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BSNC 2000 > Pain > Flashcards

Pain Flashcards

1
Q

Physiological process of pain

A

transduction
transmission
perception
modulation

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2
Q

Nociceptors

A

sensory neurons that detect painful stimuli

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3
Q

Chemical Mediators causing pain

A 
prostaglandins (tissue cell membrane)
histamine (mast cells)
bradykinin (liver protein)
serotonin (platelets)
substance P
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4
Q

Epidemiology of pain in OA

A

> 50% in community have chronic pain

>80% in nursing homes have chronic pain

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5
Q

Acute Pain

A

rapid onset
clearly linked to triggering injury/event
short duration
decreases with healing

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6
Q

Chronic Pain

A

pain lasting >3 months. can last years

can be d/t underlying pathology, injury, medical treatment, inflammation, neuropathic

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7
Q

Pain Theories

A

gate-control theory

neuromatrix theory

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8
Q

Eudynic pain

A

normal transduction of pain sensation d/t noxious stimuli

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9
Q

Types of pain

A

referred
cutaneous
somatic
visceral

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10
Q

Somatic pain

A

sharp pain localized to an area of injury

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11
Q

Visceral pain

A

pain that occurs w/i a body cavity (thorax, abdomen, pelvis)
may radiate to other area
caused by: swelling, stretching, hypoxia

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12
Q

Hypoxia

A

pain caused by decreased availability of oxygen to tissue cells
can occur d/t hypoperfusion or hypoxemia

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13
Q

Nociceptive pain

A

eudynic pain

normal associated with tissue injury

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14
Q

Neuropathic pain

A

caused by disease or pathology to the somatosensory system

pain sensation that originates in the PNS/CNS without afferent stimuli

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15
Q

Neuropathic pain exemplars

A 
postherpetic neuralgia
diabetic neuropathy
phantom pain
trigeminal neuralgia
post-stroke pain
complex regional pain syndrome
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16
Q

Individual Risk Factors

A

communication barriers

cognitive impairment or developmental barriers

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17
Q

Pain assessment tools

A

pain scale (numbers or faces)
self-assessment
behavioral pain tools

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18
Q

Analgesic classes

A

non-opioid
opioid
adjuvant analgesic

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19
Q

Non-Opioid analgesia

A

acteminophen
NSID
COX-2 selective NSAID
*mild pain. used as an adjunct w/ opioids

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20
Q

Opioid analgesia

A 
hydromorphone
oxycodone
fentanyl 
morphine
*moderate-severe pain
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21
Q

Adjuvant analgesai

A

anticonvulsant (gabapentin)
local anesthesia
antidepressant

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22
Q

First Line Treatment for Neuropathic Pain

A

anticonvulsants (gabapentin)

antidepressants

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23
Q

Somatic Senses

A

pain
touch
temperature
proprioception

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24
Q

Types of somatic neurons

A

general - pain, touch, temp. widespread
special somatic - muscles, joints, tendons. proprioception & kinesthesia
general viscera - viscera. fullness & discomfort

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25
Q

Somatosensory pathway

A

1st order neuron - periphery to CNS
2nd order neuron - reflex/sensory pathway. spinal cord –> thalamus
3rd order neuron - thalamus –> cerebral cortex

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26
Q

Types of somatosensory fibers (peripheral)

A

A, B, C

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27
Q

Sensory neurons transmitting info from limbs/trunk

A

first-order dorsal root ganglia

28
Q

Sensory neurons transmitting info from head

A

trigeminal sensory neurons

29
Q

A-delta fibers

A

myelinated. fastest rate of conduction
detect somatic stimuli (touch, heat, heat/mechanical pain)
associated with withdrawal reflex

