Pain and Psychology Q's for assessment

Question 1

define Pain

Answer 1

unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’.
- Output from the brain, not an input

Question 2

define Acute pain

Answer 2

Short term, happens immediately
(burns, chemical, allergic reaction, trauma)

Question 3

define Chronic pain

Answer 3

Long term
( Dementia, cancer, lupis)

Question 4

define Nociceptive pain

Answer 4

• Pain that arises from actual or threatened damage to non-neural tissue
• This is due to the activation of nociceptors

Question 5

define Nociplastic pain

Answer 5

• 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

Question 6

define Neuropathic pain

Answer 6

• Pain caused by abnormal tissue or disease of the somatosensory nervous system

Question 7

define Noxious stimuli

Answer 7

• is a stimulus that is damaging or threatens damage to normal tissue

Question 8

define Transduction

Answer 8

-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

Question 9

define Transmission

Answer 9

• Involves movement of the pain sensation to the spinal cord
• Happens in 3 stage =

1. Nociceptive signal is transmitted from the site of transduction along the first order neuron to the dorsal horn in the spinal cord
2. Along the second order neuron in the spinal cord to the brain stem
3. 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

Question 10

define Perception

Answer 10

• you brain, chooses what is best for your survival in that moment, whether you feel pain straight away or not

Question 11

define Modulation

Answer 11

• 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

Question 12

define Nociception

Answer 12

The sensory nervous system’s process of encoding noxious stimuli (mechanical, thermal and chemical

Question 13

define Nociceptor

Answer 13

sensory receptors that detect signals from damaged tissue or the threat of damage and indirectly also respond to chemicals released from the damaged tissue

Question 14

define Allodynia

Answer 14

pain due to a stimulus that does not normally provoke pain

Question 15

define Primary hyperalgesia

Answer 15

increased responsiveness to both heat and mechanical stimulation in the area of injury.

Question 16

define Secondary hyperalgesia

Answer 16

an increase in pain sensitivity when a noxious stimulus is delivered to a region surrounding, but not including, the zone of injury

Question 17

define Free nerve endings

Answer 17

the most abundant type of nerve endings. They lie near blood vessels between epithelial layers of the skin, quick conduction

Question 18

two types of nerves that act as nociceptors and describe each of these in a single
sentence

Answer 18

• A-Delta neurone, they are myelinated and have free nerve endings.
• C neurone, not myelinated, have free nerve endings, slower conduction

Question 19

List the three possible types of noxious stimuli

Answer 19

• Mechanical
• Chemical
• Thermal

Question 20

List the elements of the nervous system involved in the transmission and modulation of
nociception

Answer 20

• Dorsal horn of spinal cord
• First, second and third order neurone
• Thalamus
• Somatosensory cortex
• Inhibitory neurotransmitters
• A-Delta neurones

Question 21

describe how nociception and pain is experienced

Answer 21

• 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

Question 22

List the biological, sociological and psychological factors involved in our perception of pain

Answer 22

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

Question 23

List and, in a sentence each, describe the physiological changes that produce peripheral
sensitization

Answer 23

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

Question 24

List and, in a sentence each, describe the physiological changes that produce central
sensitization

Answer 24

• 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

Question 25

describe the physiological changes of neuropathic pain

Answer 25

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

Question 26

List the clinical features/presentation associated with nociceptive pain

Answer 26

• Small area of pain
• Easily demarcated
• Clear aggs and eases

Question 27

List the clinical features/presentation associated with nociplastic pain

Answer 27

• Widespread pain
• Difficult to demarcate
• Less clear aggs and eases, more consistent pain
• Allodynia
• Secondary hyperalgesia