M1: Pain Flashcards
Unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is both a sensation and emotion as it is accompanied by anxiety and the urge to escape or terminate the feeling.
Pain
The ability to experience pain is essential for
Protection from Injury
Associated with risk of tissue damage due to undiscovered injury.
Insensitivity to Pain
Should be recognized as a human right
Relief from Pain
Should be considered a disease in its own right
Chronic Pain
Should have the full status of a specialty
Pain medicine
Transmit pain impulses
A-delta & C fibers
Transmit light touch
A-beta
In the presence of inflammatory mediators, primary afferents. Have lower thresholds for pain, increased frequency of firing and become sensitive to certain stimuli which usually do not cause pain.
Sentisization
Contribute to the process of Sensitization
Inflammatory mediators
Examples of Inflammatory mediators
Prostaglandin, Leukotrienes, Bradykinin & Nerve GF “PaLaBaN”
Have a neuroeffector function and not just passive messengers of threats to tissues.
Primary Afferent Nociceptors
When activated, some nociceptors may release polypeptide mediators such as Substance P causing vasodilation, degranulation of mast cells, attracts leukocytes and increases production of inflammatory mediators.
Nociceptor-Induced Inflammation
Subserves the sensory aspect of pain
Thalamus
Subserves the emotional aspect of pain
Higher Cortical Levels
Five categories of Pain
Duration & Severity, Anatomical location, Body system involved, Cause and Temporal characteristics “DAB CT”
Pain that is of recent onset and resolves quickly
Acute
Pain that lasts a long time. Pain that extends beyond the expected period do healing.
Chronic
More than 6months
Chronic
Within 1-6 months
Subacute
Less than 6 months
Acute
Diabetic neuropathy & cancer pain are examples of
Chronic pain
Postherpetic Neuralgia & Osteoarthritis are examples of
Chronic pain
Needle prick, Venipuncture & Dysmenorrhea
Acute pain
Is different from person to person and within the same person depending on the context
Subjective perception of Pain
Is the most reliable measure of pain, with health professionals tending to underestimate severity
A person’s self-report
Worst headache of your life. Thunderclap headache.
Ruptured cerebral aneurysm leading to subarachnoid hemorrhage
Observe for specific behaviors in nonverbal patients
Grimacing, Guarding & Crying “GGC”
Type of Pain according to SYSTEM
Myofascial, Ischemic/Vascular, Rheumatic & Neuropathic Pain “MIRN”
Pain arising from a perturbation of the body
Somatogenic
Pain arising from a perturbation of the mind. Diagnosis usually made when all physical/organic causes have been ruled out.
Psychogenic
Type of Somatogenic pain caused by damage or disease affecting the nervous system
Neuropathic
Type of Somatogenic pain due to stimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity (thermal, mechanical, chemical or superficial somatic, deep somatic & visceral)
Nociceptive
Nociceptive pain that Involves the skin
Superficial somatic
Nociceptive pain that involves internal organs
Visceral
Nociceptive pain that involves muscles and joints
Deep somatic
Frostbite, First & Second degree burns, sipping hot coffee & holding a piece of dry ice are examples of
Thermal Nociceptive Pain
Fracture, Bump on head, Liver abscess distending the Glisson’s capsule, Open wound and Dog bite are examples of
Mechanical Nociceptive pain
Alcohol on an open wound, Acid thrown on the face and Muriatic acid ingestion are examples of
Chemical Nociceptive Pain
Involves the skin (superficial), joints, muscles, tendons and ligaments (deep) Usually sharp, well defined and easy to localize.
Somatic pain
Nociception from a visceral organ is sensed to be coming from an area distant from the site of the stimulus
Referred pain
Usually dull, vague and difficult to localize. Involves the internal organs.
Visceral pain
Two nerve pain fibers converge and enters on the DRG at the same time
Convergence Theory of Referred Pain
Burning, Tingling, Pins and Needles pain sensation usually associated with diabetic neuropathy.
Neuropathic pain
Pain perceived to be from a part of the body that has been lost or from which the brain no longer receives signals. A type of neuropathic pain which is commonly experienced by amputees.
Phantom pain
In phantom pain, this may relieve pain.
Local anaesthetic injection into the nerves of the stump
Pain relief in the form of excitement from sport
Episodic Analgesia
Abilitiy to recognize pain may be blunted by illness or drugs in this age group. May lead to depression, decline self care and not doing ADLs. Fear of surgery, not want others to see them as weak & pain is considered as punishment fro previous transgressions.
Elderly
Teach that pain should be tolerated and is a punishment for sins. They feel that pain is a signal that death is near.
Some Religions
Expected to be emotional and show pain
Women
Are expected to be stoic, keeping pain to themselves.
Women
