Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 2 - Control > Pain > Flashcards

Pain Flashcards

1
Q

Where is the insular cortex located?

A

If you retract the lateral sulcus of your brain you get to a deep structure called the insular cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the insular cortex?

A

a portion of the cerebral cortex folded deep within the lateral sulcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does the lateral sulcus separate?

A

the fissure separating the temporal lobe from the parietal and frontal lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is the somatosensory cortex involved in pain?

A

tells us where the pain is and the magnitude of the sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 components of the pain matrix?

A
  1. Sensory/discriminative; contributing to perception and the location of pain
  2. Affective; experience the negative, anxiety-provoking nature of pain
  3. Associative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is the insula involved in pain?

A

Linked to the imagination of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 2 major conscious ascending tracts?

A
  1. The Dorsal Column-Medial Lemniscal Pathway
  2. The Anterolateral System which consists of;
    1. Anterior spinothalamic tract
    2. Lateral spinothalamic trac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is The Dorsal Column-Medial Lemniscal Pathway responsible for?

A

Carries ensory modalities of fine touch (tactile sensation), vibration and proprioception.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the lateral spinothalamic tract responsible for?

A

carries the sensory modalities of pain and temperature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the ventral spinothalamic tract responsible for?

A

carries the sensory modalities of crude touch and pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Brown-Sequard syndrome (BSS)?

A

Hemisection of the spinal cord resulting in paralysis and loss of proprioception on the ipsilateral side as the injury or lesion, and loss of pain and temperature sensation on the contralateral side as the lesion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

General pain pathway:

A
  1. Nociceptor
  2. Afferent fibre of 1st order neuron goes to dorsal horn of spinal cord where it synapses with 2nd order neuron
  3. 2nd order neuron transmits information up lateral spinothalamic tract and travels to thalamus.
  4. 3rd order neuron goes to somatosensory cortex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which spinothalamic tract does pain information travel in?

A

Lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the nocebo effect?

A

The nocebo effect can also occur when a doctor tells you a surgery or procedure could have negative results e.g. patients frequently stop their statins as they are told it may worsen muscle aches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 2 important ways in which you can become less sensitive to pain?

A
  1. Gate control theory of pain
  2. Descending inhibitory pain fibres
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What 2 types of fibres are pain fibres?

A
  1. C fibres
  2. A delta fibres
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe C fibres

A

C-fibers are the smallest diameter, non-myelinated, and slowest sensory and motor conductivity. These fibers mediate the sensation of heat and the primary components of hot sensation and pain. More aching dull pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe a-delta fibres

A

A-delta fibers are small, myelinated, and moderate sensory conductivity speed. Slightly faster than C fibres. These fibers mediate the sensation of cold and the secondary components of cold sensation and pain. More sharp, quick pain, associated with reflexes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do nociceptors detect?

A

Noxious stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do mechanoreceptors detect?

A

Cutaneous mechanoreceptors respond to mechanical stimuli that result from physical interaction, including pressure and vibration (i.e. touch).

21
Q

Where are mechanoreceptors located?

A

They are located in the skin, like other cutaneous receptors.

22
Q

What type of fibres are mechanoreceptors innervated by? What is the exception to this?

A

They are all innervated by Aβ fibers, except the mechanorecepting free nerve endings, which are innervated by Aδ fibers.

23
Q

Describe a-beta fibres

A

A-beta fibers are intermediate size, myelinated, and fastest sensory conductivity. These fibers mediate the sensation of touch, mild pressure, vibration, and joint positioning sensations. These are measured in the sensory nerve conduction tests of standard electrodiagnostic studies (EMG/NCV).

24
Q

Which spinothalamic tract does touch information (from mechanoreceptors) enter?

A

nter the anterior spinothalamic tract.

25
Q

What is the gate control theory of pain?

A

The gate control theory of pain describes how non-painful sensations can override and reduce painful sensations.

An inhibitory connection may exist with Aβ and C fibers, which may form a synapse on the same projection neuron. The same neurons may also form synapses with an inhibitory interneuron that also synapses on the projection neuron, reducing the chance that the latter will fire and transmit pain stimuli to the brain.

Thus, depending on the relative rates of firing of C and Aβ fibers, the firing of the nonnociceptive fiber may inhibit the firing of the projection neuron and the transmission of pain stimuli.[4]

26
Q

What 3 methods of pain relief use the gate control theory of pain?

A
  1. Massage
  2. TENS machine (a method of pain relief involving the use of a mild electrical current)
  3. Spinal cord stimulation
27
Q

What are the main neurotransmitters of the descending pathway?

A

Noradrenaline and serotonin

28
Q

What is modulation of pain?

A

Pain modulation refers to the process by which the body alters a pain signal as it is transmitted along the pain pathway and explains, at least in part, why individual responses to the same painful stimulus sometimes differ.

29
Q

Nociceptive vs neuropathic pain?

A

Nociceptive pain: pain due to tissue damage and inflammation

Neuropathic pain: pain initiated or cauesd by a primary lesion or dysfunction in the CNS or PNS

30
Q

Where does shingles (varicella zoster virus) lie dormant?

