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Modalities > Lecture 5: Pain Management > Flashcards

Lecture 5: Pain Management Flashcards

1
Q

5th vital sign

A

pain

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2
Q

goals for clinicians in terms of pain management

A

eliminate source

teach function within limitations

improve pain control with physical/physiological questions

treat overall well being

improve support systems

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3
Q

optimal pain management does what

A

helps pt understand their symptoms, adhere to treatment plan, and return to normal lives

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4
Q

problem with passive meds

A

opioid crisis

doctors now prescribing less

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5
Q

problem with passive modalities

A

often waste of time for only short term relief

some clinicians dont use any modalities

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6
Q

helpfulness of subjective vs objective pain report

A

subjective = self report; most reliable

pain scales = quantitative rating of intensity

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7
Q

objective measures for pain

A

verbal rating

numerical rating

visual analogue scale

picture or face scale

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8
Q

what should you consider when choosing a type of objective pain measure

A

symptom duration
pt cognitive abilities
time needed
complexity of measure/sensitivity to change

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9
Q

nonverbal pain indicators

A

facial expression
sounds; i.e. groans, cries, etc
bracing/guarding
restlessness
rubbing area
vital sign response

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10
Q

the anterolateral spinothalamic pathway provides primary sensation for what

A

nondiscriminative/crude touch, pain, and temp

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11
Q

what is acute pain

A

less than 30 days

well localized and defined

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12
Q

what is chronic pain

A

longer than 3-6 month duration

nociceptive, neuropathic

CNS PNS SNS

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13
Q

what is referred pain

A

perceived as coming from a site different from source

i.e. visceral pain

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14
Q

anterolateral spinothalamic pathway receives signals from

A

mechanoreceptors

nociceptors

thermoreceptors

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15
Q

type of fibers in the anterolateral spinothalamic pathway

A

C fibers (peripheral n)

small/unmyelinated

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16
Q

what is nociception

A

neural process of encoding noxious stimuli

pain is NOT nociception

transmission can be facilitated or inhibited along the way before it reaches the brain (i.e. modalities can inhibit)

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17
Q

pain is an output of the brain triggered by the action potential of what and converted to what

A

triggered by action of a potential nociceptor and converted to conscious understanding of that stimulus

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18
Q

what is the perception of nociception by the cerebrum

A

pain

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19
Q

questions to ask pt about pain

A

location
intensity
type (can help determine structure)
radiates
duration
aggravating/relieving
effects on daily activities
sleep patterns
psychosocial effects

20
Q

what are the 3 dimensions of the experience of pain

A

sensory discriminative = where pain is and what it feels like

motivational affective = how pt feels about P! emotionally

cognitive-evaluative = what pt thinks about pain intellectually and what they expect

21
Q

characteristics of sensory receptors

A

at distal ends of afferent n

specific and sensitive for the type of stimulus they were designed to sense

22
Q

free nerve endings are

A

type of nociceptor/mechanoreceptor that “sense” pain

23
Q

nociceptors are triggered by

A

intense thermal, mechanical, or chemical stimuli

exogenous source: brick, acid, bleach, fire

endogenous source: fx bone, inflammation, etc

24
Q

types of nociceptors for afferent neurons

A

C fibers (80%)

A delta fibers (20%)

25
Q

characteristics of C fibers

A

small/unmyelinated (slow)

pain = dull/throbbing/aching/burning

respond to noxious levels of stimulus

slow onset, long lasting symptoms and diffusely local

blocked by opioid meds at receptor

emotional involvement

26
Q

characteristics of A delta fibers

A

larger/myelinated (faster)

more sensitive at high intensity mechanical stimulus

pain = sharp, stabbing, pricking

quick onset, short duration

localized to where stimulus arose

not blocked by opiods

no emotional involvement

27
Q

where are 1st and 2nd order neural cell bodies housed

A

1 = dorsal root ganglion

2 = dorsal horn

28
Q

what neuro path does pain sensory travel

A

spinothalamic tract

29
Q

where does the 3rd order neuron on the spinothalamic tract terminate in the brain to be percieved as pain

A

primary somatosensory cortex

30
Q

describe the multifaceted preprogrammed response of the pain matrix

A

1- conscious perception of pain

2- motor responses (physical rxn)

3- homeostatic system respons (ANS, endocrine, and immune systems)

31
Q

explain the gate control theory

A

stimulation of non-nociceptive fibers simultaneously with pain

A beta fibers (inhibit pain transmission to higher centers) trump the other slower signals from C fibers

brain only recieves A beta signals

“closes the gate” to the pain signal

32
Q

how do modalities follow the gate control theory

A

thermoreceptors send signal on A beta fibers to brain

estim = electrical impuslse felt instead

33
Q

examples of gate control theory that are often unconsciously preformed

A

rubbing a contusion, strain, sprain

applying moist heat

massaging sore muscles

34
Q

how do opioids and opiopeptins (endorphins) work in the central and peripheral nervous systems

A

peripheral = have inhibitory actions causing presynaptic inhibition of nociceptive signal

central = relieve pain naturally as they attach to reward centers in the brain

35
Q

explain the endogenous opioid systems theory

A

act as neuromodualtors and have inhibitory actions on pain pathways

release of opiopetins plays important role in controlling pain during emotional stress

act of C fibers peripherally but NOT A delta

explains paradoxical pain relieving effects of painful stimulation like acupuncture and TENS

36
Q

pain management appraches act physiologically by doing what

A

controlling inflammation

altering nociceptor sensitivity

increased binding to opioid receptors

modifying n conduction

modulating pain transmission

altering higher level aspects of pain perception

management of psychological and social aspects

37
Q

drawbacks to pharmacologial agents for pain management

A

adverse side effects

may not be sufficient

risk of dependence

may need multidisciplinary treatment

pt adherence

38
Q

what are systemic analgesics and examples

A

primary method of pain management

i.e. NSAIDs, acetaminophen, opiates, antidepressants, sedatives

39
Q

what are spinal analgesia drugs and examples

A

epidural or subarachnoid space of spinal cord; bypass brain blood barrier and reduce systemic side effects

opiods, local anestheics, corticosteroids

40
Q

what are local injections/benefits

A

into structures or painful/inflamed areas

short term pain relief used mainly for procedures

41
Q

all pharmacological agents control pain by

A

modifying antiinflammatory mediators at periphery

altering pain transmission from periphery to cortex

altering central perception of pain

42
Q

pt edu for pain management should include

A

info about neuophysiology of pain

reassurance that pain with mvmt isn’t a sign of further damage

reassure that pain is normal post trauma

complete elimination of pain is not generally achievable in short term

pain is multifactorial

pain almost always resolves with time

43
Q

what modalities assist in pain management

A

thermo = cold/hot pack

mechanical = US, traction, compresison

EMT = ESTIM, laser light

44
Q

what are the benefits of physical agents

A

reduce intensity (prevents acute turning chronic)

give pt some control over symptoms

pt can have autonomy

reduced medical cost

minimal risk of adverse side effects

no risk of dependence

no sedation

opportunity to practice related pain management skills

give pt therapeutic window

45
Q

how does TENS control pain

A

stimulates A beta fibers

and

stimulates release of opiopeptins at spinal cord and higher levels

Modalities (7 decks)

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