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Block 4; Week 1-Michelle > Clinical Management of Pain--Blake > Flashcards

Clinical Management of Pain--Blake Flashcards

1
Q

What is the IASP definition of pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

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2
Q

What are 4 of the main effects of chronic pain on a patient? What does each mean?

A

Physical functioning–activity level, sleep
Psychological morbidity–depression, anxiety, anger
Social Consequences–relationships, sex
Societal Consequences–health care costs, lost work days.

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3
Q

What are the 4 categories of pain when it is categorized in an etiology-based manner?

A

Nociceptive
Neuropathic
Cancer
Psychogenic

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4
Q

What are the 2 main types of nociceptive pain & what does each refer to?

A

Somatic Pain–arises from bone, muscle, ligament, skin

Visceral Pain–arises from organs

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5
Q

What is neuropathic pain?

A

pain arising from a lesion or disease affecting the somatosensory system.

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6
Q

What is mixed pain?

A

combo of nociceptive & neuropathic, usu seen in cancer

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7
Q

What type of pain are these examples of?
cholecystitis
nephrolithiasis

A

visceral pain (nociceptive pain)

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8
Q

What type of pain is this an example of?

chest wall pain from lung cancer

A

mixed pain

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9
Q

What type of pain are these examples of?

radiculopathy, CRPS

A

neuropathic pain

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10
Q

What type of pain are these examples of?
ankle sprain
arthritis

A

somatic pain (nociceptive pain)

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11
Q

Why is it that a person w/ 9/10 chronic pain can roll over & go to bed?

A

b/c chronic pain just operates differently than acute pain. need to think of the 9/10 as the amount that the pain is taking over their lives.

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12
Q

What are the 4 pain assessment scales used?

A

Verbal Pain Intensity Scale
Visual Analog Scale
0-10 Numeric Pain Intensity Scale
Faces Scale

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13
Q

What is the estimate for the total number of people in the U.S. experiencing neuropathic pain (excluding back pain)?

A

1, 765, 000.

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14
Q

What are the 3 components of a comprehensive treatment plan?

A

biological approach
psychological intervention
social/rehabilitative issues

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15
Q

What are the 2 main sympathetic blockade techniques?

A

stellate ganglion block

lumbar sympathetic block

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16
Q

What is the usu nociceptor structure & what are the 2 main types?

A

unmyelinated axons w/ small cell body diameter

2 types: C-fiber & A delta fiber

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17
Q

What are the 2 functional properties of nociceptors?

A
  1. encode stimulus intensity into a noxious range

2. primary afferent sensitization: increase in excitability due to endogenous mediators & factors

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18
Q

What are the 4 events that are necessary for the nociceptor to convey info to the CNS about noxious stimuli?

A
  1. Signal Transduction
  2. Signal Transformation
  3. AP propagation
  4. Signal Transmission
19
Q

What happens during signal transmission?

A

AP initiates release of NT on the 2nd order neuron

20
Q

Which receptor is important in nociceptor signal transduction & depolarization of the peripheral terminal?

A

TRPV1 receptor

21
Q

Describe the characteristics of peripheral nociceptor sensitization.

A 
increased excitability
lower threshold for activation
sometimes ongoing spontaneous activity
main cause of hyperalgesia
can cause central sensitization
22
Q

What does it mean to have an increase in excitability of peripheral nociceptors?

A

increase in excitability = increased response to noxious stimuli

23
Q

What is hyperalgesia?

A

increased pain produced by the stimulation of the site of injury

24
Q

What is central sensitization?

A

an increased excitability of central neurons

25
Q

What is allodynia?

A

pain resulting from normally painless stimuli

26
Q

What are lamina I & lamina II the primary site for?

A

excitatory neuropeptide input from primary afferent neurons

27
Q

What is lamina II considered?

A

substantia gelatinosa

28
Q

Spinomesencephalic neurons target which 2 areas?

A

midbrain

PAG: periaqueductal grey

29
Q

What is the periaqueductal grey an important region for?

A

important area for regulation of nociception

key structure for relaying descending pain modulation via RVM nuclei

30
Q

What are 4 super important areas for supra spinal pain processing?

A

periaqueductal grey
thalamus
sensory cortex
limbic system

31
Q

What happens @ the thalamus?

A

almost all sensory systems send signals to the thalamus that are then directed to specific cortical representation areas

32
Q

What is the rough idea behind the Gate Control theory of pain?

A

activation of a beta fibers produces an inhibitory effect on a delta & c fibers. Rubbing an area of injury can help get rid of the pain–>stops the pain signals.

33
Q

After an injury, what happens to a fiber terminals & c fiber terminals?

A

c fiber terminals atrophy

a fiber terminals sprout into the superficial dorsal horn

34
Q

What are the 2 main EAA (excitatory amino acids) that are NTs released from primary afferents & act on ligand-activated ion channels?

A

glutamate

aspartate

35
Q

What are the 2 main EAA-activated ion channels?

A

AMPA

NMDA

36
Q

What is AMPA responsible for?

A

fast nociceptive transmission

37
Q

What is NMDA responsible for?

A

sustained depolarization **big focus of chronic pain research.

38
Q

What are 2 excitatory NT that act via channel activation & 2nd messenger systems?

A

CGRP

Substance P

39
Q

What is CGRP involved in?

A

peripheral vasodilation

40
Q

What is Substance P involved in?

A

it is a modifier & is co-released w/ glutamate & is involved in neurogenic inflammation

41
Q

Inhibitory Amino Acids (IAA) are NT released from what? What are the 2 main types of IAA?

A

2 main types of IAA:
GABA
Glycine
**released from spinal interneurons

42
Q

Aside from GABA & Glycine what are other NT that are released from spinal interneurons?

A

opioids

ACh

43
Q

What are the 2 main NT released from supra spinal sources?

A

Serotonin

NE

Block 4; Week 1-Michelle (6 decks)

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