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Pain Management > Introduction to Pain Management Lecture 1 > Flashcards

Introduction to Pain Management Lecture 1 Flashcards

0
Q

According to Cascade of Pain Classification:

How is “Longevity” classified?

A

Acute and Chronic

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1
Q

Define Pain (as by the International Association for the Study 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

According to Cascade of Pain Classification, how long is pain endured to be considered “Acute”?

A

Acute is considered less than 3- 6 months

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3
Q

According to Cascade of Pain Classification, how long is pain endured to be considered “Chronic”?

A

Chronic is greater than 3- 6 months

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4
Q

According to Cascade of Pain Classification, how is the underlying pathophysiology classified as?

A

Nociceptive and Non-Nociceptive

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5
Q

Nociceptive pain is classified into what two categories?

A

Somatic and Viceral

*Associated with the stimulation of specific nociceptors and can be either somatic or viceral

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6
Q

Non-nociceptive pain is classified into what two categories?

A

Neuropathic and Idiopathic or Psychogenic

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7
Q

How is nociceptive, Somatic pain defined as?

A

Pain that has an identifiable locus as a result of tissue damage causing the release of chemicals from injured cells that mediate pain

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8
Q

What are the characteristics of nociceptive, Somatic pain?

What is an example of Somatic pain?

A
  • Well localized (Type A nerve fibers)
  • Sharp pain in nature
  • Generally hurts at the point or area of stimulus

Example: A pin prick

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9
Q

How is nociceptive, Viceral pain defined as?

A

Diffuse and can be referred to another area of the body. It is often associated with distention of an organ capsule or the obstruction of a hollow viscus. Also, it is often accompanied with autonomic reflexes such as nausea, diarrhea, or vomitting

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10
Q

What are the characteristics of nociceptive, Viceral pain?

What is an example of Viceral pain?

A
  • Dull
  • Cramping
  • Squeezing
  • Often vague in nature
  • Pressure pain that may radiate

Example: Generalized abdominal pain with nausea and vomitting for an appendicitis

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11
Q

How is non-nociceptive, Neuropathic pain defined as?

A

Caused by damage to peripheral or central neural structures resulting in abnormal processing of painful stimuli

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12
Q

What are the characteristics of non-nociceptive, Neuropathic pain?
What is an example of Neuropathic pain?

A
  • Burning - Tingling
  • Shock-like - Stabbing sensation
  • Numbness - “Pins and Needles” sensation
  • Throbbing sensation

Example: “Boot toe”

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13
Q

How is non-nociceptive, Idiopathic or Psychogenic pain defined as?

A

Associated with chronic pain states and is used to describe pain that has no apparent cause. Neither nociceptive or non-nociceptive mechanisms can be identified as the cause for pain, and psychological systems are commonly present

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14
Q

What is Algesia?

A

Increased sensitivity to pain

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15
Q

If it is “pain producing”, it is considered:

A

Algogenic

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16
Q

What is Allodynia?

A

Where a normally non-harmful stimulus is perceived as painful

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17
Q

The absence of pain in the presence of a normally painful stimulus is the definition of _________.

A

Analgesia

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18
Q

What is Dysesthesia?

A

An unpleasant painful abnormal sensation, whether evoked or spontaneous

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19
Q

A heightened response to a normally painful stimulus is considered to be ___________.

A

Hyperalgesia

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20
Q

What is Neuralgia?

A

Pain in the distribution of a peripheral nerve(s)

21
Q

This is the abnormal disturbance in the function of a nerve(s)

A

Neuropathy

22
Q

What is Parathesia?

A

An abnormal sensation, whether evoked or spontaneous

23
Q

What are the FOUR processes that define Nociceptive Somatic Pain?

A
  • Transduction
  • Transmission
  • Perception
  • Modulation
24
Q

In terms of Nociceptive Somatic Pain, what is Transduction?

A

Transformation of a noxious stimuli (chemical, mechanical, thermal) into an action potential

25
Q

In terms of Nociceptive Somatic Pain, what is Transmission?

A

The process by which an action potential is conducted from the periphery to, but before, the CNS

26
Q

In terms of Nociceptive Somatic Pain, what is Perception?

A

Occurs once the signal is recognized by several areas of the brain to include:

  • The Amygdala
  • Somatosensory area of the Cortex
  • Hypothalmus
  • The Anterior Cingulate Cortex
27
Q

In terms of Nociceptive Somatic Pain, what is Modulation?

A

Involves altering neural afferent activity along the pain pathway; it can SUPPRESS or ENHANCE pain signals

28
Q

What is another name for pain receptors?

A

Nociceptors, free nerve endings

29
Q

Peripheral nociceptors that conduct stimuli to the _______ horn of the spinal cord, are categorized according to morphology. Morphology factors are: _________, __________, and ________.

A
  • Dorsal
  • Diameter
  • Myelination
  • Conduction velocity
30
Q

What are TWO common nerve fibers associated with the transduction of peripheral nociceptors?

