Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD4001 Physiology > Pain > Flashcards

Pain Flashcards

1
Q

What is the definition of pain?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are two main types of pain?

A
  • Immediate pain (A delta)

- Persisting pain (C fibres)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can diabetes cause neuropathic ulcers?

A
  • Through peripheral neuropathy (loss of pain fibres)
  • Damage to toes for example, will continue, ulcers can form which can become infected
  • Poor vascular supply will extrapolate the issue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is the nerve cell body located in the nociceptor cells?

A

Dorsal Root Ganglion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

At what speed do A delta fibres carry pain signals?

A

2 - 10 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At what speed do C fibres carry pain signals?

A

1 m/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

WHat nociceptor fibres are unmyelinated?

A

C fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What type of pain is transmitted through A-delta fibres?

A

Sharp, localised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of pain is transmitted through C fibres?

A

Dull, throbbing, diffuse pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What type of fibres are the majority of nociceptors?

A

C fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What types of stimuli do A-delta fibres respond to?

A

Extremes (not usually visceral)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Do nociceptors adapt?

A

No - in fact if anything they do the opposite - become more intense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the 4 categories of the physiology of pain?

A
  • Transduction (stimulus translated into action potential)
  • Transmission (movement of AP from periphery centrally to brain)
  • Modulation (can down or up modulate the pain)
  • Perception (conscious acknowledgement of pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can cause a transduction of pain (what are the noxious stimuli)?

A
  • Heat: >45deg or less than 15deg
  • Chemical: K+, ATP, Bradykinin, histamine, Substance P
  • Mechanical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is primary hyperalgesia?

A

The recruitment of ‘sleeping’ C fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does polymodal mean?

A

Responding to several different forms of sensory stimulation (as heat, touch, and chemicals)
- Such as in nociceptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What substances can cause an increase in sensitization of nociceptors?

A
  • Prostanoids
  • Leukotrienes
  • Substance P
  • CGRP
  • Glutamate
    “Sensitizing soup”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What substances can activate nociceptors?

A
  • K+
  • H+
  • Serotonin (5-HT)
  • Bradykinin
  • Histamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where do the primary afferent pain fibres synapse?

A

Dorsal horn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the excitatory neurotransmitters between 1st and 2nd order neurons?

A
  • Glutamate (mainly)
  • Substance P
  • CGRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does glutamate bind to?

A
  • AMPA (mainly)
  • NMDA
  • G-protein couple receptors
22
Q

What fibres compose the neospinothalamic tract?

A

A delta fibres

23
Q

What fibres compose the paleospinothalamic tract?

A

C fibres

24
Q

Where do neospinothalamic tract fibres terminate?

A

Ventral posterior lateral nucleus

25
Q

Where do paleospinothalamic fibres terminate?

A

Dorsomedial and intra laminar areas

26
Q

What are the inhibitory substances of the dorsal horn?

A
  • GABA and glycenergic interneurons
  • Descending inhibition PAG-RVM-DH
  • Endogenous opioids
27
Q

Describe the GAte Control Theory? (rubbing to make a pain better)

A

Mechanoreceptor fibres synapse on inhibitory neurons of nociceptor fibres
- This allows A beta fibres to synapse on the target cell in dorsal horn

28
Q

What can the gate control theory be used clinically for?

A
  • TENS (transcutaneous electrical nerve stimulator)
  • Used often in early stages of labour
  • Patient has control over frequency of pain
  • 2 electrodes on skin set up buzzing sensation modulates pain going into dorsal horn
29
Q

What system elicits an autonomic response to pain?

A

Reticular system

30
Q

What system links perception of pain with mood?

A

Limbic system

31
Q

What do visceral nociceptors respond to distension or ischaemia?

A

Visceral nociceptors

32
Q

What do visceral nociceptors converge on to give ‘referred’ pain?

A

Second order neurons with somatic input

33
Q

What are some associated autonomic features of pain?

