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OCTS 3704 > pain and anesthesiology > Flashcards

pain and anesthesiology Flashcards

1
Q

define pain

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or describes in terms of such damage

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2
Q

characteristics of pain

A
  • body’s warning system
  • protects body from tissue damage
  • perception is necessary for survival (but when it becomes maladaptive and outlasts its physiological usefulness it is pathological and becomes not just a symptom of disease/ trauma but a disease entity itself
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3
Q

what factors contribute to pain severity?

A

pathological mechanisms
- inflammation
- central or peripheral sensitization
History/ social
- Previous pain experiences
- Reaction to pain by significant other
Cognitive factors
- Interpretation of nociception
- Coping style
Emotional factors
- Fear of pain
- Degree of anxiety

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4
Q

The difference between nociception and pain

A

Nociception
- is a function of a specific sensory system
- This system is a warning system with an adequate stimulus
- Noxious stimulus threatens or damages normal tissue
- Nociception is modulated at spinal cord level and interpreted by higher cortical structures; resulting in discomfort and perception of pain
- third-person perspective
- stimulus related
- sensory discrimination
Pain
- is the result of network activity in the brain when nociception is modulated at spinal cord level and interpreted by higher cortical structures
- first-person perspective
- perception related
- suffering

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5
Q

describe nociceptive pain

A
  • Pathological process in peripheral organ/tissue
  • Pain projection into damaged body part or referred pain
  • Pain caused by activation of nociceptive afferent fibres
  • Also termed inflammatory pain because peripheral inflammation and inflammation mediators plays a major role in initiation and amplification
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6
Q

what is pain interpretation?

A

Pain perception is the final product of a complex information processing network and requires modulation from the cerebral cortex
Whether stimuli is perceived as painful depends on:
- Nature of stimuli
- Context in which it is experienced
- Individual’s memories and emotions

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7
Q

Classification of pain

A

Neuropathic pain
- Pain initiated or caused by a primary lesion or dysfunction in the peripheral or central nervous system
- Pathological process in the somatosensory system
- Pain projection into innervation territory
Complex regional pain syndrome
- Chronic arm or leg pain developing after injury, surgery, stroke or heart attack
- Cause is not well understood but may involve abnormal inflammation or nerve dysfunction
- It is complex neuropathic pain that follows soft-tissue or bone injury (type I) or nerve injury (type II) and lasts longer and is more severe than expected for the original tissue damage
Acute pain
- Somatic
o Transmitted via sensory fibres; discrete and intense
o Muscles, tendons, periostium, skin
- Visceral
o Transmitted via sympathetic fibres; diffuse poorly localised
o Organs and peritoneum
- Referred
o Pain perception in one part of the body that I actually caused in a different site
 Angina radiating into the neck and left arm

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8
Q

what are the causes of neuropathic pain?

A

o Metabolism
 DM
 Beri-Beri
o Infections
 Post herpetic neuralgia
 HIV
 Guillian-Barre
o Toxicity
 Alcohol
 Chemotherapy
 Radiotherapy
o Trauma
 SCI
 Post surgery
o Multiple sclerosis, Syringomylenia, Post-Stroke pain

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9
Q

acute vs chronic pain

A
  • Chronic: a disease entity on its own
  • Disease with own aetiology, signs and symptoms
  • Bio-psycho-social phenomenon
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10
Q

3 central questions to guide ax of pain

A
  • What is the extent of the patient’s disease and physical impairment?
  • To what extent is the patient’s disease impeding on usual activities?
  • To what extent is the patient’s behaviour appropriate to the disease or injury?
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11
Q

what does a brief psychosocial screening during interview entail?

A
  • Activities: how is the pain affecting you sleep/appetite/relationships?
  • Coping: how do you cope/deal? What makes it better?
  • Think: do you think your pain will get better?
  • Upset: have you been anxious/depressed?
  • People: how do people respond when you have pain?
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12
Q

what is chronic pain?

