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Modalities > Pain > Flashcards

Pain Flashcards

0
Q

What can pain cause?

A

Withdrawal reflex it muscle guarding

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1
Q

What is pain?

A

An unpleasant experience involving the interaction of physical and psychological responses due to actual or potential tissue damage

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2
Q

What are the pain categories?

A

Fast vs slow
Acute vs chronic
Projected vs referred pain

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3
Q

What factors are involve in pain?

A

Anatomical structures, physiological reactions, psychological, social, cultural and cognitive factors

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4
Q

What is acute pain?

A

<6 months

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5
Q

What is persistent pain?

A

More treatable then chronic pain

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6
Q

What is chronic pain?

A

> 6 months

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7
Q

What does referred pain involve?

A

Trigger points

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8
Q

What is radiating pain?

A

Similar to referred-travels along a nerve

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9
Q

What is somatic pain?

A

Sclerotomic. (Deep)

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10
Q

Pain sources

A

Cutaneous, deep somatic, visceral, pathogenic

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11
Q

Cutaneous pain

A

Sharp, bright and burning with fast and slow onset

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12
Q

Deep somatic pain

A

Originates in tendons, muscles, joints, periosteum, and blood vessels

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13
Q

Visceral pain

A

Begins in organs and is diffused at first and may become localized

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14
Q

Psychogenic pain

A

Felt by the individual but is emotional rather than physical

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15
Q

Fast pain

A

Localized and carried through a delta axons

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17
Q

Slow pain

A

Aching, throbbing, or burning and transmitted thru C fibers

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18
Q

What can help indicate severity or injury/condition?

A

intensity and location

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19
Q

What can chronic pain lead to?

A

physical, psychological, and social dysfunction

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20
Q

What are the characteristics of an individual with chronic pain?

A

prolonged physical inactivity, muscle weakness, decreased endurance, dramatize complaints, recieve excessive treatment, drug misuse, depression, difficulty sleeping, changed eating behaviors, social isolation, dependence on other

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21
Q

What are four potential causes for chronic pain?

A
  1. changes in sympathetic nervous system
  2. changes in adrenal activity
  3. reduced production of endogenous opioids
  4. sensitization of primary afferent and spinal cord neurons
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22
Q

central hypersensitization

A

the pathways transmitting pain continue to discharge after stimulation has ceased

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23
Q

What four structures are most sensitive to damaging (noxious) stimuli?

A
  1. periosteum (joint capsule)
  2. subchondral bone, tendon, ligaments
  3. muscle, critical bone
  4. synovium, articular cartilage
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24
Q

A-alpha fibers

A

sensitive to pressure and can produce parasthesia

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25
Q

What are three types of referred pain?

A

myofascial, slerotomic, and dermatomic

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26
Q

How is sclerotomic pain transmitted?

A

Thru C fibers which can result in autonomic changes (BP, sweating) and depression, anxiety, anger, or fear

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27
Q

How is dermatomic pain transmitted?

A

A-delta fibers thru the thalamus and cortex

28
Q

What are nociceptors?

A

Specific nerve endings respond to all painful stimuli by sensing pain

29
Q

How does pain travel?

A

Thru small myelinated A-delta fibers and unmyeliated C fibers then transmit this pain sensation to the spinal cord

30
Q

Where are all nociceptors?

A

In all tissue except the nucleus pulposus nad the inner component of the annulus fibrosus of spinal discs

31
Q

How do nociceptors work?

A

They release neuropeptides and then convert the stimulus into electrical activity thru transduction creating action potentials

32
Q

What kind of pain does group IV afferent C fibers cause?

A

dull, aching, burning, throbbing, tingling, tapping pain sensations

33
Q

Can opiates block activation of C fibers?

A

yes

34
Q

Can opiates block activation of A-delta fibers?

A

no

35
Q

What kind of pain does group III afferents A-delta fibers cause?

