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Pharmacology II > Lecture 25: Clinical Pain Physiology, Assessment and Treatment I > Flashcards

Lecture 25: Clinical Pain Physiology, Assessment and Treatment I Flashcards

1
Q

what is pain

A

Unpleasant sensory and emotional experience (perception) associated with actual or potential tissue damage

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2
Q

What are some reasons why adequate analgesia may not be provided

A
  1. Economic and practical
  2. Attitude towards pain in animals
  3. Tradition
  4. Failure to recognize adverse effects of pain
  5. Removing protective effects of pain
  6. Tx pain may interfere with dx
  7. Lack of information
  8. Failure to recognize pain
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3
Q

What are some reasons to treat pain

A
  1. Quicker recovery
  2. Shorter hospital stays
  3. Fewer re-admissions
  4. Improved QOL
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4
Q

How does pain affect immune system

A

Increase cortical levels which impair wound healing and cause immunosuppression

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5
Q

How does pain affect respiratory system

A
  1. Decrease pulmonary function
  2. Increase incidence of pneumonia
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6
Q

What are affects of pain on GI system

A

Shunting of blood, decrease GI motility, decrease mucosal integrity

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7
Q

What affects does pain have on cardiovascular system

A
  1. Activate RAAS- hypertension
  2. Decreased renal perfusion
  3. Increase HR, SV, CO and myocardial O2 consumption
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8
Q

What is a nociceptor

A

Receptor preferentially sensitive to a noxious stimuli

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9
Q

What is nociception

A

Perception of noxious stimuli

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10
Q

What are the 5 processes of nociception/ pain pathway

A
  1. Transduction
  2. Transmission
  3. Modulation
  4. Projection
  5. Perception
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11
Q

What is transduction

A

Noxious stimuli sensed and transduced into electrical signals by nociceptors

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12
Q

Where are nociceptors located

A

Primary afferent neuron

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13
Q

What are the 2 nociceptor nerve endings

A
  1. A-delta
  2. C-fibers
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14
Q

What physiological effects occur at site of transduction

A

Vasodilation, edema, and inflammation

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15
Q

Transduction results in ___of primary order nociceptors

A

Sensitization

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16
Q

__are called sleeping receptors activated by tissue damaging events

A

A-delta and C-fibers

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17
Q

A-delta and C-fibers play an important role in peripheral n___

A

Sensitization

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18
Q

What is transmission

A

Propagation of action potential by the afferent neurons to the spinal cord

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19
Q

Describe the functions and characteristics associated with A-delta fibers

A
  1. Myelinated
  2. Fast condition to acute pain
  3. Sharp and well localized pain
  4. Chemical and mechanical information
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20
Q

Describe the functions and characteristics of C- fibers

A
  1. Unmyelinated
  2. Slow conduction
  3. Poorly localized dull pain
  4. Burning sensation
  5. Chronic pain
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21
Q

Describe the function and characteristics of A-beta fibers

A
  1. Myelinated
  2. Very fast
  3. Non-noxious stimuli
  4. Pressure and proprioception
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22
Q

What is modulation

A

Information is augmented or inhibited at the level of the spinal cord

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23
Q

What is projection

A

Information transmitted from spinal cord to cerebral cortex

24
Q

What is perception

A

Integration of nociception information by the brain

25
Where are the third order nociceptors located in the brain
Thalamus
26
What is the function of the lateral thalamic tracks
Sensory, discriminative and localization of pain
27
What NT are released for descending modulation
NE and 5-HT
28
What is physiological pain
Normal pain associated with presence of potentially harmful stimuli
29
What is acute pain
Physiological, normal, adaptive or protective response to pain
30
In acute pain, painful sensation ceases when ___
Stimulus is removed if no damage is done
31
What are some examples of acute pain
1. Skin incision 2. Penetrating wound 3. OVH 4. Dehorning
32
What is chronic pain
Pathologic state, involves changes in central processing
33
Chronic pain may outlast ___
Tissue injury
34
What are some examples of chronic pain
1. OA 2. Unhealed fracture, burn 3. Sciatic pain 4. Phantom pain 5. Cancer pain
35
What is somatic pain
Pain of skin, bone, tissue and muscle
36
T or F: somatic pain is well localized and has a defined distribution of nociceptors
True
37
What is visceral pain
Pain associated with visceral organs, dull
38
T or F: visceral pain has well localize pain sensations and defined distribution of nociceptors
False
39
Visceral pain is often associated with ___
Nausea
40
Visceral pain may lead to __pain
Referred
41
What are some examples of referred pain
1. Kidney stones- lower back or rear leg pain 2. Heart attack- left arm pain 3. Colic 4. Pancreatitis- mid back or lower back pain
42
What is inflammatory pain
Tissue injury or immune cell activation
43
What is an example of inflammatory pain
Surgical wound
44
What is neuropathic pain
Lesion or damage to NS- peripheral nerve, spinal cord, dorsal root ganglia
45
Wind up is a type of ___
Central sensitization
46
What is wind up
Repeated firing of primary neurons causing release of glutamate in the dorsal horn of spinal cord Application, prolongated, and recruitment of NMDA receptors
47
Wind up causes __level noxious stimuli to result in pain response
Low level
48
What are some examples of wind up pain
1. Hind leg fracture that was not repaired until 1 week post break 2. Onychetomy 3. Any sx without analgesia
49
What is analgesia
Absence of pain in response to normally painful stimuli
50
What is allodynia
Pain in response to innocuous (non-painful) stimuli
51
What is hyperalgesia
Exaggerated response to normally painful stimulus
52
What is multimodal analgesia
Combination of two or more analgesia drugs to have additive or synergistic effect
53
Multimodal analgesia works best if each drug has different __
Mechanism of action
54
What is an example of multimodal analgesia combination
1. Opioid (methadone, hydro) 2. NSAID 3. Local anesthetic
55
What is purpose of pre-emptive analgesia
Prevent establishment of central hyperexcitability that follows nociceptive stimulus. Inhibit development of central sensitization
56
What are some measurements you can take to assess pain
HR, BB, RR, pupil dilation, cortisol, catecholamines

Pharmacology II (36 decks)

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