Pain Exam 3

Question 1

Three portions of the nervous system are responsible for the sensation and perception of pain:

One is:

________ pathways – begin in the peripheral nervous system and travel to the spinal gate in the dorsal horn and then ascend to the centers in the central nervous system

Answer 1

Afferent

Question 2

Three portions of the nervous system are responsible for the sensation and perception of pain:

One is:

____________ centers – located in the brain stem, midbrain, diencephalon and cerebral cortex

Answer 2

Interpretive

Question 3

Three portions of the nervous system are responsible for the sensation and perception of pain:

One is:

________ pathways – descend from the central nervous system back to the dorsal horn of the spinal cord

Answer 3

Efferent

Question 4

Pain transduction begins when tissue is _______ by exposure to chemical, mechanical or thermal noxious stimuli

______ fibers – rapidly transmit sharp, localized “fast” pain sensation – elicit the reflex withdrawal

__ fibers – slowly transmit dull, aching or burning sensations

Answer 4

damaged

A-delta

C fibers

Question 5

All A-fibers are myelinated and the fastest

A-alpha (A-a): _______ A Fibers
A-delta: Smallest A fibers
C-fibers are unmyleniated fibers and are the ______

Answer 5

Largest

Smallest

Slowest

Question 6

Pain ____________ is the conduction of pain impulses along the A-delta and C fibers into the dorsal horn and the spinal cord

Answer 6

transmission

Question 7

Pain __________ is the conscious awareness of pain (occurs in the reticular and limbic systems and the cerebral cortex)

Answer 7

perception

Question 8

Pain __________ involves many different mechanisms that increase or decrease the transmission of pain signals throughout the nervous system

Answer 8

modulation

Question 9

Neuromodulators of pain include substances that

1. Stimulate pain nociceptors (excitatory neuromodulators)
   - Prostaglandins, bradykinins, lymphokines, substance P, glutamate, histamine

Suppress pain (inhibitory neuromodulators)

• GABA, endorphins
• Some substances excite peripheral nerves but inhibit central nerves: serotonin, norepinephrine

Answer 9

P

histamine

serotonin

Question 10

There are three Types of Acute Pain:

One is:

_______ pain – superficial, arising from the skin- described as sharp, dull, aching or throbbing (well localized) (can be associated with nausea, vomiting and shock)

Answer 10

Somatic

Question 11

There are three Types of Acute Pain:

One is:

________ pain – occurs in the organs, abdomen, or skeleton; radiating pain (poorly localized)

Answer 11

Visceral

Question 12

________ pain – pain felt in an area removed or distant from its point of origin (can be acute or chronic)

Answer 12

Referred

Question 13

Considered the thermostat center of the body

Answer 13

Hypothalamus

Question 14

A significant rise in body temperature
Sweating is a compensatory mechanism
Temp > 37.6 C

Answer 14

Hyperthermia

Question 15

Accidental or therapeutic decrease in body temperature below normal range.

Shivering and vasoconstriction occur

Leads to reduced perfusion, reduced blood flow and coagulation

Answer 15

Hypothermia

Question 16

results from prolonged high core or environmental temperatures

Answer 16

Heat Exhaustion

Question 17

A potentially lethal result of an overstressed thermoregulatory center

Can be caused by exertion and overexposure

Answer 17

Heat Stroke

Question 18

Newborns produce heat through non shivering thermogenesis which is accomplished through the metabolism of brown fat

Heat loss controlled by
Drying infant
skin to skin

CM
Crying restlessness
Skin feels cool
Acrocyanosis may be present (Blue hands and feet)

Answer 18

Newborn Thermoregulation

Question 19

Paint theories

___________ theory of pain (Descartes) – there are
specific pain receptors in the body that project to the
brain and that the intensity of pain is directly related
to the amount of associated tissue injury

_______ Theory – describes the role of impulse intensity and the repatterning of the central nervoussystem

___________ Theory – proposes that the brainproduces patterns of nerve impulses drawn fromvarious inputs, including genetic, psychologic andcognitive experiences

____ Control Theory – pain transmission is
modulated by a balance of impulses conducted to the
spinal cord

Answer 19

Specificity

Pattern

Neuromatrix

Gate

Question 20

_____ pain - protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body and immobilizes the individual to take prompt action to relieve it

– Somatic pain – superficial, arising from the skin- described as sharp, dull, aching or throbbing (well localized) (can be associated with nausea, vomiting and shock)

– Visceral pain – occurs in the organs, abdomen, or skeleton; radiating pain (poorly localized)

– Referred pain – pain felt in an area removed

Answer 20

Acute Pain

Question 21

______ pain – pain lasting for more than 12
weeks; well beyond the expected normal
healing time

– Sciatica – low back pain along the distribution of a lumbar nerve root

Answer 21

Chronic

Question 22

_______ pain – pain experiences in an
amputated limb after the stump has completely healed

• Stump pain
– Acute nociceptive pain at site of amputation

• Phantom sensations
– Feelings other than pain in missing body part

• Telescoping
– Sensation that distal part of missing limb is gradually approaching limb stump

• Phantom limb pain
– Pain perceived as

Answer 22

Phantom

Question 23

______ ____pain - In sickle cell anemia the sickled erythrocytes tend to plug the blood vessels, increasing the viscosity of the blood

Answer 23

Sickle Cell

Question 24

______ pain - Cancer-associated pain can arise from a variety of direct and indirect mechanisms
– Direct pressure, obstruction, invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection and inflammation all cause pain

– Pain can occur at the site of the primary tumor or at a distant metastatic lesion

Answer 24

Caner Pain

Question 25

________ – headache that usually begins in the temporal region unilaterally after vascular changes of cranial arteries and may cause irritability, nausea, vomiting, constipation or diarrhea and photophobia
Chronic/Genetic/Triggers - dietary

_______ - is a common neurologic disorder
and is usually a benign symptom

Answer 25

Migraine

Headache

Question 26

Chronic musculoskeletal syndrome
characterized by diffuse pain, fatigue,
increased sensitivity to touch, the abence of
systemic or localized inflammation,
nonrestorative sleep, anxiety and depression

Answer 26

Fibromyalgia