A

sharp, stabbing, ricking pain sensation

36
Q

What do A-delta fibers respond to?

A

high intensity mechanical stimulation or heat/cold stimulation

37
Q

What’s the difference between C fibers and A-delta fibers?

A

A-delta fibers may transmit non-noxious stimuli

38
Q

What are T cells?

A

second order neurons that connect with interneurons, efferent neurons for spinal cord reflexes, or to afferent neurons which transmit to the cortex

39
Q

What inhibits second order neurons?

A

substantia gelatinosa (A-beta nerves)

40
Q

What modulates the flow of afferent pathways?

A

norepinephrine, serotonin, enkephalins

41
Q

How do second order neurons work?

A

They transmit pain stimuli thru lateral spinothalamic tract(sharp pain and pain localization) and the anterospinalthalamic tract (aching pain and emotions) contralateral aspect of the spinal cord to the thalamus

42
Q

What do third order neurons do?

A

They interact with the second order afferents to send pain to the cortex where sensation of pain reaches consciousness

43
Q

Where does the “fight or flight” response come from?

A

The sympathetic nervous system

44
Q

What are sympathetic efferents activated by?

A

acute pain/injury but they do not cause pain

45
Q

How does surgery or chemical means help with pain?

A

They interrupt with sympathetic nervous system actvity

46
Q

Reflex sympathetic dystrophy (RSD)

A

post traumatic dystrophy, sympathetically maintained pain, complex regional pain syndrome, tissue damage with or without nerve involvement

47
Q

What can reflex smpathetic dystrophy cause?

A

severe pain, hyperesthesia, skin atrophy, edema, stiffness, increased sweating, decreased hair growth

48
Q

What is substance P?

A

chemical mediator supposedly involved with transmission of neuropathic and inflammatory pain

49
Q

Where is substance P found?

A

central nervous system. 20% of C fibers, and inflammatory exudate

50
Q

What does substance P do?

A

excite pain transmitting neurons in the dorsal horn

51
Q

What do opiopeptins do?

A

Bind to opiate receptors in the nervous system and acts like morphine

52
Q

Where are opiopeptins found?

A

in peripheral nerve endings, regions of the nervous system and brain

53
Q

What are some pain assessment scales?

A

visual analog, graphic pain charts, McGill pain questionnaire, numeric pain scale, and facial scale

54
Q

How do opioids and opiopeptins inhibit pain

A

Cause presynaptic inhibition as they supress the inward flux of calcium, cause postsnaptic inhibition as they activate an outward potassium current, inhibit gamma aminobutyric acid from being released in periaqueductal gray matter and the raphe nucleus, and electrical stimulation of the above areas has been shown to inhibit pain

55
Q

What do physical agents do to control pain?

A

control the release of inflammatory mediators, stimulate afferent non-noxious sensory fibers, slow nerve conduction velocity, and decrease sensitivity of muscle spindle

56
Q

What is mechanical trauma?

A

It invokes both C and A-delta fiber sensations

57
Q

When does a muscle spasm occur?

A

when T cells synapse with anterior horn cells in a spinal cord reflex loop causing muscle contractions

58
Q

What happens in the pain-spasm-pain cycle?

A

Fluid build up of irritants, muscle contraction mechanically compressing nociceptors

59
Q

What are some benefits to using physical agents?

A

reduced side effects, patient can use independently to treat themselves, and they provide comfort when nothing else is available

60
Q

messiner’s corpuscles

A

activated by light touch

61
Q

pacinian corpuscles

A

respond to deep pressure

62
Q

merkel’s corpuscles

A

respond to deep pressure and hair follicle deflection

63
Q

ruffini corpuscles

A

sensitive to touch, tension, heat, joint change in position

64
Q

krause’s end bulb

A

sensitive to decreased temperature

65
Q

nociceptors

A

sensitive to extreme mechanical, thermal, or chemical energy

Modalities (6 decks)

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