceral organs is often misperceived as coming from a somatic location.

ex :

  • Heart –> Left arm
  • Esophagus –> Left chest and back
  • Urinary bladder –> posterior inside thigh and buttocks
  • Left Ureter –> Lower Left Quadrant pain
  • Right Prostate –> Right lower quadrant , right calf and posterior inner
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25
Q

What type of afferents converge on lamina V wide dynamic range neurons?

A

Nociceptive and non-nociceptive afferents (Aβ = touch)

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26
Q

What type of neurons are in lamina V within the dorsal horn?

A

WIDE-DYNAMIC-RANGE NEURONS

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27
Q

Where do the wide-dynamic-range neurons receive sensory input from in the body?

A

Wide-dynamic-range neurons receive sensory input from both visceral organs and skin areas.

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28
Q

There are two distinct aspects of the experience of pain in which the anterolateral system supplies information to different structures of the brain. What are they?

A

First pain (spinothalamic tract) – Sensory Discriminative – Information on:

  • Location
  • Intensity
  • Quality

Second pain (integrative centers in forebrain)– Affective-Motivational :

  • Unpleasant feeling
  • Fear
  • Anxiety
  • Autonomic activation
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29
Q

What are dorsal column–medial lemniscal symptoms?

A

Loss of sensation of touch, pressure, vibration, and proprioception

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30
Q

What are anterolateral symptoms?

A

Deficits of pain and temperature perception

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31
Q

Because of the anatomical difference in the site of decussation, a unilateral spinal cord lesion results in what kind of symptoms on what side of the body (2)?

A

Dorsal column medial lemniscal type symptoms: loss of sensation of touch, pressure, vibration and proprioception : IPSILATERAL to the LESION

Anterolateral type symptoms: Deficits of pain and temperature perception: CONTRALATERAL to lesion.

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32
Q

How do both the nociceptive and mechanosensory pathways ascend in the spinal cord?

A

The anterolateral system (nociceptive) crosses and ascends in the contralateral anterolateral column of the spinal cord
The dorsal column – medial lemniscal system ascends in the ipsilateral dorsal column.

33
Q

If there is a lesion restricted to the left half of the spinal cord, what dissociated sensory loss and mechanosensory deficits would result?

A

A lesion restricted to the left half of the spinal cord results in dissociated sensory loss and mechanosensory deficits on the left half of the body, with pain and temperature deficits experienced on the right.
** Anterolateral symptoms (pain and temperature) on the contralateral side therefore, in this case on the right.
Dorsal column–medial lemniscal symptoms (loss of sensation of touch, pressure, vibration, and proprioception) on the ipsilateral side, therefore on the left in this case.

34
Q

What is the most important/ main neurotransmitter for pain?

A

SUBSTANCE P

35
Q

When does peripheral sensitization occur?

A

Peripheral sensitization occurs when the nociceptive fibers interact with the “inflammatory soup”: ATP, Prostaglandin, bradykinin, 5-HT, H+, Histamine, that is released when tissue is damaged.

36
Q

What is the ROLE or purpose of peripheral sensitization (2)?

A
  • Peripheral sensitization protects the injured area and promotes healing (HYPERALGIA)
  • Increased blood flow and migration of white blood cells to the local site protects against infection.
37
Q

What is hyperalgesia?

A

Hyperalgesia is an abnormally increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves and can cause hypersensitivity to stimulus. E.g. increased sensitivity to temperature after a sunburn.

38
Q

How many neurons will carry the pain signal to the cortex and where are they synapses taking place?

A

3 NEURONS will carry the signal. First synapse in dorsal horn (at 2nd order neuron), 2nd synapse in thalamus (Anterolateral system) 3rd synapse in medulla (mediolateral system)

39
Q

What is Central Sensitization in Chronic pain?

A

The increase in excitability of neurons in the dorsal horn of the spinal cord following high levels of activity in the nociceptive afferents

40
Q

When does Central Sensitization occur?

What is the “consequence” of Central sensitization?

