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Physical Agents > Lecture #7 (Pain) > Flashcards

Lecture #7 (Pain) Flashcards

1
Q

Definition of pain:

A

An unpleasant experience involving the interaction of physical (sensation) and psychological (emotional) responses due to actual or potential tissue damage.

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2
Q

What are three categories of pain?

A

Fast vs. slow pain (A & C fibers)
Acute vs. chronic pain
Projected or referred pain

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3
Q

What is the most common reason patients seek healthcare?

A

Pain

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4
Q

What is acute pain?

A

Pain lasting less than 6 months.

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5
Q

What is persistent pain?

A

Pain that is more treatable than chronic pain.

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6
Q

What is chronic pain?

A

Pain lasting longer than 6 months.

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7
Q

Trigger points typically are associated with what pain?

A

Referred.

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8
Q

What is radiating pain?

A

Pain that travels along a nerve (similar to referred).

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9
Q

What is somatic or sclerotomic pain?

A

Joint pain, a deep pain that is carried on C fibers.

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10
Q

What are the four sources of pain?

A

Cutaneous, deep somatic, visceral, and psychogenic.

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11
Q

Which type of pain is sharp, bright and burning with a fast and slow onset?

A

Cutaneous

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12
Q

Which type of pain originates in the tendons, muscles, joints, periosteum, and blood vessels?

A

Deep somatic

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13
Q

Which type of pain begins in organs and is diffused at first and may become localized?

A

Visceral

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14
Q

Which type of pain is felt by the individual but is emotional rather than physical?

A

Psychogenic

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15
Q

Which type of pain is carried through A-delta axons?

A

Fast pain.

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16
Q

Which type of fibers is slow pain (aching, throbbing, burning) transmitted through?

A

C fibers

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17
Q

What typically indicates the severity of an acute injury?

A

Intensity, location, and past experiences of pain.

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18
Q

What type of pain does not resolve in the usual period of time typical of the injury and does not respond to treatment?

A

Chronic pain.

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19
Q

What are four potential causes of chronic pain?

A

Changes in sympathetic nervous system
Changes in adrenal activity
Reduced production of endogenous opioids
Sensitization of primary afferent and spinal cord neurons

20
Q

What is “wind-up” or central hypersensitization?

A

When the pathways transmitting pain continue to discharge after the stimulation has stopped.

21
Q

List the structures from most sensitive to damaging stimuli:

A

Periosteum, joint capsule
Subchondral bone, tendon, ligaments
Muscle, cortical bone
Synovium, articular cartilage

22
Q

What occurs when articular cartilage come off the bone and ossifies in the joint capsule?

A

Osseositis chrondrositis ossificans

23
Q

What is referred pain?

A

Pain that occurs away from the actual site of injury.

24
Q

What are the three types of referred pain?

A

Myofascial, sclerotomic, and dermatomic.

25
Q

What is myofascial pain?

A

Trigger points or small hyperirritable areas within muscle resulting in bombardment of the CNS.

26
Q

What is the difference between myofascial active points and latent points?

A

Active points cause constant pain (jump signs) and latent points cause pain when irritated.

27
Q

This is usually described as fibrositis, myositis, myalgia, myofascitits, and muscular strain:

A

Myofascial pain.

28
Q

What is sclerotomic and dermatomic pain?

A

Deep pain with slow or fast characteristics that can originate from sclerotomic,myotomic, or dermatomic nerve irritation or injury.

29
Q

What fibers transmit sclerotomic pain?

A

C fibers causing deep aching and poorly localized pain

30
Q

What type of pain may result in autonomic changes such as vasomotor control, blood pressure, and sweating?

A

Sclerotomic pain.

31
Q

What fibers are irritated and cause dermatomic pain?

A

A-delta fibers–the pain is sharp and localized.

32
Q

Where does dermatomic pain project to?

A

The thalmus and cortex directly.

33
Q

What is a deep pain from the bone due to being innervated by a spinal segment?

A

Somatic pain.

34
Q

Which pain fibers are myelinated and which are not?

A

A-delta fibers = myelinated

C fibers = unmyelinated

35
Q

What are nociceptors?

A

Pain receptors.

36
Q

True or false:

Nociceptors are found in all tissue.

A

False: they are not found in the nucleus pulposus or inner component of the annulus fibrosus of IVD.

37
Q

What is a chemical mediator that is supposedly involved with the transmission of neuropathetic and inflammatory pain that is found in the CNS and excites pain transmitting neurons in the dorsal horn.

A

Substance P.

38
Q

How do physical agents help to control pain?

A

Through controlling the release of inflammatory mediators, stimulating sensory fibers, slowing nerve conduction velocity, and decreasing the sensitivity of muscle spindles.

39
Q

What are some sense organs that help control perceptions of pain? (x6)

A

Meissner’s corpuscles (light touch)
Pacinian corpuscles (deep pressure)
Merkel’s corpuscles (deep pressure and hair follicle deflection)
Ruffini corpuscles (touch, tension, heat, joint position change)
Krause’s end bulbs (decreased temp)
Nociceptors

40
Q

True or false:
Most analgesic agents are believed to slow or block the immpulses ascending along the A-delta and C fiber pathways through direct input into the dorsal horn through descending mechanisms.

A

True

41
Q

What is the gate theory of pain?

A

Increasing the activation of A-beta figers inhibits T cells closing the spinal gate to the cerebral cortex and therefore decreasing the perception of pain.

42
Q

How does TENS, massage, and analgesic balms work to manage pain?

A

Stimulate large-diameter afferent fibers.

43
Q

How does cold and ultrasound work to manage pain?

A

Decrease pain fiber transmission velocity.

44
Q

How does acupuncture, deep massage, and TENS work over trigger points to manage pain?

A

Stimulate small diameter afferent fibers and descending pan control mechanisms.

45
Q

How does TENS specifically work to manage pain?

A

Stimulate the release of beta-endorphins through prolonged small-diameter fiber stimulation.

46
Q

What is the pain-spasm-pain cycle of muscle spasms?

A

There is a fluid build up of irritants that cause the muscles to contract which compress nociceptors and then creates pain which furthers the spasm which creates additional pain.

47
Q

What kind of trauma invokes both C and A-delta fiber sensations?

A

Mechanical trauma (i.e. a fracture).

Physical Agents (13 decks)

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