30
Q

B fibers

A

myelinated

detect cutaneous/subcutaneous stimuli

31
Q

C fibers

A

non-myelinated. slowest rate of conduction

detect warm-hot mechanical/chemical pain, heat-cold pain

32
Q

Hyperalgesia

A

hypersensitivity to pain

33
Q

Pain etiology

A

nociceptive - stimulation of pain receptors

neuropathic - damaged or dysfunctional sensory axons

34
Q

Pain threshold

A

minimum amount of stimuli required for pain perception

35
Q

Pain tolerance

A

maximum amount of pain a person is willing to tolerate

36
Q

Peripheral nerve fibers that detect pain

A

A & C

37
Q

Pain Classification

A

duration (acute, chronic)
location (cutaneous, somatic, visceral, referred)
etiology (nociceptive, neuropathic)
frequency (intermittent, constant)

38
Q

Somatic tissue

A

muscle
joints
tendons
periosteum

39
Q

Physiological pathway of pain

A

1st order
2nd order. decussates and ascends to thalamus
3rd order

40
Q

Factors influencing pain

A 
psychological state
cultural/spiritual
other (age, sex, comorbidities)
cognitive
past experience
41
Q

Noxious Stimuli

A

mechanical
thermal
chemical

42
Q

Mechanical stimuli

A

pressure
swelling/distension
incision, cut, abrasion

43
Q

Thermal stimuli

A

burns (contact, fire, electrical, radiation)
scalds (steam, hot liquid)
frostbite

44
Q

Chemical stimuli

A

inflammatory or chemical mediators
acid
capsaicin

45
Q

Substance P

A

neuropeptide released by C-fibers at the dorsal horn

may result in unlocalized pain d/t diffusion of neuropeptide

46
Q

Cutaneous pain

A

superficial structures
can have slow or rapid onset
sharp, burning
localized region

47
Q

Somatic pain

A

deeper somatic structures (periosteum, bone, muscle, tendon, joints)
diffuse area
radiation can occur

48
Q

Visceral pain

A

occurs in the organs. caused by damage to visceral walls
usually diffuse, unlocalized area. can be referred elsewhere.
commonly associated with pathology & SNS symptoms

49
Q

Referred pain

A

pain that manifests in a location different from the origin
moreso assoc with visceral > somatic pain
occurs d/t convergence of somatic/visceral afferent neurons in the spinal cord & embryologic origin of tissue

50
Q

Examples of referred pain

A

peritoneum –> umbilicus
diaphragm –> shoulder
myocardium –> radiating up jaw or down arm

51
Q

Characteristics of acute pain

A 
<3-6 months
recent onset
nociceptive 
assoc with SNS symptoms , anxiety 
subsides when underlying pathology resolved 
protective function
52
Q

Characteristics of chronic pain

A

> 3-6 months
no SNS activation
psychological/behavioral changes (irritability, anxiety, depression, withdrawal, decreased sleep, libido, appetite changes)
pathological condition

53
Q

Types of opioid receptros

A

mu

kappa

54
Q

Mu side effects

A 
analgesia 
pupillary constriction
respiratory depression
decreased GI motility
euphoria
physical dependence
55
Q

Kappa side effects

A

some analgesia
pupillary constriction
sedation
dysphoria

56
Q

Transduction

A

transformation of sensation into neurochemical stimulus that travels from sensory receptor –> spinal cord

57
Q

Transmission

A

transmission of nerve impulse from spinal cord to cortex for processing

58
Q

Perception

A

conscious awareness/perception of painful stimuli

59
Q

Modulating

A

release of endorphins/chemicals that help minimize or affect the sensation of pain

60
Q

4 P’s of Pain Mgmt

A

Prevention
Psychological
Physical
Pharmaceutical

61
Q

Preventive pain mgmt

A

mobilization
use of mobility aids
proactive referrals
use of braces/splints

62
Q

Psychological pain mgmt

A 
Guided imagery
Meditation
Relaxation techniques
Reiki 
Counseling 
Humor
63
Q

Physical pain mgmt

A 
RICE
hot/cold therapy
acupuncture
TENS machine 
massage
physiotherapy
positioning 
exercise
64
Q

Pharmaceutical mgmt

A

Opioid analgesics
Non-opioid analgesics
Adjuvant analgesics

65
Q

PQRST

A 
provoking/palliative factors
quality/quantity
region/radiation
severity
temporal

BSNC 2000 (9 decks)

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