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Pathophysiology > Chapter 47 - Pain > Flashcards

Chapter 47 - Pain Flashcards

1
Q

_______ cause inflammation when tissue injury occurs.

A

prostaglandins

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2
Q

What is pain threshold?

A

level of pain stimulation required to be percieved

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3
Q

What are the two major subtypes of pain?

A
  1. physiologic
  2. pathologic
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4
Q

What are the clinical manifestations of cancer-related pain?

A
  • sympathetic nervous system activation
  • behavoiural changes
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5
Q

What is pain expression?

A

way in which the pain experience is communicated to others

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6
Q

What are the 4 stages in the physiology of pain?

A
  1. transduction
  2. transmission
  3. perception
  4. modulation
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7
Q

_____ result from dysfunction of the brainstem areas involved with modulation of craniovascular afferent fibers

A

migraines

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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
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9
Q

______ pain is percieved in an area other than side of injury

A

referred

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10
Q

What is radiculopathy?

A

pain due to spinal nerve injury

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11
Q

What are treatments for trigeminal neuralgia?

A

anticonvulsants, surgical nerve decompression and gamma radiosurgery

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12
Q

True or false: the etiology of fibromyalgia syndrome is known.

A

false - not known

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13
Q

What are emotional conditions that would open and close the gate?

A

open

  • anxiety/worry
  • tension
  • depression

close

  • positive emotions
  • relaxation
  • rest
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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

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15
Q

______ are useful for locating a source of neurologic pain

A

dermatomal maps

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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

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17
Q

What is radiculopathy?

A

pain located in the pattern of a dermatome that occurs with spinal nerve injury

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18
Q

Clicker: The _______ is the level of painful stimulation required to be percieved.

A) perception

B) tolerance

C) expression

D) threshold

A

D

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19
Q

What is the treatment for chronic pain?

A

pain clinic with multimodal therapies

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20
Q

What is pathologic pain?

A

pain occurs after tissue injury, but long-term changes occur in PNS and CNS via somatosensory pathways

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21
Q

True or false: glumate release stimulating the “wind up” phenomenon can lead to (acute/chronic) pain.

A

chronic

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22
Q

______ is associated with disordered mechanisms in the CNS.

A

fibromyalgia syndrome (FMS)

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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
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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

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25
Q

What are the risk factors of fibromyalgia?

A
  • trauma
  • sexual abuse
  • stress
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26
Q

What does neuropathic pain result from?

A
  • altered central processing of nociceptive input (releasing norepinephrine onto nociceptors)
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27
Q

What is a sensory dermatome?

A

a particular area of the body surface innervated by a spinal nerve with nociceptor fibers

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28
Q

What is accute pain?

A
  • 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
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29
Q

true or false: young and old often recieve inadequate pain management

A

true

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30
Q

true or false: infants do not have pain perception

A

false - they do

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31
Q

What is the “wind up” phenomenon and what neurotransmitter stimulates it?

A
  • 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
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32
Q

What are the 3 classifications of pain?

A
  1. duration (acute, chronic)
  2. source (cancer, neuropathic, ischemic)
  3. location and referral pattern
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33
Q

_____ interprets pain quality

A

cortex

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34
Q

What are the 3 factors that open or close the gate?

A
  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
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35
Q

True or false: Adequate of cancer-related pain control is a major factor affecting quality of life

A

true

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36
Q

Describe the pathogenesis of chronic pain.

A

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.

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37
Q

What are the clinical manifestations of trigeminal neuralgia?

A
  • sharp or shooting, electrick shock pain
    • may be pain free between episodes or
    • complain of a dull ache in area
38
Q

True or false: men are affected by fibromyalgia syndrome more than women.

A

false - women affected more

39
Q

What does activation of the sympathetic nervous system during acute pain do?

A
  • increased HR, respiration, BP
  • dilated pupils
  • perspiration
  • pallor
  • increased circulating blood glucose
  • decreased gastrointestinal motility
  • hypomotility of bladder
40
Q

How is pain modulated within the brain/spinal cord?

A

endogenous opioids (enkephalins, endophins)

41
Q

True or false: vertebral disk disease is an example of radiculopathy

A

true

42
Q

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.

A

prostaglandins, cyclooxygenase

43
Q

Distinguish between the 4 types of headaches?

A
  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
Q

What is transduction?

A
  • 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
Q

What are the clinical manifestations of neuropathic pain?

A
  • allodynia
  • hyperalgesia
  • atrophy of affected extremity
  • coldness in affected area
  • dystrophic changes
    • hair loss
    • shiny skin
46
Q

Why is referred pain percieved in an area other than the site of injury?

A

pain generally referred to other structures in the same dermatome

47
Q

What are the clinical manifestations of chronic pain?