A

After repeated stimulation over a long period of time (weeks to months)

Allodynia: The triggering of a pain response from stimuli which do not normally provoke pain.
Induction of pain by a normally innocuous (inoffensive) stimulus

41
Q

What is the mechanism of Central sensitization in chronic pain?

A

LONG TERM POTENTIATION (synaptic plasticity)

42
Q

What is the percentage of people who experience a phantom limb or pain after losing a limb?

A

70%

43
Q

Is pain more or less AFTER amputation?

A

Pain after amputation is USUALLY MORE than before amputation.

44
Q

Who designed the mirror box?

A

Dr. Ramachandran.

45
Q

What was the mirror box designed to do?

A

The mirror box is designed to relieve phantom pain associated with limb loss by viewing the intact limb in the reflection while commanding symmetrical movements of the remaining limb and corresponding phantom.

46
Q

Does Dr. Ramachandran’s mirror box therapy produce any relief form pain sensations?

A

Dr. Ramachandran’s mirror box therapy produces a remarkable degree of relief from pain sensations. He reasoned that vision might normalize aberrant somatosensory and motor signals related to the missing limb if a subject is given visual feedback consistent with the intended movements of the missing limb.

47
Q

What is the goal of using mirror box therapy in terms of “re-mapping” the brain?

A

Neurons lose their original inputs from the remote limb. By doing this exercise with the mirror it is a functional reorganization of the somatosensory cortex by using tactile stimulation of other body parts

48
Q

Is the placebo effect a true physiological mechanism or is it only imagined by the patients?

A

Yes.

49
Q

What are 7 factors of the placebo effect in which a person would find symptom relief?

A
  1. Emotions
  2. Verbal cues
  3. Conditioning
  4. Expectations
  5. Learning
  6. Contextual cues
  7. Motivation
50
Q

Do placebo’s have side effects? (such as headaches, dizziness tingling extremities, staggering gait)

A

YES!

51
Q

Can the placebo effect contribute to the efficacy of medical treatments and other therapies?

A

YES - The placebo effect can contribute to the efficacy of all medical treatments and may explain the results obtained in non-conventional therapies like hypnosis, homeopathy etc.

52
Q

What happened to the endogenous opioid receptors in cortical and subcortical regions of the brain after a placebo analgesic pill was taken?

A

The endogenous opioid receptors in the cortical and subcortical regions became ACTIVATED.

53
Q

How is there proof that the placebo effect is effective?

A

Naloxone – An antagonist of opioid receptors can BLOCK placebo effect.

54
Q

How many levels of pain inhibitions systems are there in our system to lower pain?

A

FIVE Levels exist to lower pain in our system

55
Q

What Level of pain inhibitions system is on the cortical level?

A

Level 5 (V) (Descending cortical inhibition) – Distraction / excitement

↓ nociceptive info by expectations, excitement, distraction, placebo’s

56
Q

What level of pain inhibition system is on the hormonal level?

A

Level 4 (IV) (Hormonal) – Trigger at pituitary glands – release of hormones, decreasing nociceptive signal (PAIN) e.g. : CAR crash – broken leg – but can still run.

↓nociceptive info by HORMONAL ENDORPHINS

57
Q

What level of pain inhibitions system is on the neuronal pathway?

A

Level 3 (III) (Fast acting neuronal pathway from brainstem)

↓ nociceptive info by the release of SEROTONIN AND ↓SUBSTANCE P

58
Q

What level of pain inhibitions system is on the dorsal horn?

A

Level 2 (II) (Dorsal horn)

↓ nociceptive info through cutaneous stimulation (TENS)

59
Q

What level of pain inhibitions system is on analgesics?

A

Level 1 (I) (Peripheral)

↓ prostaglandins by analgesics (aspirin / ice)

60
Q

What is GATE CONTROL THEORY?

A

Non painful input closes the nerve gates to painful input which prevents pain sensation from traveling to the CNS.

e.g. Rubbing or massaging an injured / painful area = RECRUITMENT OF AB FIBERS = inhibit projection neuron in pain pathway.

Same mechanism with TENS.

61
Q

What do descending systems do?

A

Descending systems modulate the transmission of ascending pain signals. ORIGINATE in cortex, insula and amygdala, hypothalamus, midbrain , pons and medulla -

62
Q

In the McGill Pain Questionnaire, the descriptors fall into what 4 major groups?

A
  1. Sensory (items 1-10)
  2. Affective (items 11-15)
  3. Evaluative (item 16)
  4. Miscellaneous (Item 17-20)
63
Q

When a person experiences pain;
A - One part of the brain is active at any one time
B – Multiple parts of the brain are active, but in succession to each other
C – Many parts of the brain are involved simultaneously.

A

Answer: C

Many parts of the brain are involved simultaneously when a person experiences pain.

64
Q

In a pain experience…….

A

There is not just one pain centre in the brain, as people used to think. There are many. We call these areas ‘IGNITION NODES’.

These brain parts include clusters of nodes used for:

  • sensation
  • movement
  • emotions
  • memory

Pain just borrows these parts to express itself. In chronic pain, some of these nodes are hijacked or even enslaved by the pain experience. It’s almost like an addiction to pain.

Pain should diminish as tissues heal – however, sometimes pain will persist. Why?

Pain will persist – associated with nerve damage.

65
Q

What are the common symptoms associated with peripheral nerve pain?

A
  • Pins and needles
  • Burning pain
  • Pain at night, especially in hands and feet
66
Q

Stress can often make neurological pain (persistent nerve pain) worse, and is associated with what?

A

PAIN VIGILANCE

67
Q

If a nerve is injured what common situations can Ignite the pain?

A

Movement or sustained posture can ignite an injured nerve.

68
Q

What happens to an injured nerve over time?

A

Leads to altered CNS alarms. SENSITIZATION of pain pathways

69
Q

Can ‘thoughts and beliefs’ or ‘thoughts viruses’ in people with persistent pain who don’t understand the physiology of pain enhance their pain?

A

YES. These negative thoughts are known to CAUSE and ENHANCE low back pain and PROBABLY anywhere in the body.

70
Q

What is pain expression based on?

A

PERSONALITY

71
Q

What is the relationship a “PASSIVE COPER” has with pain (4)?

A
  • STOP when feel pain
  • over time that amount of activity before onset of pain will REDUCE
  • disability, disuse and depression (can) set in
  • Descent into chronicity: more common in people who are afraid of pain and re-injuring themselves.
72
Q

What is the relationship that a “HIGH ACHIEVER” has with pain?

A

BOOM-BUST PATTERN: Pain comes on, but you persevere – you tolerate it as much as you can – try to ignore it –keep going, distracting yourself then BOOM – Your pain is unbearable: and you BUST.

73
Q

When pain sensitivity is higher, do flare ups happen faster or less often?

A

Flare ups happen faster when sensitivity is higher.

74
Q

The BOOM-BUST pattern is more common in what personality type?

A

Perfectionists and high achievers

75
Q

What are the consequences of the BOOM BUST pattern of “high achievers”?

A

Clients are EXHAUSTED and flare up for days or even weeks.

76
Q

What are the 3 (4) steps of Pacing and Graded Exposure?

A

1- Decide what you want to do more of.
ex: walking, cycling, working etc.…

2- Find your BASELINE.
ex: How long can I walk before a flare up?

  • I can walk for 30 min, but I pay for it next day.
  • Walk 20 minutes?
  • No – will still pay for it
  • 10 min?
  • Probably not? Definitely not up hills
  • 5 min? Flat surface?
  • Maybe?
  • 3 min? flat surface?
  • YES.
    Therefore 3 minutes on a flat surface is the absolute baseline.

3- Plan your progression
ex: plan to walk slightly further each day of the next week – 3.5 min, then 4 min, 4.5 min, 5 min, 5.5 min etc.

4- Don’t flare-up (but don’t freak out if you do!)

77
Q

Why is pain level important when looking at pacing and graded exposure?

A

Pain level is important because it will tell you when you might injure yourself

78
Q

What is the TT (Old Tissue tolerance) line?

A

Normally where you get injured

EXCI 360 (4 decks)

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