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SUM'20 - Regional > Pain Guide - Regional > Flashcards

Pain Guide - Regional Flashcards

1
Q

The most common symptom that brings patients to see a physician is _________.

A

pain

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2
Q

Pain is almost always a manifestation of a___________ ___________.

A

pathological process

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3
Q

In a general sense, pain management applies to the entire discipline of _________________.

A

anesthesiology

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4
Q

In a modern sense, pain management involves management of both _____________ and ____________ pain in both inpatient and outpatient settings.

A

perioperative, nonsurgical

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5
Q

What two domains can pain management be broken into?

A

Acute and Chronic

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6
Q

In what two ways is the sensation of pain often described?

A

Protopathic (Noxious) and Epicritic (Non-noxious)

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7
Q

Epicritic Sensations are ….

A

light touches, pressure, proprioception and temperature discriminations

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8
Q

Protopathic Sensations are…

A
  1. pain
  2. Detected by high-threshold receptors
  3. Conducted by smaller, lightly myelinated (alpha-delta) and unmyelinated (C) nerve fibers.
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9
Q

Pain

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms as such damage.

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10
Q

Pain Classifications that Drive Course of Treatment are …

A
  1. Pathophysiology (nociceptive or neuropathic)
  2. Etiology (arthritis or cancer)
  3. Affected Area (headache or lower back)
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11
Q

Term used to describe neural responses to traumatic or noxious stimuli are …

A

Nociception (All nociception produces pain but not all pain results from nociception).

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12
Q

Nociceptive pain is caused by …

A

activation or sensitization of peripheral nociceptors that transduce noxious stimuli.

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13
Q

Neuropathic pain is a result of …

A

injury or acquired abnormalities of peripheral or central neural structures.

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14
Q

Pain Perception is related to ….

A

gender and age (May decrease with age and may disappear entirely after the age of 40.)

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15
Q

Epicritic Sensations are characterized by

A

low-threshold receptors

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16
Q

Epicritic Sensations are generally conducted by …

A

large myelinated nerve fibers

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17
Q

Protopathic Sensations are detected by …

A

high-threshold receptors

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18
Q

Protopathic Sensations are conducted by …

A

smaller, lightly myelinated (alpha-delta) and unmyelinated (C) nerve fibers.

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19
Q

Acute pain is caused by …

A
  1. noxious stimulation due to injury
  2. a disease process
  3. abnormal function of muscle or viscera
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20
Q

Acute pain is usually …

A

nociceptive, which serves to detect, localize and limit tissue damage.

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21
Q

The 4 physiological processes involved in acute pain are…

A
  1. Transduction (time)
  2. Modulation (makes)
  3. Perception (pain)
  4. Transmission (temporary)
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22
Q

Somatic pain may be …..

A

superficial or deep

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23
Q

Superficial somatic pain is due to …

A

nociceptive input arising from skin, subcutaneous tissue, and mucous membranes.

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24
Q

Superficial somatic pain is characterized by …

A

well localized, sharp, pricking, throbbing, or burning sensations.

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25
Q

Deep somatic pain arises from …

A

muscles, tendons, joints, or bones.

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26
Q

Deep somatic pain is characterized by …

A

dull, aching, less localized pain.

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27
Q

Visceral pain is due to …

A
  1. disease process

2. abnormal function involving an internal organ or its covering (parietal pleura, pericardium, or peritoneum)

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28
Q

The 4 sub-types of visceral pain are …

A
  1. Localized visceral pain (dull, diffuse,usually mid-line causing sweating and changes to blood pressure and heart rate)
  2. Localized parietal pain (sharp, stabbing, usually localized around organ)
  3. Referred visceral pain
  4. Referred parietal pain
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29
Q

When pain fails to resolve because of abnormal healing or inadequate treatment, it becomes ….

A

chronic pain.

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30
Q

Chronic pain is defined as ….

A
  1. pain that persists beyond the usual course of an acute disease
  2. pain that persists after a reasonable time for healing to occur (1-6 months)
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31
Q

A distinguishing factor of chronic pain is that …

A

psychological mechanisms and environmental factors frequently play a major role.

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32
Q

A pain pathway is …

A

the transmission of pain from periphery to cerebral cortex.

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33
Q

Where can cell bodies of primary afferent neurons be found?

A

Within the dorsal root ganglia of the spinal cord.

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34
Q

First order neurons synapse with …..

A

second order neurons.

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35
Q

First order neurons synapse with second order neurons in the …

A

ipsilateral dorsal horn of the spinal cord.

36
Q

Third order neurons send signals to …

A

the cerebral cortex.

37
Q

Second order neurons synapse with …

A

third order neurons.

38
Q

Second order neurons synapse with third order neurons in the …

A

thalamus.

39
Q

After first order neurons synapse with second order neurons in the ipsilateral dorsal horn of the spinal cord, they…

A

cross mid-line and ascend in the contralateral spinothalamic tract to reach the thalamus.

40
Q

The majority of first order neurons send what end of their axons into the spinal cord?

A

proximal

41
Q

The majority of first order neurons send their axons into the spinal cord via the gray matter of the ipsilateral dorsal root at which levels?

A
  1. cervical
  2. thoracic
  3. lumbar
  4. sacral
42
Q

First order neurons also synapse with …

A
  1. Interneurons
  2. Sympathetic neurons
  3. Ventral Horn motor neurons
43
Q

Pain fibers may ascend or descend one to three spinal segments in _________ _________ before synapsing with second order neurons.

A

Lissauer’s Tract

44
Q

Second order neurons are either …

A
  1. Nociceptive -specific neurons

2. Wide dynamic range (WDR) neurons

45
Q

Nociceptive -specific neurons serve only …

A

noxious stimuli.

