CHRONIC PAIN Flashcards
A subjective and entirely individually personal experience
influenced by learning, context, and multiple
psychosocial variables
Pain
T/F Pain serves as an adaptive function designed to protect the
organism from harm
T
The one that said that pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage
International Association for the Study of Pain
It is a physiologic response to a “noxious” event which is time limited where in treatment should be aimed at removing the problem
Acute Pain
A type of pain that happens 3-6 mos p the initiating event which is both psychological and behavioral
Chronic Pain
T/F Acute pain may not be associated with ongoing noxious event or
pathologic process
F, Chronic
Chronic pain may be associated with ______ and ______
Disrupted sleep
Declining function
Chronic pain eventually ceases to serve any ____ role
protective
Chronic pain can become a source of:
Dysfunctional behaviors
Suffering
Disability
Untreated chronic pain can lead to multiple issues such as:
-Increased cost of health care
-Overuse or misuse of psychoactive medications
-Iatrogenic complications
-Increased economic and social costs
This pain includes repeated episodes of acute pain such as recurrent episodes of back pain
Recurrent pain
T/F Recurrent pain may also include Acute pain where symptoms are intermittent such as migraine HA
F, Chronic
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A chronic biopsychosocial disease characterized
by impaired control over drug use, compulsive
use, continued use despite harm, & craving
Addiction
Medications whose primary indication is a condition other than pain but have demonstrated benefit in pain mx
Includes antidepressants, anti convulsants, corticosteroids, neuroleptics, etc.
Adjuvent medication
Pain caused by a stimulus that does not
normally provoke pain (e.g. pt perceives touch as pain)
Can occur d/t medical disorder, result of past trauma/injury, or present idiopathically by itself (Fibromyalgia, Migraine, postherpic neuralgia)
Allodynia
Absence of pain in response to stimulation that
would normally be painful
Analgesia
A syndrome of sustained burning pain, allodynia,
& hyperpathia after a traumatic nerve lesion,
often combined with vasomotor & sudomotor
dysfunction (such as diabetic autonomic
neuropathy) & later trophic changes, such as in
the skin & connective tissues in the area
Causalgia
Pain initiated or caused by a primary lesion or
dysfunction in the central nervous system; pain
that the brain thinks is in the area but it’s not
there anymore
Central Pain
Pain that exists when individuals have developed
extensive pain behaviors, such as preoccupation
with pain, passive approach to health care,
significant life disruption, feelings of isolation,
demanding, angry, or doctor-shopping
Chronic Pain Syndrome
A maladaptive pattern of drug use marked by
tolerance & a drug class-specific withdrawal
syndrome that can be produced by abrupt
cessation, rapid dose reduction, decreasing
blood levels of drug, or administration of an
antagonist
Dependence
An unpleasant abnormal sensation, whether
spontaneous or evoked
Feels like a shock, burning, or tightening
Dysesthesia
An increased response to a stimulus that is
normally painful
Hyperalgesia
Increased sensitivity to stimulation (most likely,
touch), excluding the special senses
Hyperesthesia
Pain associated with cancer
Malignant pain
Pain initiated or caused by a primary lesion,
dysfunction, or transitory perturbation in the
peripheral or central nervous system
Neurogenic Pain
Pain initiated or caused by a primary lesion or
dysfunction in the nervous system
Neuropathic pain
The opposite of a placebo or the placebo effect.
A nocebo is an inert treatment or event that
increases Sx because the patient believes it will
increase Sx. The expectation of pain can result in
both increased pain from painful stimuli &
allodynia, pain from a normally non painful
stimulus
Nocebo effect
A receptor preferentially sensitive to a noxious
stimulus that would become noxious if
prolonged
Nociception
Refers to the affective component of pain.
