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After the MSA > 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 described in terms of such damage

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2
Q

Immediate pain

A

A delta fibres

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3
Q

Persisting pain

A

C fibres

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4
Q

How do we perceive pain?

A
  • Primary afferent comes from the periphery through the dorsal horn and terminates in spinal cord
  • It synapses and the second order neurone projects to the thalamus
  • 3rd order neurone projects to the somatosensory cortex
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5
Q

What are the differences between a delta fibres and c fibres?

A
  • A delta fibres are myelinated, C fibres are unmyelinated
  • A delta = sharp, localised pain, C= dull throbbing diffuse pain
  • A delta = minority of nociceptor, c= majority
  • A delta= fast conduction (6-30m/s), C= slow conduction (0.5-2m/s)
  • A delta are not usually visceral
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6
Q

What is transduction?

A

• Conversion of a noxious stimulus (heat, mechanical, chemical) into an action potential in a nociceptor

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7
Q

What is primary hyperalgesia?

A

Recruitment of sleeping c fibres

An area that has been damaged is more tender e.g. pressing on a bruise

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8
Q

Describe transmission

A
  • Between 1st and 2nd order neurones
  • No single excitatory substance ( GABA- main, substance P, CGRP)
  • No single pain receptor but glutamate binds to AMPA, NMDA, G protein coupled receptors
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9
Q

Where is the main side of modulation of pain?

A

At the dorsal horns

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10
Q

What are the 3 mechanisms of descending inhibition?

A
  • GABA and glycinergic interactions
  • Descending inhibiton PAG- rostral ventral medulla
  • Endogenous opioids are released and act at the dorsal horn
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11
Q

What is gate control theory?

A
  • Action potentials acting on AB fibres inhibit the A delta pain fibres reducing pain
  • Presynaptic pain inhibition produced by mechanical stimulation
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12
Q

What is the pain matrix?

A 
There are two aspects:
• Earliest response 
- spinal cord
- thalamus 
- somatosensory cortex
• Fine distinction, inter individual variation 
- spinal cord
- brainstem PAG
- amygdala and hippocampus 
- prefrontal cortex 
- insula 
- cingulate cortex
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13
Q

Describe perception of pain

A
  • The end result where the neuronal activity becomes a conscious experience
  • Past experience, current situations, understanding all modulate
  • Reticular system elicits an autonomic response
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14
Q

What links the perception of pain with mood

A

The limbic system

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15
Q

Describe visceral pain

A
  • Visceral nociceptors respond to distension or ischaemia
  • Visceral primary afferents will activate multiple second order neurones
  • Pain is more diffuse
  • converge on second order neurones with somatic input
  • Referred pain (convergence)
  • Mostly C fibres
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16
Q

Describe prevention and preparation strategies for pain

A

• Anticipation and simple adjustments e.g. ice
• Distraction
• Education
• Challenge misconceptions
• RE-branding
- ‘pain should be too strong a word, you will be tender’
- patient control: ‘raise your hand if you want me to stop

17
Q

Step 1 pain ladder

A

• Simple analgesic

other medications for neuropathic pain

18
Q

Step 2 pain ladder

A

• Use a mild opioid e.g. codeine, tramadol
• Continue simple analgesic
(other medication for neuropathic pain)

19
Q

Step 3 pain ladder

A

• Use a strong opioid e.g. morphine
• Continue simple analgesic
(other medication for neuropathic pain)

20
Q

What is neuropathic pain?

A

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

21
Q

allodynia

A

Pain on light touch

22
Q

What are the causes of neuropathic pain

A
  • Trauma
  • Diabetic neuropathy
  • Postherpetic neuralgia
  • Trigeminal neuralgia
  • Post stroke pain
23
Q

Paraesthesia

A

An abnormal sensation spontaneous or evoked

24
Q

Dysaesthesia

A

An unpleasant abnormal sensation spontaneous or evoked

25
Q

Alllodynia

A

Pain due to a stimulus that does not normally provoke pain

26
Q

Hyperalgesia

A

Increased pain from a stimulus that normally provokes pain

27
Q

Hyperpathia

A

A painful syndrome characterised by an abnormally painful reaction to a stimulus, especially a repetitive stimulus as well as an increased threshold

28
Q

Neuralgia

A

Pain in the anatomical distribution of a nerve or nerves

After the MSA (22 decks)

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