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Pain Flashcards

1
Q

What is pain?

A

Pain is the feeling or perception of irritating, sore, stinging, aching, throbbing, miserable, or unbearable sensations arising from a part of the body.

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2
Q

What is the sensory process for pain?

A

Nociception is the sensory process that provides the signals that trigger pain.

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3
Q

What is Congenital Analgesia?

A

The inability to feel pain from birth

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4
Q

Where are nociceptors found?

A

Nociceptors are found in the periphery as simple free nerve endings.

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5
Q

Where do peripheral nerve fibers terminate?

A

Peripheral nerve fibre branches & terminates as naked, unmyelinated endings in dermis.

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6
Q

What is the process of pain and hyperalgesia?

A

Tissue damage and inflammation triggers release of substances e.g prostaglandins, bradykinin and histamine that can sensitize peripheral nociceptors and induce hyperalgesia.

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7
Q

What is hyperalgesia?

A

Abnormally heightened sensitivity to pain.

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8
Q

What are the types of nociceptors?

A

Transduction of nociceptive stimuli occurs in the free nerve endings of unmyelinated ‘C’ fibres and thinly myelinated ‘Ad’ fibres.

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9
Q

What are the different modalities that nociceptors respond to?

A

Mechanical: respond to strong pressure.

Thermal: respond to burning heat / extreme cold.

Chemical: respond to histamine or other chemicals

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10
Q

Most nociceptors are polymodal and respond to what?

A

Mechanical, thermal & chemical stimuli.

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11
Q

What is the use of microneurography?

A

To see the distribution of nociceptors on the skin

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12
Q

What is the process of microneurography for comparison of thermoreceptor and nociceptor?

A

Thermal stimuli applied to receptive field of cutaneous thermoreceptor and nociceptor

B. Record afferent firing in response to incremental temperatures

C. Graph plotting afferent firing frequency versus temperature

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13
Q

What type of fibres do thermal and mechanical nociceptors have?

A

Aδ fibres (myelianted)

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14
Q

What type of fibres do polymodal nociceptors have?

A

C fibres ( unmeyelinated)

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15
Q

What is the general prinicpile of large diameter fibres?

A

Large diameter, rapidly conducting afferents (I/II) associated with low threshold mechanoreceptors.

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16
Q

What is the general prinicpile of small diameter fibres?

A

Small diameter, slow conducting afferents (III/IV) associated with nociceptors and thermoreceptors.

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17
Q

What is the characteristic of 1st pain?

A 
Fast A-delta fibres
Sharp or prickling
Easily localised
Occurs rapidly
Short duration
Mechanical or thermal nociceptors
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18
Q

What is the characteristic of 2nd pain?

A 
Slow C-fibres
Dull ache, burning
Poorly localised
Slow onset
Persistent
Polymodal nociceptors
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19
Q

How are the role of each sensory afferent in pain perception investigated?

A

It is possible to selectively anaesthetise C fibres and A delta fibres to dissect out the role of each sensory afferent in pain perception

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20
Q

What is the role of perception of nociception that is small and myelianted and one that is unmyelianted?

A

Small and myelinated –> sharp pain

Unmyelianted –> burnign pain

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21
Q

What is the route of nociceptive fibres?

A

Nociceptive fibres have their cell bodies within the dorsal root ganglion.

Afferent terminals enter the dorsal horn and travel up/down a short distance within the Zone of Lissauer.

Afferent terminals synapse onto neurones within the superficial laminae of the dorsal horn.

Principle areas innervated by nociceptor afferents are lamina I and lamina II (substantia gelatinosa).

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22
Q

How is nociceptive input from viscera and skin detected?

A

Nociceptive afferents from internal organs e.g. viscera and the skin enter spinal cord through common routes and target overlapping populations of spinal neurons

This ‘cross-talk’ accounts for referred pain whereby visceral pain is perceived as having a cutaneous source by the sufferer.

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23
Q

What is the referred pain of angina?

A

Pain is localised by the patient to the upper chest wall and the left arm

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24
Q

Where is referred pain for appendicitis at early stages ?

A

Pain is referred to the abdominal wall around the navel.