Suffering includes both emotional (e.g., anxiety & anger) & cognitive (e.g., thoughts of
helplessness) components, & may be d/t a
combination of unpleasantness &
catastrophizing (making a “catastrophe” out of minor issues)
Suffering
Musculoskeltal causes
Spinal pain
Headaches
Arthritis
Other causes
Stroke
Spinal Cord Injuries
Multiple Sclerosis
HIV/AIDS
Cancer
This model of pain indicates that tissue damage causes pain sensations. This also works for acute pain
Traditional model of pain
Traditional model is unable to explain other examples of pain where no
damage could be found
-
Physical factors interact with personal and
environmental factos to affect body function and structure, activity, and participation in life activities
Biopsychosocial
This happens when patients have developed extensive pain behaviors. It can be considered a disease rather than a symptom affecting ALL aspects of life
Chronic Pain Syndrome
T/F CPS should address primary pathology and perpetuating factors
F, secondary
CPS RX should address:
peripheral and central
sensitization,
disinhibition,
anxiety,
catastrophizing,
fear
avoidance, etc.`
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According to this approach, acute pain is primarily nociceptive wherein Mechanical, thermal, chemical, and free nerve endings in
the periphery transmit information about noxoius
stimuli via different nerves
Integrated Biobehavioral Approach
2 Different brain areas process different types of pain:
A. SI Somatosensory Cortex
B. SII Somatosensory Cortex
- Sensory discriminatory aspect of pain
- Recognition, learning, and memory of pain events
A
B
This processes pain and unpleasantness which contributes to affect, cognition, and response selection
Anterior Cingulate Cortex
This area mediates autonomic responses o noxious stimulation and is considered to be the ________ component of pain related memory and learning
Insula
AFFECTIVE
This is a complex network of synaptic links initially determined by genetics which is modified by psychological and sensory inputs both
before and during the pain experience
Pain Neuromatrix
Pain neuromatrix is wherein pain is a complex web of interactions modulated by both _____ and _____ physical & psychological states
current
previous
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This theory is proposed by Melzack and Wall which talks about how a nonpainful stimulus can decrease the perception
of pain
Gate Control Theory
According to The Gate Control Theory, it is a ______control in wounded athletes & soldiers
Descending
In the Gate control theory, it is mediated by _______ and descending ______ connections
Norepinephrine
Noradrenergic
Melzack proposed the neuromatrix to explain how the
pain experience is mediated by multiple factors
-
This pathway travel through the Dorsal funiculus
Dorsal Inhibitory Pathways
In the Dorsal Inhibitory Pathways, neurotransmitters secreted in the dorsal horn:
Noradrenaline
Acetylcholine
Serotonin
Glycine
_________ factors modify activity of the pain
pathways in all levels of the nervous system
Descending inhibitory
_______ sensitivity can be reversed by ________ (antagonist)
Opioid
Naloxone
Modulaters in the GCT
Placebo, antidepressants, anticonvulsants
In the GCT, structures involved:
Hypothalamus
Amygdala
Periaqueductal grey area (PAG)
Rostral ventromedial medulla (RVM)
This is the decreasing modulationwhich can increase pain as well as inhibit it. The expectation of pain can result in both increased pain from painful stimuli but also allodynia
Nocebo effect
Nocebo effect can be mediated by:
Caudal anterior cingulate cortex
Head of the caudate
Cerebellum
Contralateral cuneiform nucleus
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Afferent nociceptive input is increased through a
decreased threshold, increased responsiveness and/or
increased receptive field
Peripheral Sensitization
In peripheral sensitization, inflammatory mediators include:
Cytokines
Prostaglandins
Serotonin
T/F For peripheral sensitization, Injury sensitizes the nerve through either inflammation
witihin the neural connective tissue or indirect
compromise of the axons
F, direct
Inflammation in the CNS causes increased sensitization
by increasing excitability in the dorsal horn
Central Sensitization
Central sensitization may result in:
hyperalgesia, allodynia, aftersensations, summation
T/F Central sensitization provides a physiologic explanation for pain in the
presence of identifiable injury
F, absence of identifiable injury
Central sensitization is a ______mechanism for pain during stress or psyche
Physical
T/F Central sensitization can be maintained by ongoing nociceptive input or be
independent of nociceptive input
T
Central sentization can occur in the ff:
SC,
RVM,
amygdala,
anterior cingulate cortex,
and trigeminal brainstem complex
This are Repeated low-frequency nociceptor stimulation
results in progressively increased action potential in
the dorsal horn cells
Wind-up
T/F Wind up can cause short-term potentiation
F, long-term
Central sensitization can occur in conditions such as:
Fibromyalgia
Widespread myofascial pain
Chronic headache
TMJ disorders
Neuropathic pain
Occurs when the pain fiber synapses with the seconday
neuron in the dorsal horn is amplified, resulting in the
firing of the secondary neuron with lower peripheral
stimulus
Hyperalgesia
Decreased firing threshold or decreased inhibition
Short-term allodynia
Includes sprouting of A Alpha and Beta fibers to synapse
with nociceptor fibers causing sensory input to be pain
Long-term allodynia
