Chapter 47 - Pain Flashcards
1
Q
_______ cause inflammation when tissue injury occurs.
A
prostaglandins
2
Q
What is pain threshold?
A
level of pain stimulation required to be percieved
3
Q
What are the two major subtypes of pain?
A
- physiologic
- pathologic
4
Q
What are the clinical manifestations of cancer-related pain?
A
- sympathetic nervous system activation
- behavoiural changes
5
Q
What is pain expression?
A
way in which the pain experience is communicated to others
6
Q
What are the 4 stages in the physiology of pain?
A
- transduction
- transmission
- perception
- modulation
7
Q
_____ result from dysfunction of the brainstem areas involved with modulation of craniovascular afferent fibers
A
migraines
8
Q
What are the clinical maifestations of headaches?
A
- unilateral throbbing
- nausea
- vomitting
- photophobia - fear of light
- phonophobia - fear of sound
- lacrimation - flow of tears
9
Q
______ pain is percieved in an area other than side of injury
A
referred
10
Q
What is radiculopathy?
A
pain due to spinal nerve injury
11
Q
What are treatments for trigeminal neuralgia?
A
anticonvulsants, surgical nerve decompression and gamma radiosurgery
12
Q
True or false: the etiology of fibromyalgia syndrome is known.
A
false - not known
13
Q
What are emotional conditions that would open and close the gate?
A
open
- anxiety/worry
- tension
- depression
close
- positive emotions
- relaxation
- rest
14
Q
What do substance P, glutamate, GABA, cholecystokinin, and calcitonin-gene related peptide have in common?
A
involved in synaptic transmission at spinal cord level
15
Q
______ are useful for locating a source of neurologic pain
A
dermatomal maps
16
Q
Clicker: A patient presenting with a severe pounding headache accompanied by nausea and photophobia is likely experiencing a ________ headache.
A) tension
B) migrane
C) sinus
D) chronic
A
B
17
Q
What is radiculopathy?
A
pain located in the pattern of a dermatome that occurs with spinal nerve injury
18
Q
Clicker: The _______ is the level of painful stimulation required to be percieved.
A) perception
B) tolerance
C) expression
D) threshold
A
D
19
Q
What is the treatment for chronic pain?
A
pain clinic with multimodal therapies
20
Q
What is pathologic pain?
A
pain occurs after tissue injury, but long-term changes occur in PNS and CNS via somatosensory pathways
21
Q
True or false: glumate release stimulating the “wind up” phenomenon can lead to (acute/chronic) pain.
A
chronic
22
Q
______ is associated with disordered mechanisms in the CNS.
A
fibromyalgia syndrome (FMS)
23
Q
What are mental conditions that would open and close the gate?
A
open
- focusing on the pain
- boredom
close
- intense concentration or distraction
- involvement and interest in life activities
24
Q
What is substantia gelatinosa?
A
is a collection of cells in the dorsal horns of the spinal cord that receives direct input from the dorsal (sensory) nerve roots, especially those fibers from pain and thermoreceptors
25
What are the risk factors of fibromyalgia?
* trauma
* sexual abuse
* stress
26
What does neuropathic pain result from?
* altered central processing of nociceptive input (releasing norepinephrine onto nociceptors)
27
What is a sensory dermatome?
a particular area of the body surface innervated by a spinal nerve with nociceptor fibers
28
What is accute pain?
* results from tissue injury (physiological cause)
* resolves when it heals, 3-6 months max
* causes elevated heart rate, respiratory rate, blood pressure, pallor, sweating, nausea, and anxiety
* treatment via conventional analgesia
29
true or false: young and old often recieve inadequate pain management
true
30
true or false: infants do not have pain perception
false - they do
31
What is the "wind up" phenomenon and what neurotransmitter stimulates it?
* glutamade binding to NMDA receptors stimulates synaptic memory in the pain pathway
* excessive or repeated stimulation of c fibers sensitizes the spinal cord neurons so that even mild stimulation may be percieved as painful
32
What are the 3 classifications of pain?
1. duration (acute, chronic)
2. source (cancer, neuropathic, ischemic)
3. location and referral pattern
33
\_\_\_\_\_ interprets pain quality
cortex
34
What are the 3 factors that open or close the gate?
