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Musculoskeletal 1 > Pain > Flashcards

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

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2
Q

Types of nociceptors?

A
  1. Thermal
  2. Mechanical
  3. Polymodal
  4. Silent nociceptors
  5. Free nerve endings
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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
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4
Q

Mechanical nociceptors

A
  • Sense intense pressure
  • A delta fibers carry the information to the dorsal horn
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5
Q

Polymodal nociceptors:

A
  • Highly intense mechanical, chemical or thermal stimuli
  • Carried by C fibers
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6
Q

Silent nociceptors

A
  • affernet for viscera
  • Firing threshold reduced with inflammation or various chemicals
  • Tend to be dormant
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7
Q

Free nerve endings

A

Mechanism for generating action potentials is unknown

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8
Q

Primary pain afferent fiber types

A
  • small A delta fibers
  • C- Fibers
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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)
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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)
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11
Q

Large Afferent fiber types

A
  • A alpha
  • A beta
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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
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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
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14
Q

What types of chemicals make a nociceptors more sensitive

A
  • Histamine
  • Prostaglandins
  • Leukotriene
  • Cytokines
  • Nerve growth factors
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15
Q

What activiates the nociceptors and produces pain/algogen

A
  • Bradykinin
  • Serotonin
  • Glutamate
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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
  1. When there is injury you immediately feel pain and can identify where you hurt yourself
  2. Concerned with the
  • Quality: burning, sharp dull, aching
  • Location:
  • Duration:
  • intensity
25
Q

Motivational-affective

A
  • What you do in response
  • Ex: fall and hold body part
  • Concerned with unpleasantness and our motivation toward escape
26
Q

Cognitive-evaluative

A
  • 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
Q

Locations where pain can be altered: level 1

A
  • periphery
  • Non narcotic analgesic (NSAIDs and tylenol) that inhibit prostaglandins to desensitize nociceptors
28
Q

Locations where pain can be altered: level 2

A
  • dorsal horn
  • Where they exert their effect in the dorsal horn
  • Can be done by massaged, joint mobs, rocking motions
29
Q

Locations where pain can be altered: level 3

A
  • 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
Q

Locations where pain can be altered: level 4

A
  • hormonal system:
  • Release of endorphins
31
Q

Locations where pain can be altered: level 5

A
  • cortical level:
  • Past experiences with pain
  • and if you know what will happen
32
Q

Allodynia

A

normally non-painful stimuli elicit pain

33
Q

Hyperalgesia

A

response to noxious stimuli is amplified and prolonged
- primary: response occurs at the site of injury/tissue damage
- secondary: occurs outside site of injury

Musculoskeletal 1 (42 decks)

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