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MI2 > Chronic or Persistent Pain > Flashcards

Chronic or Persistent Pain Flashcards

1
Q

What are A fibres?

A
  • Myelinated somatic nerve fibres
  • Largest in diameter, fastest conduction
  • Divided into alpha, beta, gamma & delta
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2
Q

What do delta fibres transmit?

A

Messages concerning pain, temperature & touch

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3
Q

What fibres are sharp and dull pain transmitted by?

A
  • Sharp: A-delta fibres

- Dull: Slow transmitting, unmyelinated C fibres

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4
Q

How is pain from above and below the neck transmitted?

A
  • Neck & below: Afferent neurons of spinal nerves

- Head: Sensory fibres of cranial nerves 5, 7, 9 & 10

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5
Q

How does the scientific community think persistent pain occurs?

A
  • Via neuroplasticity

- In the lamina, there are 5 wide dynamic range (WDR) 2nd order nociceptors

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6
Q

What are the characteristics of WDR?

A
  • High threshold
  • Highly adaptable
  • Main cause of chronic pain
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7
Q

What are the 3 stages of adaptation of WDR?

A
  • Potentiation
  • Intra-terminal genetic expression
  • Genetic expression (make more receptors in the brain)
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8
Q

What is the effect of passive interventions on WDR?

A

Passive interventions such as massage/touch may keeps exciting WDR, i.e. passive interventions may prolong/worsen chronic pain

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9
Q

What happens in the potentiation stage?

A
  • If WDR get used a lot, they adapt
  • Many adaptations
  • More chemicals made
  • Message transmitted earlier
  • Increase in resting level of excitement of cell’s action potential to fire
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10
Q

What happens in the intra-terminal genetic expression stage?

A
  • Holds open receptors
  • Double sodium than normal gets into nerve cells (tells brain there is double the amount of pain)
  • No extra messages come from injured tissue
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11
Q

What happens in the genetic expression stage?

A
  • Receptors mutate, so will take up other chemicals that are available
  • E.g. adrenaline (why some chronic pain patients complain of increased pain with anger)
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12
Q

What is the order of response to pain in the brain?

A
  1. Anterior cingulate cortex: attention
  2. Prefrontal cortex: Forward planning, emotion
  3. S1: Localisation, intensity
  4. S2
  5. Insular
  6. Thalamus
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13
Q

What is the process of pain transmission?

A
  1. Peripheral signal: Generator/receptor chemical
  2. Signal amplifier: Spinal cord neuroplasticity
  3. Signal receiver: Brain
  4. Signal modulator: Brain
  5. Inhibitory dysfunction: Brain
  6. Descending input: Brain to spinal cord
  7. Efferent output from spinal cord to muscles
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14
Q

What is the difference before descending inhibition & facilitation?

A
  • Descending inhibition: “It’s not that dangerous”

- Descending facilitation: “It’s more dangerous than that”

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15
Q

What is kinesiaphobia?

A

Fear of movement (pain)

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16
Q

What is the Tampa measure?

A

Fear avoidance measure

17
Q

What is an example that can be used to explain how pain is not always caused by tissue damage?

A

Phantom limb pain

18
Q

How should pain be considered?

A
  • As a human experience, rather than a marker of injury

- Perceived differently by everyone

19
Q

What does chronic pain syndrome appear to reflect?

A
  • A failure to adapt, i.e. the individual cannot cope with the unimproved symptoms
  • The presence of factors that interfere with adaptation may promote chronic pain (e.g. depression, inactivity, relationship problems)
20
Q

What are orange flags?

A

Mental health factors

  • Mental health disorders
  • Personality disorders
21
Q

What are yellow flags?

A
  • Unhelpful beliefs about injury
  • Poor coping strategies
  • Pasive role in recovery
22
Q

What are blue flags?

A

Social factors

  • Low social support
  • Unpleasant work
  • Low job satisfaction
  • Excessive work demands
  • Non-English speaking
  • Sense of injustice
  • Problems outside work
23
Q

What are black flags?

A

Other factors

  • Threats to financial security
  • Litigation
  • Compensation thresholds
24
Q

When will the brain produce pain?

A

When the brain concludes that:

  • Danger to the body tissue exists
  • Action is required
25
Q

What influences people’s perception of pain?

A
  • Sensory input from the body
  • Previous experience
  • Cultural factors
  • Social/work environment
  • Expectations about consequences of danger/pain
  • Beliefs, knowledge & logic
26
Q

What other body systems are affected by pain?

A
  • SNS
  • Motor
  • Endocrine
  • Immune
27
Q

How is the SNS affected by chronic pain?

A
  • Adrenaline activates WDR & sensitised C fibres
  • Difficulty sleeping & healing
  • Blood sugar difficulties
  • Agitation
28
Q

How is motor function affected by chronic pain?

A
  • Motor control problems
  • Sustained tissue load
  • Secondary injury/nociceptive input
29
Q

How is the endocrine system affected by chronic pain?

A
  • Sustained cortisol levels
  • Tissue breakdown
  • Immune difficulties
  • No sex drive
  • Poor digestion
  • Constipation
30
Q

How is the immune system affected by chronic pain?

A
  • Glia attacked
  • Neurones sensitised
  • Spreading pain in a non-dermatomal & non-Penfold’s homunculus distribution
31
Q

What is the most important intervention for chronic pain?

A

Education

32
Q

Where does pain modulation occur?

A

Spinal cord (control of transmission of nociceptive info) & in the cerebral cortex

33
Q

When do WDR neurons become more sensitised?

A

After repeated activation of nociceptors

34
Q

What happens when WDR neurons become more sensitised?

A

Stimulation of affected body part (which is normally not painful) is now capable of evoking pain) - Reversible process

35
Q

What is chronic pain?

A
  • Sensitisation of WDR neurons remains present
  • Primary afferent begins to form new connections between neurons
  • Inhibitory interneurons die
  • Pain signals are augmented
  • Irreversible process
36
Q

What is pain perception influenced by?

A

Prior experience & the context in which the noxious stimulus occurs

MI2 (10 decks)

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