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Pain Flashcards

1
Q

Why does pain matter?

A

Common PC or symptom, encounter a lot of patients living with pain and required to Prevent, Recognise, Assess and Treat pain effectively (PRAT)

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2
Q

What acronym can be used to remember what is required to combat pain?

A

PRAT

  • Prevent
    
- Recognise 

  • Assess
    
- Treat
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3
Q

What is pain?

A

unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage

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4
Q

What is chronic pain?

A

Pain which has persisted beyond normal tissue healing time

The WHO official 12-week duration (arbitrary) + management

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5
Q

What are the two main types of pain (based on the fibres mediating the pain experience)?

A
  1. Fast: sharp, pricking, acute pain felt within 0.1s of stimuli
  2. Slow pain: burning, aching, throbbing and chronic which is associated with tissue destruction
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6
Q

Why do we have pain functionally?

A

Protective measure to minimise tissue damage

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7
Q

What are the two main types of nerve fibres and what pain do they elicit?

A

a Delta + C fibres

a Delta: immediate pain e.g. stand on pins

C fibres: persisting pain e.g. trauma of chronic conditions

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8
Q

What is the withdrawal reflex?

A

An unconscious reflex which is involuntary happening at the level of the spinal cord which is polysynaptic involving sensation then transduction by receptor and afferent sensory neurone then interneurone and AP along efferent motor neurone to evoke change (e.g. flex hand) and inhibit antagonistic muscle group (e.g. extensor compartment to avoid opposing flexion of hand) + excitation of one muscle compartment in leg and inhibition of the other to allow stability in crossed extensor reflex

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9
Q

What is the pain flexion reflex?

A

Withdrawal reflex involving flexion of limb to reduce pain stimuli e.g. standing on pin

  1. Painful stimuli stepped on (pin on foot)
  2. Nociceptor detects harmful stimuli
  3. Primary sensory neurone enters spinal cord and diverges
    3a. Ascending pathway to brain for sensation and posture adjustment
    3b. Withdrawal reflex pulls foot away from painful stimulus; reciprocal inhibition
    3c. Crossed extensor reflex supports body weight shift; reciprocal inhibition
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10
Q

What example is there of a common disease in which a comorbidity involves inability to detect pain?

A

Diabetes Mellitus and peripheral neuropathy leading to reduced ability to feel pain, tingling, sharp pains, hyperalgesia, muscle weakness, loss of reflexes, loss of balance and serious foot problems: ulcers, infections and bone and joint pain

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11
Q

How do you test peripheral neural function in diabetics?

A

Use a 10g monofilament which allows standard application of pressure until the monofilament buckles

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12
Q

What are the stages of the pain process?

A
  1. Transduction
  2. Transmission 


  3. Modulation 


  4. Perception
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13
Q

What is a nociceptor?

A

Free nerve endings of A and C fibres which act as pain receptors, detecting physical or chemical damage occurring in the tissues

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14
Q

Which of the following is not a feature of delta fibres?

A. Myelinated

B. Sharp, localised pain detection

C. Fast conduction

D. Visceral

A

D. Visceral

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15
Q

Which of the following is not a feature of delta fibres?

A. Myelinated

B. Sharp, localised pain detection

C. Fast conduction

D. Dull, throbbing pain detected

A

D. Dull, throbbing pain detected

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16
Q

Which of the following is not a feature of C fibres?

A. Unyelinated

B. Sharp, localised pain detection

C. Slow conduction

D. Dull, throbbing pain detected

A

B. Sharp, localised pain detection

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17
Q

Which of the following is not a feature of C fibres?

A. Unyelinated

B. Somatic mainly

C. Slow conduction

D. Dull, throbbing pain detected

A

B. Somatic mainly

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18
Q

What is meant by double pain sensation?

A

Sudden painful stimulus gives double pain sensation as fast-sharp pain transmitted by Ad fibre pathways then after a slow pain transmitted by C fibre pathway

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19
Q

What is transduction?