1. activity in pain fibers - opens gate
2. activity in other sensory nerves (i.e. rubbing the affected area) - closes the gate
3. messages from the brain
* concentrating on the pain - opens gate
* trying not to think about it - closes gate
35
True or false: Adequate of cancer-related pain control is a major factor affecting quality of life
true
36
Describe the pathogenesis of chronic pain.
Injury leads to pain and inflammation which is healed. Although healed, pain signals continue which cause structural CNS chances to alter neural transmission. This leads to chronic pain, hyperalgesia, allodynia, and spread of pain.
37
What are the clinical manifestations of trigeminal neuralgia?
* sharp or shooting, electrick shock pain
* may be pain free between episodes or
* complain of a dull ache in area
38
True or false: men are affected by fibromyalgia syndrome more than women.
false - women affected more
39
What does activation of the sympathetic nervous system during acute pain do?
* increased HR, respiration, BP
* dilated pupils
* perspiration
* pallor
* increased circulating blood glucose
* decreased gastrointestinal motility
* hypomotility of bladder
40
How is pain modulated within the brain/spinal cord?
endogenous opioids (enkephalins, endophins)
41
True or false: vertebral disk disease is an example of radiculopathy
true
42
Fill in the blanks. Tissue injury results in the realse of ______ from the breakdown of phospholipids in cell membranes. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the _______ enzyme and block the production of prostaglandins.
prostaglandins, cyclooxygenase
43
Distinguish between the 4 types of headaches?
1. **sinus:** pain behind forehead and/or cheekbones
2. **cluster:** pain in and around one eye
3. **tension:** pain is like a band squeezing the head
4. **mirgrane:** pain, nausea, and visual changes
44
What is transduction?
* process of converting painful stimuli to neuronal actional potentials at the sensory level
* nociceptors transduce noxious stimuli into action potentials
* chemical mediaters alter the membrane potential of the pain
45
What are the clinical manifestations of neuropathic pain?
* allodynia
* hyperalgesia
* atrophy of affected extremity
* coldness in affected area
* dystrophic changes
* hair loss
* shiny skin
46
Why is referred pain percieved in an area other than the site of injury?
pain generally referred to other structures in the same dermatome
47
What are the clinical manifestations of chronic pain?
* psychological
* job loss
* irritability
* depression
48
What is the treatment for cancer-related pain?
* multifaceted approach
* potent medications
49
What is trigeminal neuralgia?
* sudden, momentary, but excruciating pain along second and third divisions of trigmental nerve
50
True or false: carpal tunnel syndrome is an example of a peripheral neuropathy
true
51
What is perception?
when brain interprets pain as painful
52
\_\_\_\_\_ pain results from tissue injury in which the nerves become damaged or dysfunctional
neuropathic pain
53
Pain of myocardial infraction being felt in the jaw or left arm, shoulder pain after pelvic procedures, and diaphragmatic irritation from peritonities are all examples of what type of pain?
a) Cancer-related
b) Neuropathic
c) Referred
c
54
What does cancer-related pain result from?
* infiltration of organs
* compression of structures by expanding tumor
* result of cancer treatments
55
There are \_\_\_\_% of C fibers in the body.
a) 10
b) 45
c) 75
d) 90
d
56
True or false: trigminal neuralgia is more common in men than women
false - more common in women
57
What are the symptoms of neuropathic pain?
* constant aching
* intermittent sharp, shooting, burning, or shock-like pain
58
True or false: sharp, stinging, cutting, pinching feelings of pain are modulated by a-delta fibers.
true
59
What is fibromyalgia syndrome (FMS)?
* chronic widespread pain affecting all four extremeties
* hypoeralgesia
* trigger or tender points
* posterior side
* greater trochanter
* gluteal
* supraspinatus
* trapezius
* occiput
* anterior side
* knee
* lateral epicondyle
* second rib
* low cervical
60
List the fibers in order of ***increasing*** speed: a-delta fibers, c-fibers, a-beta fibers
c-fibers (unmylenated), a-delta fibers (lightly mylenated), a-beta fibers (heavily mylenated)
61
Describe the physiology of modulation of pain.