46
Q

WDR (wide dynamic range neurons) receive …

A

noxious and non-noxious input.

47
Q

Axons of second order neurons cross mid-line to which side of the spinal cord?

A

contralateral side

48
Q

Axons of second order neurons terminate in the ….

A

spinothalamic tract.

49
Q

Axons of second order neurons send their fibers to these regions of the brain…

A
  1. the thalamus
  2. reticular formation
  3. nucleus raphe magnus
  4. periaqueductal gray
50
Q

What is classically considered to be the major pain pathway?

A

the Spinothalamic Tract

51
Q

The Spinothalamic tract lies …

A

anterolaterally in the white matter of the spinal cord.

52
Q

Is the Spinothalamic tract an ascending or descending tract?

A

ascending

53
Q

The Spinothalamic tract can be divided into the …

A
  1. Lateral Spinothalamic Tract (Neospinothalamic)

2. Medial Spinothalamic Tract (Paleospinothalamic)

54
Q

The Lateral Spinothalamic Tract carries …

A

discriminative aspects of pain such as location, intensity and duration.

55
Q

The Lateral Spinothalamic Tract projects mainly …

A

to the ventral posterolateral nucleus of the thalamus.

56
Q

The Medial Spinothalamic Tract projects to …

A

the medial thalamus.

57
Q

The Medial Spinothalamic Tract is responsible for …

A

mediating the autonomic and unpleasant emotional perceptions of pain.

58
Q

Other than the Spinothalamic Tract, what are alternative pain pathways?

A
  1. Spinoreticular Tract
  2. Spino-Mesencephalic Tract
  3. Spinohypothalamic and Spinotelencephalic Tracts
  4. Spinocervical Tract
  5. Certain pain responsive fibers in the dorsal columns.
59
Q

Which pain pathway mediates arousal and autonomic response to pain?

A

Spinoreticular Tract

60
Q

Which pain pathway may be important in activating anti-nociceptive descending pathways?

A

Spino-Mesencephalic Tract

61
Q

Which pain pathway has some projections to the peri-aqueductal gray?

A

Spino-Mesencephalic Tract

62
Q

Which two pain pathways activate the hypothalamus and evoke emotional behavior?

A
  1. Spinohypothalamic Tract

2. Spinotelencephalic Tract

63
Q

Which pain pathway ascends uncrossed to the lateral cervical nucleus?

A

Spinocervical Tract

64
Q

The Spinocervical Tract ascends uncrossed to the lateral cervical nucleus which relays the fibers to the …

A

contralateral thalamus.

65
Q

Where do certain fibers that are responsive to pain in the dorsal columns ascend?

A
  1. medially

2. ipsilaterally

66
Q

Third order neurons are located …

A

in the thalamus.

67
Q

Third order neurons send fibers to …

A

somatosensory areas I and II in the postcentral gyrus of the parietal cortex and the superior wall of the sylvian fissure respectively.

68
Q

Perception of pain and discrete localization of pain occur in which cortical areas?

A

somatosensory areas I and II (postcentral gyrus of the parietal cortex and the superior wall of the sylvan fissure respectively)

69
Q

Most third order neurons from the lateral thalamic nuclei project to …

A

the primary somatosensory cortex.

70
Q

Third order neurons from the intralaminar and medial nuclei project to …

A

the anterior cingulate gyrus.

71
Q

Third order neurons from the intralaminar and medial nuclei are likely involved in …

A

mediating the suffering and emotional components of pain.

72
Q

Nociceptors are characterized by …

A
  1. a high threshold for activation

2. encoding the intensity of stimulation by increasing their discharge rates in a graded fashion

73
Q

Describe noxious sensations.

A
  1. fast, sharp, well localized (A fibers-“first pain”)

2. slow, dull, poorly localized (C fibers-“second pain”)

74
Q

What are the three nociceptor types?

A
  1. Mechanonociceptors
  2. Silent Nociceptors
  3. Polymodal Mechanoheat Nociceptors
75
Q

The nociceptor type that responds to pinch and pinprick is …

A

Mechanonociceptors

76
Q

The nociceptor type that only responds to the presence of inflamation is …

A

Silent Nociceptors

77
Q

The nociceptor type that responds to excessive pressure, extremes of temperature, and noxious substances is …

A

Polymodal Mechanoheat Nociceptors (bradykinin. histamine, 5-HT, H+, K+, prostoglandins)

78
Q

Which nociceptor type is most prevalent?

A

Polymodal Mechanoheat Nociceptors

79
Q

Which nociceptors are present in both somatic and visceral tissues?

A

Cutaneous Nociceptors

80
Q

Primary afferent neurons reach tissues by traveling along …

A

spinal somatic, sympathetic, or parasympathetic nerves.

81
Q

Somatic nociceptors include those found in …

A

skin (cutaneous) and deep tissues (muscle, tendons, fascia, and bone).

82
Q

Viseral noviceptors include those found in …

A

internal organs.

83
Q

The cornea and tooth pulp are unique in that they are almost exclusively innervated by …

A

nociceptive A Delta and C fibers.

84
Q

Which nociceptors are less sensitive to noxious stimuli than cutaneous nociceptors?

A

deep Somatic Nocicpetors

85
Q

Which nociceptors are easily sensitized by inflamation?

A

deep Somatic Nocicpetors

86
Q

Pain arising from these nociceptors is dull and poorly localized.

A

deep Somatic Nocicpetors

87
Q

Specific deep Somatic Nocicpetors exist in muscles and joint capsules. They respond to …

A
  1. mechanical stimuli
  2. thermal stimuli
  3. chemical stimuli

SUM'20 - Regional (17 decks)

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