Pain Flashcards
Cartesian model of pain states
All pain is caused by injury and increased pain means more damage
3 treatments from the Cartesian model
Avoidance
Injections/meds
Surgery
Pain def
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
3 types of pain
Nociceptive pain
Neuropathic pain
Central sensitization (cs) pain or nociolastic pain
Nociolastic pain def
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain
Nociceptive pain description
Damage to body tissue usually localized and diminishes naturally
Neuropathic pain description
Derive from CNS/PSN damage or disorder/disease causing pain and sensory dysfunction
They are neuroanatomically logical
How is pain described in Nociceptive pain
Sharp achy throbbing
How is pain described in nueropathic pain
Burning
Shooting
Pricking
Central sensitization pain or nociolastic pain would be described as
Vague or dull
Def dysesthesia
Unpleasant abd normal sensation (encoded or spontaneous)
Allodynia def
Pain encoded by stim that is not usually noxious
Hyperalgesia def
Excessive sensitivity to stimuli that are normally mildly painful
2 types of dysesthesia
Allodynia
Hyoeralgesia
When part of your body is injured, special pain receptors convey the pain messages to your brain: t/f
False
Receptors send Nociceptive (a sensation) and the pain is interpreted by the brain
Pain only occurs when you’re inured: t/f
False
Injury or degenerative processes may be present in absence of pain
Significant pain may be present with no identifiable disease process or after tissue healing (emotional experience - cane develop due to emotional overload)
The timing and intensity of pain matches the timing and
number of signals in nociceptors (danger receptors): t/f
False
Repeated stimulation can result in a progressive increase in action potentials (action potential wind up)
- if prolonged can result in death of interneuron
- can also change receptors in the end order neuron (can increase danger messages)
Nerves should connect a body part to the brain in order for that part to be in pain: t/f
False
Phantom limb pain
Pain dependent on how the body part is represented in the somatosensory homunculus
In chronic pain, the central nervous system becomes more sensitive to nociception: t/f
True
Changes interneurons, second order neurons, expands and sprouts receptor fields > increasing sensitization
Changes descending modulation (endogenous chemicals reduced in chronic pain)
The body tells the brain when it is in pain: t/f
False
Body sends Nociceptive signals and Brian interprets how they are expressed (neuro/pain tag or pain neuromatrix)
Pain neurotag includes what structures (bonus: what do they do?)
Premotor/motor cortex: org. Motor reaction
Cingulate cortex: concentration
Prefrontal cortex: problem solving and memory
Amygdala: fear, fear conditioning
Sensory cortex: sensory discrimination
Hypothalamus/thalamus: stress response, autonomic dev, motivation
Cerebellum: coordination and movement
Hippocampus: memory, recognition, fear conditioning
Spinal cord : gate to periphery
The brain sends messages down your spinal cord that can increase the nociception (danger messages) going up your spinal cord: t/f
True
Changes in the CNS as a result of action potential windup allow for increased info to be processed in the brain
Nerves adapt by increasing resting level of excitement: t/f
True
Various types of ion channels exist on nerves
• Voltage, chemical, temperature, mechanical, immune, spontaneous, hydrogen, light-gated
Ion channels posses _______________ characteristics
Neuroplastic
Can change sensitivity
Ion expression continually changes: half life is reported to be __________
48 hrs
Chronic pain means that an injury hasn’t healed properly: t/f
False
Receptors on nerves work by opening ion channels (gates) in the wall of the nerve: t/f
True
Ion channel expression is dependent on genetic coding and brains expression of survival needs
Challenge expression constantly changes: (increased expression can cause sensitivity)
Worse injuries always result in worse pain
False
Environment has no effect on the amount of pain: t/f
False
Injuries in high stress environments are 7-8 times more likely to result in persistent pain
It is possible to have pain and not know about it
False
Pain is a conscious decision by the brain
The placebo effect is an _________ mechanism to modulate pain experience
Endogenous
Second order neuron activation is dependent on
Amount of nociception from tissues
interneuron activity
competing info from contralateral side of the body and spinal levels above and below
ion channel availability in second-order neuron
availability of neurotransmitters & descending modulation
In persistent pain, a ____________ (greater/lesser) concentration of f protein channels may be seen in second order neurons
Greater
When you are injured, chemicals in your tissues can make nerves more sensitive: t/f
True
Can influence opening/closing of specific ion channels
Adrenaline and cortisol (can increase sensitivity)
What is the stress response
Response during an immediate threat is complex and involves multiple body systems
• Adrenaline, muscles, language, breathing, GI system, other
Effects of cortisol
Primarily increases blood sugar, suppresses the immune system and aids in fat, protein and
carb metabolism
• Prevents release of substances that cause inflammation
• Increases cytokines which can increase inflammatory process throughout body
Chronic pain demonstrates differences in ___________ function
Cns
Chronic pain = “_______________ neuroplasticity” or ________________
Maladaptive
Increased sensitivity
Chronic pain can be associated with …..
Associated with abnormal intracortical inhibitory mechanisms
• Bodily-related neural representations become less precise= “Smudging”
Ultimately the increased sensitivity and decreased precision contribute to complexity of chronic pain
Testing for sensitive nervous system
- Graphesthesia
- Grid Localization
- 2-Point Discrimination
• Pain Pressure Thresholds
• NeurodynamicTesting
• Nerve palpation
• Left/Right Discrimination
When testing the goal is to achieve ________% accuracy
80