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25
Pain afferent release what excitatory neurotransmitter?
Glutamate
26
What is the important neuropeptide in pain afferents?
Substance P
27
What type of pathway is the ascending pain pathway?
Contralateral pathway
28
What are the 3 components of the ascending pain pathway?
Lateral (neo-) spinothalamic tract. Spinoreticulothalamic tract Anterior spinothalamic tract to the reticular formation and periaqueductal grey matter
29
What is dissociated sensory loss?
A unilateral spinal lesion will produce sensory loss of touch, pressure, vibration and proprioception below the lesion on the same side. Diminished sensation of pain below the lesion will be observed on the opposite side.
30
Give a example of a syndrome where dissociated sensory loss occurs?
Brown-Sequard syndrome
31
What type of scan can you see pain?
PET scan
32
What is the process of pain and temperature from the face and head?
Trigeminal System: (5th Cranial nerve) Small diameter afferents descend in the spinal trigeminal tract to the brain stem. Synapse with second-order sensory neurons in the pars caudalis. Axons then ascend contralaterally to thalamus in the trigeminothalamic tract (also called the trigeminal lemniscus). Projects to cortex via the ventral posteromedial nucleus.
33
What is phantom pain?
Pain and touch sensations with no sensory inputs
34
What are features of chronic pain and pathological pain?
Increased pain (hyperalgesia) or touch -evoked pain (allodynia)
35
In who'm is phantom pain usually seen in?
50-80% of amputees pathological pain A possible link between any pain existing pre-amputation i.e. acute injury or chronic pain
36
What is the possibly causes of phantom pain and is there any treatment?
Aetiology unclear May be result of cortical re-organization in the ‘virtual’ body maps of thalamus and cortex In phantom limb patients, maps distorted such that stroke on ‘face’ felt on missing limb Highly resistant to treatment
37
What is central sensitization?
Is a condition of the nervous system that is associated with the development and maintenance of chronic pain
38
What causes central sensitization?
Permanent change in the synaptic structure of the dorsal horn
39
What is a function of opoid?
Presynaptic inhibition
40
GIve example of acute pain?
``` skin abrasions deep tissue injury postoperative dental superficial burn labour ```
41
Give examples of chronic pain?
``` inflammatory pain neuropathic pain neuralgias musculo-skeletal pain amputation/phantom visceral cancer migraine ```
42
What can hyperalgesia be?
A reduced threshold for pain An increased intensity of painful stimuli Spontaneous pain
43
What occurs in hyperalgesia?
Nociceptors normally respond to stimuli which damage tissue. However, tissue that has already been damaged or inflamed is unusually sensitive.
44
What doees the gate theory of pain explain?
This theory explains why pain can be reduced by stimulating mechanoreceptors e.g. rubbing your knee after falling over.
45
Give example of opiate receptors?
mu, kappa and sigma
46
What is Dysaesthesias ?
unpleasant abnormal sensations
47
What is Allodynia ?
Pain in response to non painful stimuli
48
What is nociceptive pain?
Caused by actual tissue damage and painful stimuli at nociceptors Can be subdivided by its: - Location - Quality / character
49
What are the benefits of acute pain?
Part of trauma response Protective--> avoid further damage Learning experience
50
What is the adverse effects of acute pain?
Humanitarian issues Cardiovascular stress Respiratory compromise Hypercoagulation!
51
What is the first analgesia in the analgesia ladder?
Acetaminophen Aspirin NSAIDs COX-2 inhibitors
52
What is the second analgesia in the analgesia ladder?
Codeine Dihydrocodeine(Propoxyphene) Tramadol
53
What is the third analgesia in the analgesia ladder?
Morphine Fentanyl Hydromorphone Buprenorphine Methadone
54
what is the main use of non opoid analgesia?
Efficacy in acute pain management | and control of nociceptive pain
55
Where do NSAIDs/COX-2 inhibitors act mainly?
Peripherally white paracetamol is more central activity
56
Where do opoid analgesia mainly act?
Presynaptically pain signal transmission is reduced - Postsynaptic membrane is hyperpolarised, decreasing the probability of action potential generation
57
When do you not give opoids?
Renal failure Do not use morphine or codeine sedative metabolites accumulate
58
What is a epidural analgesia?
``` Epidural analgesia is a specialised technique of pain management. It is obtained by administering drugs directly into the epidural space. An epidural catheter is usually placed to allow repeated doses or an infusion of the drug to be given ```
59
When is epidural analgesia used?
``` Postoperatively: thoracic, abdominal, groin/perineal, lower limb surgery – Labour pain – Chronic pain ```
60
What are the benefits of epidural analgesia?
``` High quality pain relief • Improved pulmonary function • Reduced sepsis and chest infection • Reduced cardiac morbidity • Reduced vascular graft failure • Reduced incidence of deep venous thrombosi ```
61
Where is the epidural space? What does it contain?
Potential space --> Between dura mater and the wall of the vertebral canal. • Composed of connective tissue, fat and blood vessels and nerve roots Tissue in folds
62
What is Neuropathic pain?
Spontaneous pain and hypersensitivity to pain in association with damage to, or a lesion of, the nervous system
63
Give examples of neuropathic pain?
``` Post herpetic neuralgia – Painful diabetic neuropathy – Trigeminal neuralgia ``` Post traumatic / post operative
64
What is neuropathic pain assoicated with?
Intense pain that may be accompanied by other pain phenomena Often persistent or recurrent Associated with severe comorbidity and poor quality of life
65
What is the Features suggesting neuropathic pain?
Pain different from normal everyday pain Pain in absence of ongoing tissue damage Pain in area of sensory loss Paroxysmal or spontaneous pain Allodynia Hyperalgesia Dysaesthesias
66
How do you measure pain quality?
McGill Pain Questionnaire | MPQ
67
What is the advantages of McGill Pain Questionnaire | (MPQ)?
Well validated Quality assessed
68
What is the disadvantages of McGill Pain Questionnaire | (MPQ)?
Time consuming Insensitive to small change in intensity
69
What are the Drug Therapy for neuropathic pain?
NSAIDs - poor Antidepressants Anticonvulsants Opioids Membrane stabilising drugs Topical drugs
70
What are the Non medical management of Chronic Pain?
Models of pain modulation Psychological assessment Management implications: Cognitive behavioral therapy Stress management Attention/distraction techniques

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