A
  • Sweating
  • Pallor
  • nausea
  • Tachycardia
  • Hypertension
34
Q

WHat can prevent and prepare for pain?

A
  • Anticipation and simple adjustments (e.g. ICE)
  • Distraction
  • Education
  • Challenge misconceptions
  • Ametop, EMLA
  • Re-brand tell patient they may be tender e.g instead of painful
  • Patient control “raise hand if want to stop”
35
Q

What are pain scoring systems scored from?

A

0 - 15 (above 10 being extreme pain)

36
Q

What medications can be used to treat step 1 (mild pain)?

A

Simple analgesics

37
Q

What medications can be used to treat step 2 (moderate pain)?

A

Mild opioids (e.g codeine, tramadol, continue simple analgesics)

38
Q

What medications are used to treat step 3 (severe pain)?

A

Strong opiods
(e.g morphine)
Continue simple analgesics

39
Q

What other medications can be added on at any pain stage on the WHO ladder?

A

Medications for neuropathic pain (e.g amitriptyline, gabapentin)

40
Q

What was the WHO pain ladder developed to treat?

A

Cancer pain (nociceptive pain) (emphasises oral treatment)

41
Q

What is neuropathic pain?

A

A pain arising as a direct consequence of a lesion or a disease affecting the somatosensory system

  • Shooting/stabing
  • Spontaneous and evoked pains
  • Allodynia
  • Common (3-18%)
  • Challenge to manage
42
Q

What is the most common causes of neuropathic pain?

A
  • Traumatic (phantom limb pain)
  • Diabetic neuropathy
  • Posthepatic neuralgia
  • Trigeminal neuralgia
  • Post-stroke pain
43
Q

What can be used to treat neuropathic pain?

A
  • Gabapentin
  • TCAs
  • Anticonvulsants
44
Q

What can be seen on examination in neuropathic pain?

A

changes in colour and sensation

45
Q

How long does pain have to persist for it to be deemed chronic?

A

12 weeks

46
Q

What is thought to be responsible for the neuroplasticity behind chronic pain?

A
  • Prolonged inflammatory response results in decreased pain threshold in primary afferents
  • Increased production of substance P and CGRP
  • Recruitment of NMDA receptors (wakes up WDR, wind up phenomenon)
  • Changes in gene and receptor expression in DRG and dorsal horn neurons
47
Q

What is the fear-avoidance model?

A
  • If patient is fearful of pain (something may be underlying it)
  • Patient will be more negatively affected by it and it will disable them more than an ordianry person
  • Constant negative - downward spiral
48
Q

What are the non-modifiable risk factors for chronic pain?

A
  • Female
  • Age
  • Genetic predisposition
  • lower socio-economic status
  • Occupational factors
  • History of abuse
  • Compensation
49
Q

What are the modifiable risk factors for chronic pain?

A
  • Past experience of pain (that site and others)
  • Anxiety and depression
  • Catastrophizing beliefs
  • Surgical approach
  • Attitude
  • Communication
50
Q

What are complex regional pain syndromes?

A
  • Severe continous neuropathic pain
  • Abnormal sensation
  • Vasomotor change
  • Sudomotor change
  • Motor / trophic change
  • Regionally restricted e.g. hand
  • Disproportionate to the trauma
51
Q

What can complex regional pain syndrome show on examination?

A
  • Brawny discolouration
  • Shiny skin
  • Cyanotic fingers
  • Brittle ridged fingernails
52
Q

What is the budapest criteria?

A

Diagnoses complex regional pain syndrome

  1. Patients must report continuing pain disproportionate to the trauma
  2. Patients must report at least one symptom in three of the four following categories (sensory hyperalgesia and/or allodynia, vasomotor, sudomotor oedema, motor/trophic weakness)
  3. Patients must display one sign in two of the categories above
  4. Signs and symptoms must not be better explained by another diagnosis

MD4001 Physiology (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions