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Pain Flashcards

1
Q

what is the definition of pain?

A

pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of damage

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2
Q

pain duration:

A

acute: 6 months

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3
Q

what is nociceptive pain?

A

caused by stimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity (nociceptors)

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4
Q

what 3 modes of noxious stimulation is nociceptive pain classified by?

A

1- thermal
2- mechanical
3-chemical

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5
Q

nociceptive pain is divided into what 3 categories?

A

1-visceral (diffuse, difficult to locate and often referred)

2-deep somatic (dull, aching, poorly localized pain)

3-superficial somatic (sharp, well defined and clearly located)

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6
Q

what is neuropathic pain?

A

caused by damage or disease affecting any part of the nervous system involved in bodily feelings (somatosensory system)

often described as burning, tingling, electrical, stabbing or pins and needles.
bumping the “funny bone” elicits acute peripheral neuropathic pain

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7
Q

what is phantom pain?

A

a pain felt in part of the body that has been lost or from which the brain no longer receives signals

it is a type of neuropathic pain

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8
Q

what is psychogenic pain?

A

pain caused, increased, or prolonged by mental, emotional or behavioral factors

sufferers are often stigmatized because both medical professionals and the general public tend to think that pain from a psychological source is not “real”

mind believes they are in pain, are not faking

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9
Q

what is referred pain?

A

pain that occurs away from the pain site
nerve- to its area of innervation
dermatomal area
embryologic development

examples:

  • heart: upper chest, L shoulder, jaw, arm
  • diaphragm: lateral tip of either shoulder
  • gallbladder- R shoulder, inferior angle of R scap
  • Kerr’s sign: pain on tip of shoulder=ruptured spleen
  • L5-S1- lateral leg and foot
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10
Q

what are the 2 types of referred pain?

A

1- myofascial pain

2- sclerotomic and dermatomic pain

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11
Q

myofascial pain:

A

trigger points, small hyper-irritable areas within a muscle in which nerve, impulses bombard CNS and are expressed at referred pain

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12
Q

sclerotomic & dermatomic pain:

A

sclerotome: area of bone/fascia that is supplied by a single nerve root
myotome: muscle supplied by a single nerve root
dermatome: area of skin supplied by a single nerve root

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13
Q

paresthesia=

A

abnormal spontaneous sensations

such as: burning, tingling, pins and needles

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14
Q

dysesthesia=

A

any unpleasant sensation produced by a stimulus that is usually painless

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15
Q

anesthesia=

A

complete loss of sensation

usually discriminative sensation

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16
Q

hypesthesia=

A

partial loss of touch and pressure sensations

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17
Q

hyperesthesia=

A

increase sensitivity to touch and pressure sensations

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18
Q

analgesia=

A

complete loss of pain and temperature sensations

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19
Q

hypalgesia=

A

partial loss of pain and temp sensations

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20
Q

hyperalgesia=

A

increase sensitivity to pain sensations

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21
Q

myalgia=

A

tenderness or pain in the muscles

22
Q

malaise=

A

general discomfort; uneasiness

23
Q

causalsia=

A

intense burning pain

aka complex regional pain syndrome
when nerve gets inflamed

24
Q

allodynia=

A

nonpainful stimuli evokes pain

25
Q

fast pain:

A

localized; carried through Adelta axons in skin

more discriminative

  • primarily located in marginal nucleus (lamina I)
  • projects to more lateral areas via discrete, more direct pathways (lateral thalamus (VPL), post central gyrus of parietal cerebral cortex)
  • concerned more w/ perception of sharpness, intensity and location
26
Q

slow pain:

A

aching, throbbing, burning

carried by C fibers

primarily located in lamina II & V

produced in response to stim by chem mediators of inflammation
-histamine, protaglandin, substance P, etc

projects more medially via polysynaptic pathways

concerned with the affective component of pain

  • anguish, depression, fear, anger
  • arousal, attention, motivation
27
Q

nociceptive neuron transmits pain info to SC via:

A

unmyelinated C fibers and myelinated Adelta fibers

the smaller C fibers (group IV) carry impulses at a rate of .5-2.0 m/sec
want to avoid- much more uncomfortable
deep pain

the larger Adelta fibers (group III) carry impulses at a rate of 5-30 m/sec
more of awareness/protection
superficial/somatic pain. reflex responses

28
Q

acute pain:

A

<6 months

underlying pathology can be identified

usually potential or actual tissue damage

group III fibers primarily

can increase muscle tone, HR, BP, SANS

well localized, esp in skin

proportional to injured area

protective function

29
Q

chronic pain:

A

> 6 months

can have no damaging or threatening stimulus present

pain remaining after injury is healed

30
Q

pain theories:

A

recent research shows the concept of pain as a sensation produced by injury, inflammation or other tissue pathology is no longer true

pain is a conglomeration of a lot of things

specificity

pattern:

  • frequency
  • intensity

the neuromatrix outputs produce the multiple dimension of the pain experience and the homeostatic and behavior responses

31
Q

what does the body self neuromatrix consist of?

A

sensory
affective
cognitive

more neuropsychology- just need to understand that there are different aspects that affect perception of pain

32
Q

insular cortex=

A

feeling that distinguished pain from other homeostatic emotions (itch, nausea)

33
Q

anterior cingulate cortex=

A

motivational element

34
Q

sensory cortex=

A

distinctly located pain

35
Q

afferent group III fibers for lamina :

A

I, IV, V

36
Q

afferent group IV fibers for lamina:

A

II

37
Q

primary afferents synapse on:

A

tract cells

inhibitory interneurons that regulate ascending flow of nociceptive input

facilitory interneurons that regulate ascending flow of nociceptive input

interneurons that mediate local reflexes

38
Q

WDR

A

wide dynamic range cells
multimodal
in lamina IV and V

39
Q

inflammation and the axon reflex:

A

The triple response:
stretch skin–> red line, flare, and wheal

the wheal and flare result from the activity of pain receptors that transmit impulses along their axons not only in the normal orthodromic direction towards the CNS but also in the antidromic direction from axon forking nodes into the neighboring skin, where the free nerve endings respond by releasing substance P, resulting in the accumulation of fluid that constitutes the wheal response

40
Q

what does substance P do?

A

binds to the artery walls causing them to dilate and to produce the flare response

also binds to mast cells and stimulates them to release histamine. resulting in the accumulation of fluid that constitutes the wheal response

41
Q

neo thalamic tract

A

sharp, acute pain

goes medially to brainstem parts concerned with pain, then goes to thalamus

42
Q

spino thalamic tract

A

AKA: paleo pain system

dull pain
slower

43
Q

how do TENs work?

A

modulation of the dorsal horn

pain goes to projection neuronthat goes to ant/lat system
also projects to interneuron (inhibitory interneuron) and inhibits it (disinhibits); so pain fiber causes excitation of projection neuron or disinhibition of projection neuron; mechanoreceptor goes to lamina 4-5 and facilitate interneurons and excites them, which inhibits the projection cell and inhibits projection neuron; makes pain go away

44
Q

raphe nucleus produces:

A

serotonin

45
Q

lateral tegmental nucleus produces:

A

norepinephrine

46
Q

descending modulatory systems:

A

periaqueductal and raphe nucleus (in midline of reticular formation) and lateral tegmental nucleus

projection cells go up, some to periaqueductal gray
this says “how are we going to react?”

sends descending fibers to the other 2 nuclei

mediator from periaqueductal gray to these 2 sites is endorphins.

fibers from the periaqueductal gray sends signals to the raphe nucleus and lateral tegmental nucleus. raphe releases seratonin, lateral tegmental releases NE on inhibitory interneurons.
tracts come down to dorsolateral fasciculus of dorsal horn, enter dorsolateral tract, produce enkephalin which raises threshold of modulatory interneurons in laminas. –>this makes it harder for projection fibers to fire, causing less pain potentials to be firing off

endogenous opiates modulate pain

47
Q

hyperactive SANS=

A

pain

48
Q

complex regional pain syndrome=

A

causalia
RSD
shoulder hand syndrome
post-traumatic dystrophy

severe pain out of proportion to injury
hyperesthesia
allodynia
trophic changes (skin- hyperhidrosis, edema, stiffness, sweating, decrease hair grown)

unknown mechanism

theories: excitation of nociceptors (axon reflex), activation of group IV fibers

49
Q

primary afferent fibers (Abeta, Adelta, and C fibers) transmit impulses from the:

A

periphery

through the dorsal root ganglion (DRG) and into the dorsal horn of the SC

50
Q

nociceptive specific cells are mainly found in the :

A

superficial dorsal horn (laminae I-II)

51
Q

most WDRs are located:

A

wide dynamic ranges

deeper than nociceptive cells (lamina V)

Neuro (48 decks)

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