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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
Q

Where are the third order nociceptors located in the brain

A

Thalamus

26
Q

What is the function of the lateral thalamic tracks

A

Sensory, discriminative and localization of pain

27
Q

What NT are released for descending modulation

A

NE and 5-HT

28
Q

What is physiological pain

A

Normal pain associated with presence of potentially harmful stimuli

29
Q

What is acute pain

A

Physiological, normal, adaptive or protective response to pain

30
Q

In acute pain, painful sensation ceases when ___

A

Stimulus is removed if no damage is done

31
Q

What are some examples of acute pain

A
  1. Skin incision
  2. Penetrating wound
  3. OVH
  4. Dehorning
32
Q

What is chronic pain

A

Pathologic state, involves changes in central processing

33
Q

Chronic pain may outlast ___

A

Tissue injury

34
Q

What are some examples of chronic pain

A
  1. OA
  2. Unhealed fracture, burn
  3. Sciatic pain
  4. Phantom pain
  5. Cancer pain
35
Q

What is somatic pain

A

Pain of skin, bone, tissue and muscle

36
Q

T or F: somatic pain is well localized and has a defined distribution of nociceptors

A

True

37
Q

What is visceral pain

A

Pain associated with visceral organs, dull

38
Q

T or F: visceral pain has well localize pain sensations and defined distribution of nociceptors

A

False

39
Q

Visceral pain is often associated with ___

A

Nausea

40
Q

Visceral pain may lead to __pain

A

Referred

41
Q

What are some examples of referred pain

A
  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
Q

What is inflammatory pain

A

Tissue injury or immune cell activation

43
Q

What is an example of inflammatory pain

A

Surgical wound

44
Q

What is neuropathic pain

A

Lesion or damage to NS- peripheral nerve, spinal cord, dorsal root ganglia

45
Q

Wind up is a type of ___

A

Central sensitization

46
Q

What is wind up

A

Repeated firing of primary neurons causing release of glutamate in the dorsal horn of spinal cord

Application, prolongated, and recruitment of NMDA receptors

47
Q

Wind up causes __level noxious stimuli to result in pain response

A

Low level

48
Q

What are some examples of wind up pain

A
  1. Hind leg fracture that was not repaired until 1 week post break
  2. Onychetomy
  3. Any sx without analgesia
49
Q

What is analgesia

A

Absence of pain in response to normally painful stimuli

50
Q

What is allodynia

A

Pain in response to innocuous (non-painful) stimuli

51
Q

What is hyperalgesia

A

Exaggerated response to normally painful stimulus

52
Q

What is multimodal analgesia

A

Combination of two or more analgesia drugs to have additive or synergistic effect

53
Q

Multimodal analgesia works best if each drug has different __

A

Mechanism of action

54
Q

What is an example of multimodal analgesia combination

A
  1. Opioid (methadone, hydro)
  2. NSAID
  3. Local anesthetic
55
Q

What is purpose of pre-emptive analgesia

A

Prevent establishment of central hyperexcitability that follows nociceptive stimulus.

Inhibit development of central sensitization

56
Q

What are some measurements you can take to assess pain

A

HR, BB, RR, pupil dilation, cortisol, catecholamines

Pharmacology II (36 decks)

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