Pain and Psychology Q's for assessment Flashcards
define Pain
unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’.
- Output from the brain, not an input
define Acute pain
Short term, happens immediately
(burns, chemical, allergic reaction, trauma)
define Chronic pain
Long term
( Dementia, cancer, lupis)
define Nociceptive pain
- Pain that arises from actual or threatened damage to non-neural tissue
- This is due to the activation of nociceptors
define Nociplastic pain
- Pain that Aries from altered nociception despite no clear evidence of actual or threatened tissue damage
- This causes the activation of peripheral nociceptors or evidence for disease or lesion (abnormal tissue) of the somatosensory system (network of neurones allowing motor movements) causing the pain
define Neuropathic pain
- Pain caused by abnormal tissue or disease of the somatosensory nervous system
define Noxious stimuli
- is a stimulus that is damaging or threatens damage to normal tissue
define Transduction
-stimulus, detection of pain and start of action potential
- this begins with the free nerve endings of C fibres and A-delta fibres of primary afferent neurones respond to noxious stimuli
define Transmission
- Involves movement of the pain sensation to the spinal cord
- Happens in 3 stage =
- Nociceptive signal is transmitted from the site of transduction along the first order neuron to the dorsal horn in the spinal cord
- Along the second order neuron in the spinal cord to the brain stem
- Then to the thalamus where the second order neuron links to the third order neuron, carrying the message to the somatosensory cortex and higher levels of the brain
define Perception
- you brain, chooses what is best for your survival in that moment, whether you feel pain straight away or not
define Modulation
- Modulation occurs when neurones In the brain send signals back down the spinal cord by release of neurotransmitters
- Descending inhibition involves the release of inhibitory neurotransmitters that block or partially block the transmission of pain impulses, and therefore produce analgesia
define Nociception
The sensory nervous system’s process of encoding noxious stimuli (mechanical, thermal and chemical
define Nociceptor
sensory receptors that detect signals from damaged tissue or the threat of damage and indirectly also respond to chemicals released from the damaged tissue
define Allodynia
pain due to a stimulus that does not normally provoke pain
define Primary hyperalgesia
increased responsiveness to both heat and mechanical stimulation in the area of injury.
define Secondary hyperalgesia
an increase in pain sensitivity when a noxious stimulus is delivered to a region surrounding, but not including, the zone of injury
define Free nerve endings
the most abundant type of nerve endings. They lie near blood vessels between epithelial layers of the skin, quick conduction
two types of nerves that act as nociceptors and describe each of these in a single
sentence
- A-Delta neurone, they are myelinated and have free nerve endings.
- C neurone, not myelinated, have free nerve endings, slower conduction
List the three possible types of noxious stimuli
- Mechanical
- Chemical
- Thermal
List the elements of the nervous system involved in the transmission and modulation of
nociception
- Dorsal horn of spinal cord
- First, second and third order neurone
- Thalamus
- Somatosensory cortex
- Inhibitory neurotransmitters
- A-Delta neurones
describe how nociception and pain is experienced
- Transduction= Tissue damage causes release of substances that stimulate the nociceptors and initiate the sensation of pain
- Transmission involves movement of the pain sensation to the spinal cord
- Perception occurs when impulses reach the brain and the pain is recognised
- Modulation occurs when neurones in the brain send signals back down the spinal cord by release of neurotransmitters
List the biological, sociological and psychological factors involved in our perception of pain
Biological
- Changes in brain regions
- Genetic factors
Sociological
-Greater social support has been associated with lower levels of pain intensity in response to painful experimental stimuli
Psychological
-marital status, social support, bereavement, home and work environment, social status, and social integration
List and, in a sentence each, describe the physiological changes that produce peripheral
sensitization
Peripheral sensitization is an increased sensitivity to an afferent nerve stimulus.
- Increased excitability = Repeat stimulation causes increase resting potential in neurone, cause hyperalgesia
- Stimulation of ‘silent neurones’ = Inflammatory mediators activate silent neurones, not normally receptive to mechanical stimuli, cause allodynia
- Upregulation of gates = Gates held open
List and, in a sentence each, describe the physiological changes that produce central
sensitization
- Changes in the dorsal horn of the spinal cord and in the brain occur, particularly at the cellular level, such as at receptor sites.
- A-Beta neurone types detection (detect touch, pressure, vibration, stretch of muscle)
- Early phase = windup and opening of NMDA channels
-Normally blocked by magnesium plug
Magnesium plug removed due to wind up
Results in hyperalgesia
If A-Beta fibre connects to same 2nd order neuron then could result in allodynia
(More gates open so 2nd order neuron more easily stimulated)
-Aims to prevent further damage to tissue
Will go away if peripheral stimulation stops
describe the physiological changes of neuropathic pain
Nerve ending destroyed so open to ions therefore constantly depolarizing (ectopic action)
- sensory loss and numbness paresthesias, spontaneous pain, increased sensation of pain
- No clear cause of pain
List the clinical features/presentation associated with nociceptive pain
- Small area of pain
- Easily demarcated
- Clear aggs and eases
List the clinical features/presentation associated with nociplastic pain
- Widespread pain
- Difficult to demarcate
- Less clear aggs and eases, more consistent pain
- Allodynia
- Secondary hyperalgesia
