Lecture #7 (Pain)

Question 1

Definition of pain:

Answer 1

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

Question 2

What are three categories of pain?

Answer 2

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

Question 3

What is the most common reason patients seek healthcare?

Answer 3

Pain

Question 4

What is acute pain?

Answer 4

Pain lasting less than 6 months.

Question 5

What is persistent pain?

Answer 5

Pain that is more treatable than chronic pain.

Question 6

What is chronic pain?

Answer 6

Pain lasting longer than 6 months.

Question 7

Trigger points typically are associated with what pain?

Answer 7

Referred.

Question 8

What is radiating pain?

Answer 8

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

Question 9

What is somatic or sclerotomic pain?

Answer 9

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

Question 10

What are the four sources of pain?

Answer 10

Cutaneous, deep somatic, visceral, and psychogenic.

Question 11

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

Answer 11

Cutaneous

Question 12

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

Answer 12

Deep somatic

Question 13

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

Answer 13

Visceral

Question 14

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

Answer 14

Psychogenic

Question 15

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

Answer 15

Fast pain.

Question 16

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

Answer 16

C fibers

Question 17

What typically indicates the severity of an acute injury?

Answer 17

Intensity, location, and past experiences of pain.

Question 18

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

Answer 18

Chronic pain.

Question 19

What are four potential causes of chronic pain?

Answer 19

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

Question 20

What is “wind-up” or central hypersensitization?

Answer 20

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

Question 21

List the structures from most sensitive to damaging stimuli:

Answer 21

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

Question 22

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

Answer 22

Osseositis chrondrositis ossificans

Question 23

What is referred pain?

Answer 23

Pain that occurs away from the actual site of injury.

Question 24

What are the three types of referred pain?

Answer 24

Myofascial, sclerotomic, and dermatomic.

Question 25

What is myofascial pain?

Answer 25

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

Question 26

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

Answer 26

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

Question 27

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

Answer 27

Myofascial pain.

Question 28

What is sclerotomic and dermatomic pain?

Answer 28

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

Question 29

What fibers transmit sclerotomic pain?

Answer 29

C fibers causing deep aching and poorly localized pain

Question 30

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

Answer 30

Sclerotomic pain.

Question 31

What fibers are irritated and cause dermatomic pain?

Answer 31

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

Question 32

Where does dermatomic pain project to?

Answer 32

The thalmus and cortex directly.

Question 33

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

Answer 33

Somatic pain.

Question 34

Which pain fibers are myelinated and which are not?

Answer 34

A-delta fibers = myelinated | C fibers = unmyelinated

Question 35

What are nociceptors?

Answer 35

Pain receptors.

Question 36

True or false: | Nociceptors are found in all tissue.

Answer 36

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

Question 37

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.

Answer 37

Substance P.

Question 38

How do physical agents help to control pain?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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.

Answer 40

True

Question 41

What is the gate theory of pain?

Answer 41

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.

Question 42

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

Answer 42

Stimulate large-diameter afferent fibers.

Question 43

How does cold and ultrasound work to manage pain?

Answer 43

Decrease pain fiber transmission velocity.

Question 44

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

Answer 44

Stimulate small diameter afferent fibers and descending pan control mechanisms.

Question 45

How does TENS specifically work to manage pain?

Answer 45

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

Question 46

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

Answer 46

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.

Question 47

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

Answer 47

Mechanical trauma (i.e. a fracture).