L3: Intro to Pain Management (Granone)

Question 1

negative consequences of pain

Answer 1

hyperalgesia
sympathetic stimulation
decreased appetite
increased anesthetic drug requirements
unseen CNS changes

Question 2

adaptive inflammatory pain

Answer 2

spontaneous pain and hypersensitivity to pain in response to tissue damage and inflammation. Occurs with tissue trauma, injury, surgery

Question 3

adaptive nociceptive pain

Answer 3

transient pain in response to a noxious stimuli. Small aches and pains that are relatively innocuous and that protect the body from the env.

Question 4

allodynia

Answer 4

pain caused by a stimulus that doesn’t normally result in pain
-manifestation of peripheral n. and tissue injury that induces changes in the CNS

Question 5

hyperalgesia

Answer 5

an increased response to a stimulus that is normally painful
-localized inflammation at the site of tissue injury, in peripheral tissues, causes hyperexcitability of nociceptors due to a reduction in threshold and an increased responsiveness to noxious stimuli (peripheral sensitization)

Question 6

maladaptive pain - functional

Answer 6

hypersensitivity to pain resulting from abnormal processing of normal input. Is chronic

Question 7

maladaptive pain - central neuropathic pain

Answer 7

pain initiated or caused by a primary lesion or dysfunction in the CNS. Often called “central pain”

Question 8

nociception

Answer 8

the process of detection of potentially or actually damaging stimuli and the transmission of that information to the brain. Made up of 5 components:

1) transduction
2) transmission
3) modulation
4) projection
5) perception

Question 9

transduction

Answer 9

the conversion of noxious stimuli to an action potential at the level of nociceptors

Question 10

transmission

Answer 10

the propagation of action potentials by primary afferent neurons to the spinal cord

Question 11

modulation

Answer 11

the process by which nociceptive information is augmented or inhibited

Question 12

projection

Answer 12

the delivery of nociceptive information from the spinal cord to the brain

Question 13

perception

Answer 13

the integration of the nociceptive info by the brain. The overall conscious emotional experience of pain

Question 14

does nociceptor activation = pain?

Answer 14

NO!

Question 15

nociceptor

Answer 15

-unspecialized n. cell endings that initiate the sensation of pain, sense and transduce electrical signals at the site of tissue disruption

Question 16

graph slide 4

Answer 16

:)

Question 17

windup

Answer 17

the perceived increase in pain intensity over time when a painful stimulus is repeatedly delivered above a critical rate

• occurs as a frequency-dependent increase in the excitability of spinal cord neurons, specifically afferent C fibers (central sensitization)
• challenging to treat

Question 18

pain pathway

Answer 18

1) sensory pain receptors located on peripheral ends of sensory n. fibers convert painful chemical or physical stimuli into action potentials
2) APs open gated ion channels
3) depolarization of cell membrane and an AP

Question 19

stimuli that have potential to cause cell damage

Answer 19

heat
vibration
pressure
chemicals

Question 20

3 mechs. that release of inflammatory mediators leads to peripheral sensitization (pain amplification)

Answer 20

1) depolarization of pain sensing nerve endings
2) lowering the threshold in which depolarization occurs in primary afferent nerves
3) vasodilation and inc. permeability of blood vessels that results in an increased # of leukocytes and inflammatory mediators at the site of injury

Question 21

once an AP is triggered, signal is sent to:

Answer 21

dorsal horn of spinal cord where pain signal is processed.

Question 22

synapses of importance for this lecture

Answer 22

• neurons from ascending tracts to the brain

- alpha-motor neurons which serve as efferent limb of reflex actions in response to painful stimuli

Question 23

pain signals from spinal cord sent to:

Answer 23

contralateral thalamus –> somatosensory cortex of the brain

Question 24

slide 6**

Answer 24

:)

Question 25

somatosensory cortex is responsible for:

Answer 25

1) discrimination of pain signals

2) recognition, learning and memory of painful experiences

Question 26

somatic pain

Answer 26

pain related to the wall of the body cavity

Question 27

visceral pain

Answer 27

pain that is often poorly localized and associated with mechanical stimuli (ie. stretch of viscera), ischemia, chemical and thermal stimuli
-accompanied by changes to somatic m. tone and autonomic responses

Question 28

signs of pain in horse

Answer 28

unwillingness to use limbs
flank-watching
restless
attitude change
posture
facial expression
interaction w/ people

Question 29

T/F: HR and RR are poor indicators of pain in hospitalized dogs

Answer 29

T

Question 30

simple descriptive pain scale

Answer 30

• first pain scale to be used in animals

- 3 to 5 point scale w/ answers of mild, moderate to severe (open to interpretation)

Question 31

numerical rating scales

Answer 31

-use numeric units which are assigned to different categories of behaviors

Question 32

University of Melbourne Pain Scale

Answer 32

used to assess post-op pain

-fails to capture full details of a case

Question 33

CSU Pain Scale

Answer 33

used to assess pain clinically

-fails to capture full details of a case

Question 34

Visual Analog Scale (CAS)

Answer 34

• semi-objective
• consists of 100mm line (0 to 100 pain)
• prone to observer bias

Question 35

Glasgow Composite Measurement Pain Scale (CMPS)

Answer 35

• validated, reliable results obtained
• consists of questionnaire that examines numerous behavioral traits and then pain score is derived
• takes a long time to complete

Question 36

Short form CMPS

Answer 36

• shorter version of CMPS
• allows clinician to provide the patient proper analgesia based on the overall score
• only takes 5 mins

Question 37

benefit of preemptive analgesics

Answer 37

provide the benefit of a decreased drug requirement during maintenance and recovery of anesthesia

Question 38

multimodal therapeutic plan

Answer 38

• includes use of drugs that are directed at treating specific mech. of pain
• allows for the reduction in the dose of each drug
• reduces potential side effects