A
  • Larger myelinated A- delta nerve fibers: Primary afferent neurons that conduct action potentials at velocities between 6 and 30 meters/second and elicit FAST SHARP PAIN
  • Smaller unmyelinated C- nerve fibers: Conduct at velocities between 0.5 and 2 meters/second. AKA polymodal fibers because they respond to mechanical, chemical, and thermal injuries.
31
Q

How are smaller unmyelinated C-fibers described as?

A
  • Burning
  • Aching
  • Dull
  • Throbbing
32
Q

Describe how inflammation and peripheral nociception occurs

A

When peripheral tissues (skin, bone, viscera, etc.) receive chemical, mechanical, and/or thermal stimuli or are either traumatized by either surgery or injury; a series of BIOMECHANICS events take place in peripheral pain transduction

33
Q

Name the chemical mediators and neurotransmitters

A
  • Substance P - Serotonin
  • Glutamate - Prostaglandins
  • Bradykinin - Cytokines
  • Histamine
34
Q

Describe how chemical mediators and neurotransmitters work

A

They stimulate peripheral nociceptors, causing an INFLUX of SODIUM IONS to enter the NERVE FIBER membranes (DEPOLARIZATION) and a subsequent INFLUX of POTASSIUM IONS (REPOLARIZATION) resulting in an ACTION POTENTIAL generating a PAIN IMPULSE.

35
Q

In which pathway does Transmission of nonciceptive pain occur?

A

Spinothalamic (anterolateral) Pathway

36
Q

Where are the cell bodies of the primary afferent neurons (A-delta and C-fibers) located on the spinal cord?

A

The Dorsal Root Ganglia

37
Q

Upon entering the ______ horn, these fibers _________ and descend or ascend several spinal segments in the _____________.

A
  • Dorsal
  • Segregate
  • Tract of Lissauer
38
Q

What happens after the pain impulse leaves the Tract of Lissauer?

A

The axons of the primary afferent enter the gray matter of the dorsal horn where they synapse with the second-order neurons and terminate primarily in the Laminae of Rexed.

39
Q

At which laminae, in the Laminae of Rexed, do the primary afferent neurons terminate at?

A

I, II, and V

40
Q

How many types of second-order neurons are there?

What are they?

A

Two types

  1. Nociceptive neurons: which receive input solely from primary A-delta nerve fibers and C-fibers
  2. Wide-Dynamic-Range (WDR) neurons: receive input from both nociceptive (A-delta and C-fibers) and non-nociceptive (A-beta) primary afferents
41
Q

How are Wide-Dynamic-Range (WDR) neurons activated?

A

A variety of stimulants both innocuous and noxious

42
Q

How do second-order neurons cross the the midline of the spinal cord?
Then what do they do?

A

Through the Anterior Commissure

They ascend through the anterolateral pathway of the spinothalamic tract up to the Thalamus.

43
Q

Where do second-order neurons synapse with third-order neurons?
Then what do third-order neurons do?

A

Lateral Thalamus and the Intralaminar Nuclei

Send projections to the Cerebral Cortex

44
Q

Once third-order neurons send projections (signals) to Cerebral Cortex what occurs?

A

Perception occurs once the signal is recognized by the different areas of the brain

45
Q

Where does Modulation occur?

What can it do to pain?

A

Within the descending efferent pathways

It can either SUPPRESS or ENHANCE pain

46
Q

What is considered the body’s “Pain Control System” or “Analgesia System”?

A

The Descending Efferent Modulating Pathway from the brain

47
Q

Where do descending axons come from that synapse with and suppress pain transmission to the brainstem and the spinal cord dorsal horn?

A

Descending axons arise from:

  • The Cerebral Cortex - Hypothalamus
  • Thalamus - Periaquaductal Gray Matter
  • Raphe Magnus Nucleus
  • Locus Ceruleus (in the Pons) via the Dorsolateral Funiculis
48
Q

What play an inhibitory role in suppressing pain during Modulation?
What are they?

A

Endogenous Opioids

  • Endorphins
  • Enkephalins
  • Dynonorphins
49
Q

What occurs with the presence of “Central Sensitization”?

A

Pain Modulation is enhanced

50
Q

With pain-modulating neurotransmitters, what are the TWO excitatory neurotransmitters?
What receptors do they bind to?

A

Substance P and Glutamate

Substance P: Neurokinin 1 and 2 (NK1) (NK2)
Glutamate: NMDA, AMPA, and Kainate

51
Q

With pain-modulating neurotransmitters, what are the FIVE inhibitory neurotransmitters?
What receptor do they bind to?

A
  • Glycine: Chloride linked (GlyR)
  • GABA: GABAa, GABAb, GABAc
  • Enkephalins: Mu, Delta, Kappa
  • Serotonin: 5-HT (5-HT1-3)
  • Norepinephrine: Alpha 2 adrenergic

Pain Management (1 decks)

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