PAIN Flashcards
Provide the 4 steps in the nociceptive pain response
transduction
transmission
perception
modulation
the portions involved in the interpretation of pain signals
limbic system
reticular formation
thalamus
hypothalalmus
cortex
what is transduction
response to tissue injury
release of chemical mediators
conversion of energy types
generation of an AP
List chemical mediators involved in pain
prostaglandins
substance P
histamine
bradykinins
serotonin
potassium
3 phases of transmission
injury to SC
SC to brainstem and thalamus
thalamus to cortex
how are AP’s generated
voltage gated ion channels embedded in a cell’s plasma membrane
what part of the pain cycles provides evidence for the variability in pain experience
modulation
A DELTA
_________ myelinated
_______diameter
________ speed conducting fibres
_______ type of pain
acute or chronic
thinly
large
fast
sharp pain
acute
C fibres
_________ myelinated
_______diameter
________ speed conducting fibres
_______ type of pain
acute or chronic
unmyelinated
small
slow
dull aching pain
persistant pain
A beta
_________ myelinated
_______diameter
________ speed conducting fibres
_______ type of pain
acute or chronic
highly
large
rapid conducting
light touch, non noxious stimuli
what is the gate control theory
The Gate Control Theory of Pain is a mechanism, in the spinal cord, in which pain signals can be sent up to the brain to be processed to accentuate the possible perceived pain, or attenuate it at the spinal cord itself. activites such as rubbing can close the gate
3 types of pain of which one has 2 subtypes
nocipceptive (somatic vs visceral) neuropathic, somatoform
list 4 other types of pain
referred, phantom, cancer, intractable, breakthrough
what is intractable pain
pain not relieved by ordinary medical, surgical interventions and pain persistants
ACUTE VS PERSISTANT PAIN COMPARE
severity:
NS response:
vitals:
reason:
pt appearance:
reporting:
behaviour:
ACUTE
- mild to severe
- sympathetic
- increased HR, rr, bp
- diaphoresis, dilated pupils
- restless and anxious
- reports pain
PERSISTENT
- mild to severe
- parasympathetic
- dry warm skin, pupils normal
- beyond healing phase
- distressed and withdrawn
what is the BPI
brief pain inventory
assesses severity of pain and degree of interference of function 0-10
why are adjuvant therapies applied
not typical pain meds but helpful for management and can reduce pain meds required (opiod sparing)
examples of adjuvant therapy
amitripyline
carbemazepine
pregab
diazepam
how does paractermeol work
not exactly sure
prostaglandin production
serotonergic, opiod, nitric oxide, cannabinoid pathways.
Ibuprofen
non selective NSAID
celebrex
COX-2 specific
naproxen
non selective NSAID
MELOXICAM
LONG acting NSAID
DICLOFENAC
non selective NSAID
indomethacin
non selective NSAID
ketorolac
non selective NSAID
3 opiod receptors
mu
delta
kappa
morphine
common / many routes
fentanyl
rapid / strong / many routes
oxycodone
oral , step down
hydromorphone
5 x as potent as morph. various routes
methadone
oral . long acting, chronic pain
pethidine
less used, no advantage over other opiods
codeine
oral with other drugs v effective
which drug works with codeine particuarly effectively
paratemol
advantages to using tramadol
reduces risk of respiratory depression
lower abuse risk
less constipating
what is tramadol
weak mu opiod receptor antagonist
enhances noraderenergic and serotonergic inhibition
what type of antagonist is ketamine
NMDA
2 examples of anticonvulsants
pregab and gabapentin
how to anticonvulsants work
modulates NT release by binding to voltage gated calcium channels
closes pre synaptic CA channels
diminishes excessive neuronal activity and NT release
why are antidep often involved in pain management
exert analgesic properties without effecting mood in PP
lower dose and shorter delay for pain properties that depressant relief
how does capsaicin work
alkylamide found in capsicum
selectively stimulates primary afferent C fibres
c fibres express TRV1 that non selectively gate cations (sodium and calcium) which depolarises axons
primary mechanism is depletion of substance P
not instant, build up
OPQRSTUV
ONSET
PROVICATION / PALLIATION
QUALITY
REGION
SEVERITY SCALE
TREATMENT
UNDERSTANDING IMPACT
VALUES
4 classifications of CAM
whole body systems
mind body medicine
biologically based practices
manipulative and body based practices
examples of CAM
CBT
HYPONOSIS
NUTRITION
HERBAL
MESSAGE
MUSIC THERAPY
SPINAL JOINT MANIPULATION
TENS machines
yoga
pain assessment tool for children
QUESTT
question child
pain rating scale
evaluate behaviour and physiological change
secure parent involvement
take cause of pain into account
take action and evaluate results