A

Conversion of a noxious stimulus (heat, mechanical, chemical) into an AP in a nociceptor

20
Q

What are the threshold-nearing collective group of substances which act on nociceptors called? Name 3 examples and what they generally do.

A

Sensitising soup as they sensitise the nociceptor, bringing it closer to an AP; Leukotrienes, Substance P, Prostanoids, CGRP, Glutamate; Bring the nociceptor closer to threshold ≈ increase % of AP 


21
Q

What is transmission?

A

The process of relaying an action potential from one region of the body to the other via nerve fibres and neurones. Pain pathway involves action potential entering dorsal horn of spinal cord via primary afferent sensory neruones and synapsing with secondary order neurone then crossing over contra laterally in the thalamus (spinothalamic tract) and synapsing with a tertiary order neurone which projects to the somatosensory cortex.

22
Q

What is the modulation of pain at the dorsal horn?

A

Descending inhibition occurs via 3 mechanisms which involves:
1. GABA and glycinergic interneurones

  1. Descending inhibition: PAG —> RVM —> DH; Raphe nucleus + Pain inhibitory complex in dorsal horns of spinal cord
  2. Endogenous opioids (e.g. encephalins (ß-endorphin + dynorphin), serotonin released from Raphe nucleus)
23
Q

What is the Gate Control Theory?

A

Based on presynaptic inhibition of pain information produced by mechanical stimulation and provides basic rationale TENS procedure. By executing mechanical stimulation, mechanosensor fibres relay via primary order sensory neurone and inhibit interneurone to close the gate to noxious stimulation.

i. Opening of the gate achieved by: physical (inactivity/poor fitness), behavioural (poor pacing), emotional (anxiety, depression and hopelessness) and cognitive (worrying about the pain).

ii. Closing of the gate: behaviour (medication use, massage, heat/cold), emotion and cognition (positive coping strategies, relaxation), physical (exercise) 

+ Physiological explanation for how psychological factors affect pain perception

+ Focus on perception not sensation

24
Q

What is TENS?

A

Transcutaneous electric nerve stimulation whereby an action potential is conducted via electrode patches and frequency + AP magnitude controlled by controller ≈ modulate pain sensation

25
What is the pain matrix?
Neuromatrix (pain matrix) is all parts of the brain whose activity fluctuates when an individual is experiencing pain 

26
What is pain perception?
he result of neuronal activity becoming a conscious experience
27
What is one example of surgical interruption of pain pathways?
Cordotomy where thoracic region of spinal cord on opposite side to pain is partially cut in anterolateral quadrant ≈ interrupt anterolateral sensory pathway h/e not always successful: 1) Pain fibres may not cross the opposite side until brain + 2) Sensitisation of other pathways ≈ return of pain 

28
What is visceral pain?
Pain (≈ unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage) resulting from activation of nociceptors of thoracic, pelvis or abdominal viscera which may be sensitive to distension, ischaemia, inflammation but insensitive to other stimuli such as cutting or burning
29
What is referred pain?
Pain felt in a region whereby the stimuli is not directly affecting. Synapsing in lower or higher paravertebral ganglia allows communication with proximal and distal sympathetic chain ganglion which is the basis for referred pain and sensory stimuli can be felt one up or one down and often the dermatome of the spinal nerve at that vertebral level travels much further away as a splanchnic nerve etc e.g. cardiopulmonary splanchnic nerve supplies heart from T1-T5 however dermatome is left arm or top of ipsilateral shoulder

