Pain, documentation, disablement

Question 1

substance P

Answer 1

transmission of pain- producing impulses, makes things less comfortable

Question 2

acetylcholine

Answer 2

responsible for transmitting motor nerve impulses. PNS and CNS

Question 3

norepinephrine

Answer 3

causes vasoconstriction, underlies “fight or flight” response

Question 4

enkephalins

Answer 4

reduce pain perception by bonding to pain receptors

Question 5

endorphins

Answer 5

morphine-like neurohormone, thought to increase pain threshold by bonding to pain receptors

Question 6

serotonin

Answer 6

substance that causes local vasodilation and increase permeability of capillaries

Question 7

afferent pathways

Answer 7

first order neuron
second order neuron
third order neuron

Question 8

first order neuron

Answer 8

connects to periphral sensory receptor and projects info to DGR in spinal cord
-Aα=fastest, thick myelin, muscle spindle, GTO
-Aβ=fast, thick myelin, light touch, vibration, hair deflection
large diameter afferent
-Aδ=slow, thin myelin, sharp pain, touch, temp, pressure
-C=slowest, no myelin, dull and diffuse pain, touch, intense pressure, extreme temp
small diameter

Question 9

second order neuron

Answer 9

cell body located in DGR, crosses midline and ascends to the thalamus

Question 10

third order neuron

Answer 10

cell boy in the thalamus

Question 11

nociceptors

Answer 11

nerve endings that are sensitive to painful stimuli

• Aδ and C fibers
• noxious pain

Question 12

superficial sensory receptors

Answer 12

1. mechanoreceptors: pressure, skin, stretch, and touch. meissner’s & pascinian corpuscles
2. thermoreceptors: hold and cold receptors
3. nociceptors: free nerve endings, pain

Question 13

deep sensory receptors

Answer 13

1. proprioceptors: (GTO, muscle spindles) changes in muscle length, joint position and vibration, joint end range
2. nociceptors: free nerve endings, pain
3. mechanoreceptors: change in muscle length and tension, ligamentous deformation

Question 14

paleospinothalamic tract

Answer 14

• carries “slow pain”

- order of transmission: nociceptor, first order neuron (c fiber) to laminae II & III

Question 15

neospinothalamic tract

Answer 15

• carries “fast pain”

- nociceptor (skin, soft tissue, periosteum), first order neuron (Aδ) to DGR

Question 16

thalamus

Answer 16

area of the brain where pain is first identified and sorted

Question 17

pain perception is influenced by…

Answer 17

physical, chemical, social, psychological

Question 18

pain control theories

Answer 18

1. gate control theory
2. central biasing theory
3. endogenous opiates theory

Question 19

gate control theory

Answer 19

• considered ascending pain control mechanism
• what do you do when your elbow hurts?
• located in dorsal horn
• activate more Aβ fibers= more active, gate closes
• C fibers more active, gate opens (more pain is felt)

Question 20

descending pain modulation

Answer 20

transmit impulses from the brain

- release of enkephalins and serotonin inhibit ascending neurons

Question 21

periaqueductal gray (PAG)

Answer 21

receives input from the cortex, projects to rap he nucleus and activates neurons, then to the DRG and releases endogenous opiate called enkephalin

Question 22

raphe nucleus

Answer 22

brainstem, releases serotonin to rest of the brain

Question 23

central biasing theory

Answer 23

descending neurons are activated, causes release of enkephalins and serotonin to inhibit pain

Question 24

endogenous opiates theory

Answer 24

release of enkephalins from pituitary gland into spinal fluid
- block ascending nerve impulses

Question 25

local & referred pain

Answer 25

local: made worse with palpation, affected by mechanical changes referred: non-specific, diffuse, unknown origin, not made worse with palpation radicular: compression on nerve root

Question 26

objective pain assessment

Answer 26

- visual analog scale - pain disability index - mcGill pain questionnaire - pain body diagram

Question 27

subjective outcomes

Answer 27

how are you?

Question 28

nagi's disablement model

Answer 28

``` active pathology impairment functional limitation disability quality of life ```

Question 29

active pathology

Answer 29

injury or illness

Question 30

impairment

Answer 30

abnormality at the site of injury. | loss, reduced capacity, or altered state of ability. limited ROM, atrophy

Question 31

functional limitations

Answer 31

limitations in actions | EX: sitting, walking, stair climbing, running, cutting, throwing

Question 32

disability

Answer 32

limitations in activities | EX: doing my job, going shopping, taking the dog for a walk, playing a sport

Question 33

quality of life

Answer 33

factors that contribute to the goodness or fulfillment of life EX: emotional well-being, social support