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Starred Summer 2015 > Pain > Flashcards

Pain Flashcards

1
Q

Fast pain defined

A

Short, well localized, sharp, stabbing sensation- duration matched to stimulation

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2
Q

Fast pain from what kind of fibers

A

Myelinated A-delta fibers

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3
Q

Slow pain defined

A

Throbbing, burning, aching, diffuse, poorly localize & less related to stimulus

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4
Q

Slow pain from what kind of fibers

A

unmyelinated C-fibers

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5
Q

Eudynia

A

Symptomatic/normal pain

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6
Q

Maldynia

A

Pathophysiological disease of the nervous system

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7
Q

Dysesthesia

A

Unpleasant abnormal sensation

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8
Q

Neurogenic pain

A

Pain initiated or caused by primary lesion, dysfunction, or transitory perturbation in peripheral or central nervous system

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9
Q

Neuropathic pain

A

pain initiated or caused by primary lesion or dysfunction of nervous system

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10
Q

Gate control theory

A

Specialized nerve endings (nociceptors) whose response is modulated in dorsal horn of spinal cord

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11
Q

How fast pain travels

A

A-delta to Rexed’s lamina I and V, 2nd order neurons cross over to contralateral STT and ascend to brain

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12
Q

How slow pain travels

A

C-fibers to Rexed’s lamina II and III (also called substantia gelitanosa)

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13
Q

GABA effects on pain

A

Inhibitor - hyperpolarizes via increase in chloride in cerebral cortex, basal ganglia, cerebellum and spinal cord

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14
Q

Acetylcholine effects on pain

A

Inhibitor - increases potassium conductance in peripheral paraSNS

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15
Q

Dopamine effects on pain

A

Inhibitory by acting on adenylate cyclase

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16
Q

Norepi effects on pain

A

Inhibitor in RAS and hypothalamus

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17
Q

Epi effects on pain

A

inhibitory in RAS

18
Q

Glycine effects on pain

A

Increases chloride in spinal cord

19
Q

Endorphins effects on pain

A

excitatory for descending pathway which inhibits pain transmission

20
Q

Serotonin effects on pain

A

Inhibitory in brain

21
Q

Histamine effects on pain

A

Inhibitory in hypothalamus and RAS

22
Q

Glutamate effects on pain

A

Excitotoxic neuronal injury - acts in hippocampus, outer layer of cerebral cortex and susbstantia gelitanosa

23
Q

Pain transmission

A

Impulse -> dorsal horn -> glutamate or substance P release and then acted on by inhibitory or excitatory neurotrasmitters

24
Q

Do pain receptors adapt

A

No

25
Q

Flaccid paralysis and absent stretch reflex indicate a ____ motor neuron lesion

A

lower

26
Q

Spastic paralysis with accentuated stretch reflex in absence of skeletal muscle paralysis indicates ___ motor neuron lesion

A

upper

27
Q

primary afferent neurons are __polar with a cell body in the ____ where the ___ of sensory neurons are located

A

uni, dorsal root ganglion, cell bodies

28
Q

Incision stimulates ____, but not ____ nociceptors

A

cutaneous, visceral

29
Q

Visceral nociceptors are activated by ____

A

distension

30
Q

Muscle and joint nociceptors are activated by ____

A

stretching or pressure

31
Q

Silent nociceptors are activated after ____

A

tissue injury

32
Q

Chronic pain defined

A

Peristent beyond normal time frame, starts around 6 weeks to 3 months and lasts 1-6 months or longer

33
Q

Deep pain defined

A

diffuse and difficult to locate, referred to other structures

34
Q

Sympathetic vs parasympathetic innervation of pain

A

Para: mouth, esophagus, laryngeal nerve, upper thoracic, rectum, urethra, testicles, genitofemoral, cervix and upper vagina SNS: stomach, intestines, lungs, renal, peritoneum, etc

35
Q

Independent indicators for postoperative pain

A

Preoperative pain, younger age, type of surgery, preop anxiety, size of incision, female

36
Q

Max tylenol dose for preterm/infants/children

A

preterm 60 mg/kg, infants 75 mg/kg, children 100 mg/kg (max 4 g/day)

37
Q

Capsaicin cream

A

Burns with administration but depletes substance P

38
Q

Pain meds to avoid in elderly

A

Meperidine, non-cox NSAIDS (GI), indomethacin (GI, renal, liver), ketorolac (can use reduced dose), pentazocine (HTN/tachy), skeletal muscle relaxants

39
Q

Neuropathic pain defined

A

Damage or disease to somatosensory system (thermo/photo/mechano/chemo receptors), have dysesthesia (abnormal sensations) and pain with non-painful stimulus (allodynia)

40
Q

Approach to chronic pain management

A

Bio-psycho-social… include patient as active participant and pain expert.. outcome oriented pain with emphasis on function not pain

41
Q

Untreated or poorly treated acute pain will likely lead to ____

A

chronic pain syndromes

Starred Summer 2015 (12 decks)

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