A

Dorsal root ganglion

31
Q

Examples of neuropathic pain:

A
  • Post herpetic neuralgia
  • Painful diabetic neuropathy
  • Trigeminal neuralgia
  • Phantom pain
32
Q

What is post herpetic neuralgia?

A

The most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.

33
Q

How does neuropathic pain often present?

A

Neuropathic pain is often an intense pain which may be accompanied by other phenomena such as allodynia, paraesthesia, dysesthesia, and paroxysmal pain. Additional symptoms include sleeping difficulties, depression and anxiety.

  • Often constant, not reduced by rest
  • Associated with severe comorbidity and poor quality of life
34
Q

Treatment for nociceptive pain?

A
  • A degree of rest
  • Exercise
  • Allow repair
  • Normal WHO ladder; Paracetamol, NSAIDS, Weak opioids
  • Usually responds to pain killers
35
Q

Treatment for neuropathic pain?

A
  • Neuropathic pain killers;
    • Gabapentin
    • Pregabalin
    • Amitryptlyline
    • Duloxetine
  • Spinal cord stimulation
  • Often doesn’t respond to pain killers
36
Q

What is acute pain?

A

–Associated with trauma or injury

–Usually nociceptive

–Proportional to magnitude of injury

–Evolutionary protective function

–Assists with wound healing

–Resolves with healing

37
Q

Is acute pain nociceptive or neuropathic?

A

Nociceptive

38
Q

What is chronic pain?

A

–Pain that persists past normal duration of tissue healing;3 months but arbitrary

–May be dissociated from tissue damage

–No obvious protective function

–Causes distress and suffering

39
Q

What is the WHO analgesia ladder?

A
  1. Non-opioids e.g. paracetamol, NSAIDs, COX-2 inhibitors
  2. Weak opioids e.g. codeine, tramadol, dihydrocodeine
  3. Opioids e.g. morphine, fentany, buprenorphine
40
Q

Why should the WHO analgesia ladder not be used in chronic pain?

A

Huge addiction rates –> opioid crisis. Opiods are very good analgesics for acute pain and for pain at the end of life, but there is very little evidence that they are helpful for long term pain.

41
Q

There are many factors associated with main:

A
  • Anxiety (fear/distress mediated via increased attention)
  • Depressed affect: makes pain worse
  • Gender (socialisation/gonadatrophins)
  • Circadian variation: worse at night
  • Climatic conditions: MSK pain is relatively worse in cold weather
42
Q

Reasons why painkillers may not work:

A
  • Biopsychosocial factors
  • Tolerance
  • Misdiagnosis
  • Incorrect dose
  • Aren’t tolerated
  • Aren’t very effective!
43
Q

What type of painkiller is Gabapentin?

A

Gabapentin is used to treat epilepsy. It’s also taken for nerve pain (neuropathy). Nerve pain can be caused by different illnesses, including diabetes and shingles, or it can happen after an injury

44
Q

What are the 4 dimensions of pain?

A
  1. Nociception; the activation of Aδ or C fibers by potentially damaging energy on specialized nerve endings
  2. Pain; the input of the Aδ and C fibers into the nervous system
  3. Suffering; the negative affective response to pain, generated by higher cortical processes
  4. Pain behaviors; any behaviors which indicate the presence of pain, such as grimacing, taking medicines, or calling in sick.

These factors are not linearly related: some patients may have significant nociception with little suffering, whereas others may have severe pain behaviors with little nociception.

45
Q

What is the fear avoidance model?

A

The fear-avoidance model is a psychiatric model that describes how individuals develop and maintain chronic musculoskeletal pain as a result of attentional processes and avoidant behavior based on pain-related fear.

46
Q

What is acceptance and commitment therapy (ACT)?

A
  • The aim of ACT is to try to develop a rich, full and meaningful life
  • Learning skills to deal with difficult thoughts and feelings.

Helping you to clarify what is truly important and meaningful to you - your values - then use that knowledge to guide, inspire and motivate you to change your life

47
Q

What is spinal cord stimulation?

A

Spinal Cord Stimulation (SCS) is an established therapy that involves the delivery of energy to the spinal cord through electrodes in the epidural space

–SCS works by delivering small electrical pulses to the pain sensing pathways of the spinal cord, effectively altering the pain signals traveling to the brain.

–SCS is typically prescribed for the treatment of pain of the back, trunk, or limbs

48
Q

What is the celiac plexus block?

A

Celiac plexus blocks are injections of pain medication that help relieve abdominal pain, commonly due to cancer or chronic pancreatitis. The celiac plexus is a bundle of nerves that surrounds the aorta, the main artery into your abdomen.

49
Q

Take home messages:

A
  • Understand the pain pathway is modulated and you can use this to your advantage when treating patients
  • Recognise pain and treat it as you know it is awful and has a massive impact
  • Recognise the psychological impact of pain and that pain is not in patients head.
  • Try to decide whether a pain is acute or chronic, neuropathic or nociceptive.
  • If the medication fails consider whether there are biopsychosocial factors and decide whether increasing medications and side effects is the best option
  • If pain score is 10 sometimes increasing opioids isn’t the answer and some patients will need onward referral and occasionally there are interventions that can help

Yr 2 - Control (71 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions