Pain Flashcards
1
Q
What is pain?
A
The sensory and emotional experience associated with actual or potential tissue damage
One-half of those seeking medical attention do so due to pain
2
Q
Types of nociceptors?
A
- Thermal
- Mechanical
- Polymodal
- Silent nociceptors
- Free nerve endings
3
Q
Thermal nociceptors
A
- Sense extreme temperatures (>45º C/113ºF or <5ºC/41º F
- A delta fibers are what brings this to the dorsal horn
4
Q
Mechanical nociceptors
A
- Sense intense pressure
- A delta fibers carry the information to the dorsal horn
5
Q
Polymodal nociceptors:
A
- Highly intense mechanical, chemical or thermal stimuli
- Carried by C fibers
6
Q
Silent nociceptors
A
- affernet for viscera
- Firing threshold reduced with inflammation or various chemicals
- Tend to be dormant
7
Q
Free nerve endings
A
Mechanism for generating action potentials is unknown
8
Q
Primary pain afferent fiber types
A
- small A delta fibers
- C- Fibers
9
Q
Small A delta fibers
A
- Smaller the diameter the slower the conduction
- High thresholds for stimulation
- Afference associated with mechanical or heat - nociceptors
- 5-30 m/Sec (fast dermatomatic pain)
- Associated with flexor withdrawal reflex
sharp/pricking pain - Synapse dorsal horn in laminas 1, 2, and 5 (layers)
10
Q
C fibers
A
- High thresholds
- Deep tissues and skin
- 0.5-2 M/sec (slow sclerotomic pain)
- Afference also associated with polymodal nociceptors
- Associated with guarding immobility response to protect it
- Long-lasting burning pain
- Synapse dorsal horn (laminas 1 and 2)
11
Q
Large Afferent fiber types
A
- A alpha
- A beta
12
Q
A alpha fibers
A
- 80-120m/sec
- Afference from proprioceptors and mechanoreceptors
- Light touch
- Vibration
- joint/muscle position
- How non-painful stimuli gets to the spinal cord
13
Q
A beta fibers
A
- 35-75 m/Sec
- Afference from hairy/glabrous skin (skin of hands) and mechanoreceptors
- Rapidly adapting (ex: putting a shirt on)
- Respond to touch and vibration
14
Q
What types of chemicals make a nociceptors more sensitive
A
- Histamine
- Prostaglandins
- Leukotriene
- Cytokines
- Nerve growth factors
15
Q
What activiates the nociceptors and produces pain/algogen
A
- Bradykinin
- Serotonin
- Glutamate
16
Q
Algogen
A
structures that produce pain in the presence of sensitize nociceptors
17
Q
What are the types of pain
A
- transient
- acute/nociceptive
- chronic/nociplastic
18
Q
Transient pain
A
Minimal or no tissue damage
- Banging into something
Two parts:
- Localizing
- Dull pain for a short time period
19
Q
Acute/nociceptive pain
A
- Signals real or impending tissue damage
- Pain last beyond a few minutes
- Triggers sympathetic response (increase in HR, BP, tension in skeletal muscle)
- Pain disappears with healing: PRICE to facilitate
20
Q
Chronic/nociplastic pain
A
- Pain persists beyond normal healing time (3-6 months)
- Can be due to alteration sin nociceptive processing within the CNS (central sensitization
- More sensitive to noxious stimuli
- Associated with depression
- Increased preoccupation with somatic symptoms
- May include emotional, environmental, psychological, sociological factors
- Difficult to treat best to prevent
- May require multidisciplinary approach
- Often the goal is to get them to become functional and deal with the pain
21
Q
Pain theories
A
- gate theory
- contemporary gate-control theory
22
Q
Gate theory
A
- 1st order low threshold mechanical afferent and 1st nociceptive afferents converge on the same 2nd order interneuron
- Mechanical afferent can be more active (with stimulation) and inhibit the nociceptive neuron
- Rub, modalities, joint mobs can activate A Alpha and beta fibers that go to dorsal horn and synapse with interneuron causing it to release enkephalins (pain killer) to reduce the pain from the nociceptive neuron
23
Q
Contemporary gate-controlled theory
A
- Perception of pain includes influence of emotional, behavioral and cognitive phenomena
Components:
1. Sensory-discriminative
2. Motivational-affective
3. Cognitive-evaluative
24
Q
Sensory-discriminative component of pain
A
- When there is injury you immediately feel pain and can identify where you hurt yourself
- Concerned with the
- Quality: burning, sharp dull, aching
- Location:
- Duration:
- intensity
25
Motivational-affective
- What you do in response
- Ex: fall and hold body part
- Concerned with unpleasantness and our motivation toward escape
26
Cognitive-evaluative
- What does this mean to me based on how you perceive pain
- Based on past experiences and outcome of different response strategies
- Ex: i'm going to be out of the season
27
Locations where pain can be altered: level 1
- periphery
- Non narcotic analgesic (NSAIDs and tylenol) that inhibit prostaglandins to desensitize nociceptors
28
Locations where pain can be altered: level 2
- dorsal horn
- Where they exert their effect in the dorsal horn
- Can be done by massaged, joint mobs, rocking motions
29
Locations where pain can be altered: level 3
- neuronal descending system
- 3 structures around the brain - Periaqueductal, locus caeruleus , raphe nucleus
- Can inhibit them as these are spinal neurons that respond to noxious stimuli
- Activated by emotional response
30
Locations where pain can be altered: level 4
- hormonal system:
- Release of endorphins
31
Locations where pain can be altered: level 5
- cortical level:
- Past experiences with pain
- and if you know what will happen
32
Allodynia
normally non-painful stimuli elicit pain
33
Hyperalgesia
response to noxious stimuli is amplified and prolonged
- primary: response occurs at the site of injury/tissue damage
- secondary: occurs outside site of injury
