L29 - knowing pain Flashcards
location of insular cortex
below the lateral sulcus
pain - primary somatosensory cortex
tells us amplitude and location of pain
pain - amygdala
emotionally affected area (fearfulness / anxiety)
pain - hippocampus
memory of pain
pain - anterior cingulate cortex
tension pain
pain - brainstem
autonomic functions of body (heart rate, bp)
pain - pre-frontal cortex
modulates pain
pain definition
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
autonomic descriptions of pain
heart rate increasing
can’t sleep
blood pressure increasing
visceral descriptions of pain
sickening, nauseating
how does pain travel
spinothalamic tract
what happens to pain when emotions are tightened
increases
how can you become less sensitive to pain
- gate control theory of pain
- descending inhibitory fibres
pain fibres
C fibres
small, slower fibres
mechanoreceptor fibres
A-delta fibres
slightly longer
sharp, quick pain associated with reflexes
gate control theory of pain
- inhibitory neurones present at dorsal horn
- when touch fibres are activated, later A-beta fibres, interneurones are activated
- release of opioids in the synapse
- depolarisation
- reducing C-fibre input
- hence, touch, reduces pain
TENS machine
electrical devices often used in labour - stimulates mechanoreceptors and touch fibres, reducing pain
descending inhibitory fibres
- the midbrain consists of periaqueductal grey matter
- rich in opioid receptors
- enhances descending inhibitory pathways and reduces pain
key neurotransmitters in descending pathway
noradrenaline (fight of flight)
serotonin (mood determiner)
what are serotonin re-uptake inhibitors used for
depression and pain
nociceptive pain
pain due to tissue damage and inflammation
neuropathic pain
spontaneous pain initiated or caused by a primary lesion or dysfunction in the CNS or PNS
examples of neuropathic pain
trigeminal neuralgia (jaw claudication), phantom pain, diabetic neuropathy
features of neuropathic pain
- accompanied by positive or negative phenomena
- often constant - not reduced by rest
- associated with severe comorbidity and poor QOL
treatment for nociceptive pain
- rest
- exercise
- allow repair
- usually responds to pain killers
- normal WHO ladder - paracetamol, NSAIS, weak opioids
example of nociceptive pain
arthritis
treatment for neuropathic pain
- neuropathic pain killers
- gabapentin, pregabalin, amitriptyline
- spinal cord stimulation
- often doesn’t respond to pain killers
acute pain
- usually nociceptive
- associated with trauma or injury
chronic pain
pain that persists past abnormal duration of tissue healing
hyperalgesia
worsening of pain with opioids
measuring pain
nociceptive input (pain pathway) + biopsychosocial phenomena
nociceptive mete
VAS numeric pain distress scale
reasons why pain killers may not worl
- biopsychosocial aspects
- tolerance
- misdiagnosis
- incorrect dose
ACT
acceptance and commitment therapy
- trying to develop a rich, full and meaningful life
- learning skills to deal with difficult thoughts and feelings
spinal cord stimulation
Delivery of energy to the spinal cord through electrodes in the epidural space
- SCS works by delivering small electrical pulses to the pain sensing pathways of the spinal cord, effectively altering the pain signals traveling to the brain.
- SCS is typically prescribed for the treatment of pain of the back, trunk, or limbs