30
What groups of patients might find this more challenging to identify pain?
``` - Children 
- Elderly 
 - Learning disabilities 
 - Cognitive impairments 
 - Change in behaviour 
 - Altered conscious levels 
- Low socioeconomic (may not present) 
 - Isolation (lack of access to medical professionals) ```
31
How might you assess pain?
SOCRATES Universal Pain Assessment Tool: Rating scale used to provide an indication of severity of pain and activity tolerance
32
What is prevention and preparation?
Seeking to prevent and prepare patients for feeling pain and using a holistic, BPS model to do so 

33
What is neuropathic pain?
Pain (≈ unpleasant sensory and emotional experience associated with actual or potential tissue damage or described by the patient in terms of such damage) which arises as a direct consequence of a lesion or a disease affecting the somatosensory system
34
What are the 3 classifications of clinical features of neuropathic pain?

1. Positive phenomena:
 i. Spontaneous (without stimulus): Continuous (cutaneous, deep, visceral) or Paroxysmal 
 ii. Evoked pain (with stimulus): Allodynia (mechanical ≈ dynamic or static; + thermal), Hyperalgesia, Hyperpathia 2. Autonomic dysfunction: 
i. Vasomotor or Sudomotor 3. Negative phenomena: i. Sensor loss: thermal, vibration, soft touch
35
Which word below matches this description: 'Abnormal sensation whether spontaneous or evoked'? A. Dysaesthesia B. Paraesthesia C. Hyperalgesia D. Hyperpathia
B. Paraesthesia
36
Which word below matches this description: 'unpleasant abnormal sensation whether spontaneous or evoked'? A. Dysaesthesia B. Paraesthesia C. Hyperalgesia D. Hyperpathia
A. Dysaesthesia
37
Which word below matches this description: 'increased pain from stimulus usually provoking pain'? A. Dysaesthesia B. Paraesthesia C. Hyperalgesia D. Hyperpathia
C. Hyperalgesia
38
Which word below matches this description: 'increased pain from a stimulus that does not usually cause pain'? A. Allodynia B. Paraesthesia C. Hyperalgesia D. Hyperpathia
A. Allodynia
39
Which word below matches this description: 'painful syndrome characterised by abnormal painful reaction to stimulus'? A. Allodynia B. Paraesthesia C. Hyperalgesia D. Hyperpathia
D. Hyperpathia
40
Which word below matches this description: 'painful syndrome characterised by abnormal painful reaction to stimulus pain in the anatomical distribution of a nerve or nerves'? A. Allodynia B. Neuralgia C. Hyperalgesia D. Hyperpathia
B. Neuralgia
41
What is the neuroplasticity behind chronic pain?
Experiencing chronic, prolonged pain at sites which were previously injured but currently healthy due to maladaptive organisation of the nervous system peripherally and centrally due original damage releasing noxious stimuli and inflammation causing elevation of nociceptive input from periphery to CNS with prolonged nociception from periphery eliciting neuroplasticity response at cortical level to change somatotopic organisation for painful site, inducing central sensitisation
42
What is the aim for patients experiencing chronic pain as clinicians when considering the psychosocial aspects are intertwined with biological?
Breaking the fear-avoidance model, aiming to shift patients from LHS to RHS to experiencing no/minimal fear and confronting it which aids recovery 

43
List 5 yellow flags for back pain.
Gender Age Genetic predisposition Occupational status History of abuse Compensation Past pain experience Anxiety and depression Catastrophising beliefs Surgical approach Attitudes Communication Overprotective family or lack of support
44
What are Complex Regional Pain Syndromes?
Array of painful conditions characterised by severe continuous neuropathic pain with abnormal sensation, vasomotor change, sudomotor change, motor/trophic change, regionally restricted and disproportionate to the trauma
45
What is the Budapest Criteria?
Guidelines providing robust diagnostic framework for Complex Regional Pain Syndromes 1. Report continuing pain disproportionate to the trauma 
2. Report at least one symptom in 3 or 4 categories i. Sensory: hyperalgesia and/or allodynia 
ii. Vasomotor: skin colour and/or temperature changes/asymmetry 
iii. Sudomotor/oedema: swelling and/or sweating changes or asymmetry 
iv. Motor/trophic: weakness, tremor, dystonia, decreased ROM and/or trophic changes/asymmetry involving nails, skin and/or hair

Anaesthetics (1 decks)

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