Descending pathways the originate from the raphe magnus in the brain go to the dorsal horn and release neurotransmitters that can inhibit synaptic transmission of pain signals
62
What is the enzyme responsible for the formation of prostaglandins?
cyclooxygenase
63
What are physical conditions that would open and close the gate?
open
* extent of injury
* inappropriate activity level
close
* medication
* counter stimulation (i.e. massage)
64
What are peripheral neuropathies?
they do not follow a dermatomal pattern
65
\_\_\_\_\_ causes conscious perception of pain
lower brian centers
66
Clicker: Which of the following statements about C-afferent sensory pain fibers is true.
## Footnote
A) These fibers transmit signals very rapidly
B) They are myelinated
C) They transmit the majority of pain signals
D) Their pain signals are highly localized in the brain
C
67
True or false: pain perception does not decrease with aging, but communication and expression of pain may vary
true
68
What is the result of referred pain?
convergence of visceral nociceptor activity with primary somatic afferents in the posterior horn of the cord
69
What is allodynia?
non-noxious stilmuli may cause pain
70
Clicker: Referred pain may be percieved at some distance from the area of tissue injury, but generally felt
## Footnote
A) on the same side of the body
B) within slightly less intensity
C) within the same dermatome
D) within 10-15 cm area
71
What is this diagram of and what does this diagram show?
primary efferent pain fibers (A-delta and C fibers) entering the dorsal horn, synapsing on interneurons, crossing to the opposite side and traveling to the brain in the anterolateral tract
72
What is physiologic pain?
pain where tissue injury has occured
73
There are \_\_\_\_% of A-delta fibers in the body.
a) 10
b) 45
c) 75
d) 90
a
74
\_\_\_\_\_\_\_\_ is the physiologic mechanisms of pain processing
nociception
75
\_\_\_\_\_\_\_ pain is associated with cancer disease process
cancer-related
76
What is hyperalgesia?
pain can be significantly enhanced
77
\_\_\_\_\_\_ is a symptom of an underlying problem.
pain
78
What does gate control theory state?
non-painful stimulus can block the transmission of a painful stimulus
79
True or false: dull, burning, aching types of pain are modiated by c fibers.
true
80
What can be used as treatment for headaches?
* identifying and avoiding triggers
* antiepileptics
* ergot alkaloids
* NSAIDs
* antidepressants
* beta/alpha blockers
* calcium-channel blockers
* pain medication
81
Clicker: A patient is using transcutaneous electrical nerve stimulation (TENS) to control pain. A neurse realizes TENS decreases pain by:
## Footnote
A) interrupting peripheral transmission of nocicpetions
B) modulating pain transmission at the spinal cord level
C) altering perception and integration of nociceptive impulses in the brain
D) producing relaxation as well as analgesia
B
82
What is the result of inadequate pain treatments in neonates and infants?
persistent behavioural changes and physical changes in CNS
83
How does the brain localize a pain sensation to a particular part of the body?
nociceptor pathways are kept in specific anatomic order (sensory dermatomes)
84
What is pain tolerance?
degree of pain an individual willing to bear before seeking relief
85
\_\_\_\_\_\_ is a complex mechanism wherbey synaptic transmission of pain signals is altered
modulation
86
What is chronic pain?
* lasts longer than expected healing time, \> 6 months
* associated with disease process
* increased peripheral transduction sensitivity
* central sensitization causes abnormal state of responsiveness or increased gain of nociceptive inputs
87
What are the three treatment modalities for pain mangement?
1. interrupting peripheral transmission of nociception
2. modulating pain transmission at the spinal cord level
3. altering the perception and integration of nociceptive impulses in the brain
88
Explain this diagram.
* nociceptive signals trasmitted by first-order primary afferent neurons
* transduced by membrane depolarization due to activation of ion chanels
* conducted along A-delta and C fibers into dorsal root ganglion where they synapse with second-order nociceptive neurons
* which travel up the brainstem to third-order neurons in the thalamus which project to several cortical and subcortical regions that encode pain
89
True or false: Lamina V is the key area for referred pain
true
90
What does trigeminal neuralgia result from?
compression of trigeminal nerve by other structures causing demylination and irritation
91
Clicker: The gate control theory of pain transmission predicts that activity in touch receptors will
## Footnote
A) enhance perception of pain
B) decrease pain signal transmission in the spinal cord
C) activate opioid receptors in the CNS
D) increase secretion of substance P in the spinal cord
B
92
The \_\_\_\_\_, located in the dorsal horn of the spinal cord, modulates the afferent nerve impulses.
gate
