Pain and Control Flashcards
What are the fives stages of response to terminal illness as demonstrated in the Kubler-Ross model?
1 denial 2 anger 3 bargaining 4 depression 5 acceptance
The Kubler-Ross death and dying model can be applied to most grief or depression including illness and injury, but which type of injury is it not as applicable to?
Athletic injury
What is the cognitive appraisal model?
Response to injury depends on individual’s understanding of the injury (no stages or order)
Is depression following injury common among athletes?
No (refer to cognitive appraisal model)
What is the most common use of therapeutic modalities?
Reduce pain levels
What is transduction?
Process of changing energy of nociception into electrical action potential in the neuron
Which proprioceptors detect change in muscle length and spindle tension?
Golgi tendon organs (GTOs)
Which mechanoreceptors also detect change in joint position?
Pacinian corpuscles
Which mechanoreceptors sense pressure and touch?
Meissner’s corpuscles
Which mechanoreceptors sense skin stretch and pressure?
Merkle cells
What two things determine the velocity of nerve transmission?
Diameter of the nerve and degree of myelination
What are the unmyelinated pain fibers? Myelinated?
Unmyelinated = C fibers Myelinated = A-delta
Which first order afferent fibers are associated with only touch and vibration and NOT pain?
A-beta
What is the relationship between nerve fiber diameter and speed?
Increased diameter = increased speed
Which type of fibers are the fastest?
A-beta (greater diameter)
Which are faster: C fibers or A-delta fibers?
A-delta (due to myelination and increased diameter)
What is the location of C fibers?
Muscle, skin
What is the location of A-beta and A-delta fibers?
Skin
Which fibers have warm and cold receptors and are found in hair follicles?
A-delta
What are the smallest peripheral nerve fibers associated with pain?
C fibers
Where does the first order neuron of the pain pathway synapse?
Dorsal horn of spinal cord
What are the most important parts of the thalamus for pain transmission?
VPL and VPM
Where are the cell bodies of the third order neurons in the path pathway located?
Thalamus
Where do ascending pain fibers from just the head and face synapse in the thalamus?
VPM
Where do ascending pain fibers from the body synapse in the thalamus?
VPL
Where does localization and discrimination of pain transmission occur in the cortex?
Postcentral gyrus
What area of the brain is important for regulating emotional, autonomic, and endocrine responses to pain?
Limbic system
Ice treatment is an example of what kind of pain modulation?
Peripheral pain modulation
How does peripheral pain modulation work?
Desensitizes peripheral nociceptors and increases threshold making fewer pain impulses transmitted to the spinal cord
What is the gate theory of pain?
Non-painful stimulus can block transmission of noxious stimulus
What specific location in the spinal cord acts as a “switch operator” in the gate theory?
Substantia gelatinosa
Which endogenous pain killer is present in the substantial gelatinosa?
Enkephalins
Why does shaking your hand after hitting it with a hammer help reduce your pain?
Stimulation of A-beta fibers to cause inhibitory interneurons to be stimulated to block pain transmission
Which modulation provides sensory feedback at a non painful level to stimulate A-beta fibers to reduce pain?
TENS
What specific location is targeted during motor pain modulation?
Reticular formation and pituitary gland
What are the types of central pain modulation?
Motor and noxious pain modulation
What specific location is targeted during noxious pain modulation?
Periaqueductal gray (PAG) and raphe nucleus
The descending endogenous opiate system (DEOS) is involved in which form pain modulation?
Motor (central) pain modulation
Cryotherapy stimulates what fibers in an effort for noxious pain modulation?
C fibers
What is another name for nerve block pain modulation?
Wedensky’s inhibition
What is Wedenski’s inhibition?
When stimulation encroaches on the refractory period of the sensory nerve and causes inhibition by continual stimulation
Which types of modalities are associated with nerve block pain modulation?
Russian stimulation, interferential current
What is exercise induced hypoalgesia?
Decreased pain sensation during physical activity
When was EIH first noticed?
During Civil War and WWI when solider felt less pain during battle than in safety of a hospital
What is the scientific reason behind exercise induced hypoalgesia?
Increased endogenous opioids (endorphins) and catecholamines (epinephrine and norepinephrine)
Why is EIH an important thing to consider with patients?
Patients who are athletes could be seriously injured by not feel the intensity of their pain during a game
Is EIH more prevalent with aerobic or anaerobic exercise?
Aerobic
What are the 3 components of neuromuscular control that should be addressed in a rehabilitation plan?
1 consciously controlled muscle contraction
2 reflex responses
3 complex movement patterns
How can a knee injury lead to muscle issues?
Stretch receptors in joint capsule with joint effusion send signals to CNS leading to reflex inhibition of VMO
