Pain Flashcards
Definition of Pain
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Types of Nociceptors
Mechanoceptors, thermoreceptors, chemical nociceptors, silent nociceptors
Can be unimodal or polymodal
Pain transmission
Nociceptors pick up painful stimuli, once threshold is reached an electrial signal is conducted to the spinal cord. Travels through spinothalamic tract before reaching the brain.
Spinothalamic tract pathways
Neospinothalamic tract - fast transmission, moves from receptor site to dorsal horn using myelinated A delta fibers and directly to the thalamus
Paleospinothalamic tract - continuous, moves from receptor site to spinal cord using unmyelinated C fibers, terminate throughout the brainstem.
Exhitatory mediators of Pain
Glutamate
Substance P
Prevention of Pain Transmission
Endorphins attach to opiate receptors inhibiting exhitatory release of substances
Gate Control Theory
A neural gate is present in the dorsal horn. Controlled by large and small fibers, opened once nociceptor info exceeds the inhibitory threshold, activating the pain pathway and allowing the brain to produce the conscious sensation of pain.
Reflex Arc
Strong stimulus causes the impulse to be transmitted down motor pathways to initiate response. At the same time the impulse is being transmitted to the cerebrum for interpretation.
Acute vs Chronic Pain
Acute: sudden, transient (up to 6 months), area is well defined, suffering decreases with time, relieve pain, eventually complete pain relief occurs.
Chronic: sudden or developed, prolonged, less easily to differentiate location, suffering increases over time, actions to modify the pain experience, complete pain relief is normally not possible.
Phantom Limb Pain
pain felt in the amputated limb
DOLOR
Description Onset Location Other signs and symptoms Relieving factors
QUESTT
Question the child Use pain rating scales Evaluate behaviour and psychological changes Secure patient's involvement Take cause of pain into account Take action and evaluate results
Abbreviated Injury Score (AIS)
injury is allocated a number from 1 to 6. 6 is unsurvivable
looks at specific areas of the body and gives them a score up to 75
Injury Severity Score
Sum of the three highest numbers of AIS squared
3 impacts involved in MVAs
vehicle collide with object
occupant collide with inside of car
organs collide with inside of occupant
Injuries in an MVA depend on
type of collision
position of occupant
vehicle fitted restraints or airbags
Frontal Impact injuries
down and under - femoral and hip fractures, knee and lower leg fractures
up and over - rib fracture, pulmonary or cardiac contusion, abdo organ rupture and laceration, head and spinal injury
Lateral impact injures
Compression of pelvis Rib fracture and pulmonary contusion Organ rupture on impacted side Pelvic fracture Head and neck injuries
Rotational Impact injuries
injuries common to frontal and lateral impacts
Rollover injuries
multiple system injuries
Rear end injuries
spinal injury - hyperextension of C spine
Pedestrian Impact injuries
mutisystem 1st impact - lower leg fractures 2nd impact - fracture femur, pelvis, chest and spine 3rd impact - shoulder, pelvic, spinal internal haemorrhage and head injury
Motorcycle accidents frontal impact injuries
compression injuries to head, chest, abdo
femur fracture - bilateral
pelvic fractures
peritoneal injury
Motorcycle accident angular impact injuries
fracture upper and lower extremities
abdo cavity injuries
compression injuries to affected side