A
  • psychological
    • job loss
    • irritability
    • depression
48
Q

What is the treatment for cancer-related pain?

A
  • multifaceted approach
  • potent medications
49
Q

What is trigeminal neuralgia?

A
  • sudden, momentary, but excruciating pain along second and third divisions of trigmental nerve
50
Q

True or false: carpal tunnel syndrome is an example of a peripheral neuropathy

A

true

51
Q

What is perception?

A

when brain interprets pain as painful

52
Q

_____ pain results from tissue injury in which the nerves become damaged or dysfunctional

A

neuropathic pain

53
Q

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

A

c

54
Q

What does cancer-related pain result from?

A
  • infiltration of organs
  • compression of structures by expanding tumor
  • result of cancer treatments
55
Q

There are ____% of C fibers in the body.

a) 10
b) 45
c) 75
d) 90

A

d

56
Q

True or false: trigminal neuralgia is more common in men than women

A

false - more common in women

57
Q

What are the symptoms of neuropathic pain?

A
  • constant aching
  • intermittent sharp, shooting, burning, or shock-like pain
58
Q

True or false: sharp, stinging, cutting, pinching feelings of pain are modulated by a-delta fibers.

A

true

59
Q

What is fibromyalgia syndrome (FMS)?

A
  • 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
Q

List the fibers in order of increasing speed: a-delta fibers, c-fibers, a-beta fibers

A

c-fibers (unmylenated), a-delta fibers (lightly mylenated), a-beta fibers (heavily mylenated)

61
Q

Describe the physiology of modulation of pain.

A

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
Q

What is the enzyme responsible for the formation of prostaglandins?

A

cyclooxygenase

63
Q

What are physical conditions that would open and close the gate?

A

open

  • extent of injury
  • inappropriate activity level

close

  • medication
  • counter stimulation (i.e. massage)
64
Q

What are peripheral neuropathies?

A

they do not follow a dermatomal pattern

65
Q

_____ causes conscious perception of pain

A

lower brian centers

66
Q

Clicker: Which of the following statements about C-afferent sensory pain fibers is true.

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

A

C

67
Q

True or false: pain perception does not decrease with aging, but communication and expression of pain may vary

A

true

68
Q

What is the result of referred pain?

A

convergence of visceral nociceptor activity with primary somatic afferents in the posterior horn of the cord

69
Q

What is allodynia?

A

non-noxious stilmuli may cause pain

70
Q

Clicker: Referred pain may be percieved at some distance from the area of tissue injury, but generally felt

A) on the same side of the body

B) within slightly less intensity

C) within the same dermatome

D) within 10-15 cm area

A
71
Q

What is this diagram of and what does this diagram show?

A

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
Q

What is physiologic pain?

A

pain where tissue injury has occured

73
Q

There are ____% of A-delta fibers in the body.

a) 10
b) 45
c) 75
d) 90

A

a

74
Q

________ is the physiologic mechanisms of pain processing

A

nociception

75
Q

_______ pain is associated with cancer disease process

A

cancer-related

76
Q

What is hyperalgesia?

A

pain can be significantly enhanced

77
Q

______ is a symptom of an underlying problem.

A

pain

78
Q

What does gate control theory state?

A

non-painful stimulus can block the transmission of a painful stimulus

79
Q

True or false: dull, burning, aching types of pain are modiated by c fibers.

A

true

80
Q

What can be used as treatment for headaches?

A
  • identifying and avoiding triggers
  • antiepileptics
  • ergot alkaloids
  • NSAIDs
  • antidepressants
  • beta/alpha blockers
  • calcium-channel blockers
  • pain medication
81
Q

Clicker: A patient is using transcutaneous electrical nerve stimulation (TENS) to control pain. A neurse realizes TENS decreases pain by:

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

A

B

82
Q

What is the result of inadequate pain treatments in neonates and infants?

A

persistent behavioural changes and physical changes in CNS

83
Q

How does the brain localize a pain sensation to a particular part of the body?

A

nociceptor pathways are kept in specific anatomic order (sensory dermatomes)

84
Q

What is pain tolerance?

A

degree of pain an individual willing to bear before seeking relief

85
Q

______ is a complex mechanism wherbey synaptic transmission of pain signals is altered

A

modulation

86
Q

What is chronic pain?

A
  • 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
Q

What are the three treatment modalities for pain mangement?

A
  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
Q

Explain this diagram.

A
  • 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
Q

True or false: Lamina V is the key area for referred pain

A

true

90
Q

What does trigeminal neuralgia result from?

A

compression of trigeminal nerve by other structures causing demylination and irritation

91
Q

Clicker: The gate control theory of pain transmission predicts that activity in touch receptors will

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

A

B

92
Q

The _____, located in the dorsal horn of the spinal cord, modulates the afferent nerve impulses.

A

gate

Pathophysiology (6 decks)

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