A

Traditionally pain lasting longer than 3 months
Persistent pain or pain that outlasts its physiological value
Persists beyond course of an acute disease or after a reasonable time for injury to heal
Bio-psycho-social problem

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13
Q

define hyperalgesia

A
  • Increased response to a normally painful stimulus
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14
Q

define hyperaesthesia

A
  • Increased sensitivity to stimulation
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15
Q

define allodynia

A
  • Perception of a non-noxious stimuli as painful
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16
Q

define neural plasticity

A
  • Property of the CNS and PNS that enables modification of function according to the alterations in conditions
17
Q

define deafferentitation

A
  • Elimination or interruption of afferent nerve impulses to the spinal cord by destruction of the afferent pathway
18
Q

define hyperpathia

A
  • Pain elicited by noxious stimuli that is delayed in onset and outlasts the stimulus duration and spreads beyond the site of the stimulus
19
Q

define neuralgia

A
  • Pain in the distribution of nerve(s)
20
Q

define neuroma

A
  • Peripheral nerve damage that initiates axon regeneration creating an area of hyperexcitability
21
Q

How do we sense pain?

A
  • In peripheral tissue, when (mechanical) damage occurs [stimulus] it’s transformed into electrical signal [transduction]
  • This electrical signal is then carried up the nerve [transmission] to the CNS which starts at SC and goes to brain
  • In brain we have perception of stimulus which is the emotional and sensory perception we have. Anything that goes together with the tissue damage, which can include tastes and smells we associate with it based on previous experiences
22
Q

How brain contributes to pain

A
  • Concurrent changes in brain
    o Previously mentioned areas in the pain matrix
     Maladaptive pain coping ability including substance abuse
     Depression
     anxiety
23
Q

Name substances involved in inflammatory soup

A
  • Helps nerves become more sensitive to dangerous stimuli
  • Excites nerves to let you know that there is danger ahead
  • Histamine
  • Serotonin
  • Bradykinin
  • Adenosine-5-triphosphate
  • Prostaglandin E2
  • Sodium
  • Potassium
  • Hydrogen
  • Pro-inflammatory cytokines
    o IL-1B
    o IL-6
    o Nerve growth factor
    o TNF-a
  • ‘neurogenic inflammation’/ ‘dorsal root reflex’
    o Substance P
    o Calcitonin gene-related peptide
    o Neurokinin A
    o Nitric Oxide
24
Q

How SC can adapt to constant nociceptive stimuli and modulation of pain

A
  • Inhibitory mechanisms that might immediately try to supress nociceptive stimulus from reaching the brain. This may be a protective response to stop one from overreacting to a small stimuli
    o GABA
    o Glycine
    o Descending inhibitory pathways from the brain by supressing signal transmission from SC to brain
    o Endogenous opioids
    o Higher order brain functions
25
Q

How patient’s physiological and social milieu can contribute to transition from acute pain to chronic pain

A
  • At initial injury the person has acute pain which is intense but short lived
  • Shortly thereafter if constant stimulus persists a lower level of intensity but with longer duration of pain called background pain may come about
  • The grater the amount of total pain the greater the chances of developing chronic pain
    Physiological
26
Q

Psychosocial contributors to the transition to chronic pain

A

Patient factors
- Psychological vulnerability
- Anxiety
- Depression
- Female
- Younger adult
- Workman’s compensation
- Genetic
- Past experiences
- Social environment
- Smoker
- Poor mobility/ limb guarding
Medical/surgical factors:
- Previous moderate to severe pain
- Reoperation
- Radiotherapy/ chemotherapy
- Nerve damage
- Extensive tissue damage
- Stroke
- Central or peripheral neurological disease
o Guillain-Barre
- Long operations (>3 hours)
- Duration of analgesia
- Surgical technique
- Type of operation
o Mastectomy
o Hernia repair
o Amputation
o Caesarean section
o thoracotomy

OCTS 3704 (5 decks)

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