Ch.35 PAIN

Question 1

Awareness and information of the body’s deep and superficial parts.
Relays information regarding touch, temperature, pain, and body position.
The cell body of the dorsal root ganglion neuron, its peripheral branch, and its central axon form a sensory unit.

Answer 1

Somatosensory system

Question 2

3 types of fibers

Answer 2

Type A, B, and C

Question 3

Type A fiber

Answer 3

myelinated, fastest rate of conduction, convey pressure, touch, cold sensation, and heat information. ACUTE PAIN

Question 4

Type B fiber

Answer 4

myelinated, transmit info from cutaneous & subcutaneous receptors

Question 5

Type C fiber

Answer 5

unmyelinated, slowest rate of conduction, convey warm and hot sensation, mechanical and chemical as well as heat and cold induced pain. CHRONIC PAIN

Question 6

3 levels of Neurons:

Answer 6

FIRST ORDER- detects sensation ( periphery to CNS)
SECOND ORDER- communicates with various reflex network ( sensory pathway- brain)
THIRD ORDER -Relay info from brain to cerebral cortex/ feeling of pain (process info)

Question 7

travel up spinal nerves to the spinal cord

Answer 7

sensory impulses

Question 8

a multidimensional experience. unpleasant sensory/ emotional experience associated with actual or potential tissue damage. ALWAYS SUBJECTIVE, UNPLEASANT, AND EMOTIONAL EXPERIENCE

Answer 8

PAIN

Question 9

Both are parallel pathways that carry info from spinal cord to the thalamic level of sensation

Answer 9

Discriminaticce and Anterolateral pathway

Question 10

used for the rapid transmission of sensory information such as discriminative touch. composed of rapid, large, myelinated fibers

Answer 10

discriminative pathway

Question 11

provides transmission of sensory information such as pain, thermal sensations, crude touch and pressure that does not require discrete localization of signal source

Answer 11

Anterolateral pathway

Question 12

Affects arousal, mood, attention
Activates the reticular activating system (controls sleep/wake cycles
slower conducting, mostly made- up of type C fibers
associated with chronic pain as well as visceral pain
concerned with diffuse and dull aching pain

Answer 12

Paleospinothalmic tract

Question 13

Allows localization, identification of pain
rapid transmission from sensory to thalamus, made up of mostly type A fibers
associated with sharp fast reacting

Answer 13

Neospinothalmic tract

Question 14

Theory that regards pain as a separate sensory modality. Evoke the activity by specific receptors that transmit info by special nerve endings. Pain centers are regions in the forebrain

Answer 14

Specificity theory

Question 15

Theory where pain signals are sent to the brain only when stimuli come together only when there is a specific pattern being created

Answer 15

Pattern Theory

Question 16

Theory of the modification of the specificity theory, presence of neurogating mechanism in spinal cord account for pain or any author sensory modalities. Excess of impulses which is then sent to the brain

Answer 16

Gate control theory

Question 17

Theory that proposes the brain contains a widely distributed neural network multiple sensory, limbic, thalamic components. Consist of two loops between the thalamic and cortex. Create Pain Sensation when nothing is present

Answer 17

neuromatrix theory

Question 18

PAIN MECHANISMS:

initiated by pain receptors (nociceptors) that are activated by harm to peripheral tissue, “ pain sense”

Answer 18

nociceptive pain

Question 19

PAIN MECHANISMS:

arises from distinct injury or dysfunction of the sensory axons or peripheral or sensory central nerves

Answer 19

neuropathic pain

Question 20

PAIN MECHANISMS:

point at which the person perceives that it is painful

Answer 20

pain threshold

Question 21

PAIN MECHANISMS:

total pain experience, maximum intensity that a person is willing to endure the pain.

Answer 21

pain tolerance (everyone has different tolerances)

Question 22

Cutaneous Pain

Answer 22

superficial, localized, sharp, burning

Question 23

Deep Somatic Pain

Answer 23

muscles, tendons, joints, radiate, swelling

Question 24

Visceral Pain

Answer 24

organs, common pain produced by disease

Question 25

Referred Pain

Answer 25

pain that originates in the abdomen, diffuse, poorly localized

Question 26

Acute Pain

Answer 26

Short duration Remits when underlying process is resolved Elicited by surgery or trauma to body tissue Should be aggressively managed Give preemptive and multimodal therapy Give pain medication before the pain becomes severe Management helps with mobility and respiratory movements

Question 27

Chronic Pain

Answer 27

Pain that last longer than might be reasonably expected Highly variable Nociceptors are persistently stimulated Serves no useful purpose Causes psychological, physiological, familial, and economical stress Management is complex and depends on the cause of the pain, the underlying health problem, and life expectancy of the individual It is best managed by a multidisciplinary team

Question 28

Altered pain sensitivity: | continued stimulation causes pain (hypersensitivity)

Answer 28

hyperpathia

Question 29

Altered pain sensitivity: | spontaneous, unpleasant sensations (foot asleep)

Answer 29

paresthesias

Question 30

Altered pain sensitivity: | distortions of somesthetic sensation (diabetic neuropathy)

Answer 30

dysesthesia

Question 31

Altered pain sensitivity: | reduced pain sensation

Answer 31

hypalgesia

Question 32

Altered pain sensitivity: | absence of pain

Answer 32

analgesia

Question 33

Altered pain sensitivity: | pain after no noxious stimulus (fibromyalgia)

Answer 33

allodynia

Question 34

neurogenic stimulation

Answer 34

``` Tissue damage inflammatory mediators stimulate nociceptors impulses run up C fibers dorsal nerve root reflex inflammatory mediators move back down and are released into tissues ```

Question 35

Causes of neuropathic pain

Answer 35

``` Pressure on nerve Physical injury to neuron Chemical injury to neuron Infection of neuron Ischemia Inflammation ```

Question 36

Neuropathic pain syndromes include

Answer 36

Trigeminal neuralgia (tic douloureux) Postherpetic neuralgia Phantom limb pain

Question 37

Pain in children:

Answer 37

Pain begins in the neonatal period Able to accurately and reliably report pain at 3 years of age Children remember pain Careful assessment is key Use numeric scales as well as picture scales Pharmacologic and nonpharmacologic methods

Question 38

Pain in older adults:

Answer 38

Pain increases in older adults Unrelieved pain can led to immobility and falls Impaired appetite, sleep disturbances, and cognitive dysfunction Decreases quality of life If patient is lucid , pain is easier to assess Drug metabolism is different in older adults and should be taken into account when prescribing pharmacologic methods Nonpharmacologic

Question 39

Pain Management: | ASSESSMENT

Answer 39

``` COLDSPA pain is subjective cannot be measured elimination of the cause careful history numeric pain scale ```

Question 40

Pain Management:

Answer 40

include nonpharmacalogic and pharmacologic

Question 41

Nonpharmacologic include:

Answer 41

Cognitive behavioral interventions Physical agents Electroanalgesia Acupuncture

Question 42

Pharmacalogic include:

Answer 42

use of drugs combo of narco and non-narco and adjuvant analgesics (tolerable pain) long term use= increase in dosage

Question 43

Nonnarcotic analgesics include

Answer 43

aspirin and NSAIDS ( Antipyretic and anti-inflammatory effect Inhibition of COX-enzymes) Acetaminophen : no an anti-inflammatory ( low temp/relieve pain)

Question 44

Opioid Analgesics

Answer 44

Group of medications with morphine-like actions Morphine and codeine Acute and chronic pain Helps to give routinely before pain is severe