Pain Guide - Regional Flashcards
The most common symptom that brings patients to see a physician is _________.
pain
Pain is almost always a manifestation of a___________ ___________.
pathological process
In a general sense, pain management applies to the entire discipline of _________________.
anesthesiology
In a modern sense, pain management involves management of both _____________ and ____________ pain in both inpatient and outpatient settings.
perioperative, nonsurgical
What two domains can pain management be broken into?
Acute and Chronic
In what two ways is the sensation of pain often described?
Protopathic (Noxious) and Epicritic (Non-noxious)
Epicritic Sensations are ….
light touches, pressure, proprioception and temperature discriminations
Protopathic Sensations are…
- pain
- Detected by high-threshold receptors
- Conducted by smaller, lightly myelinated (alpha-delta) and unmyelinated (C) nerve fibers.
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms as such damage.
Pain Classifications that Drive Course of Treatment are …
- Pathophysiology (nociceptive or neuropathic)
- Etiology (arthritis or cancer)
- Affected Area (headache or lower back)
Term used to describe neural responses to traumatic or noxious stimuli are …
Nociception (All nociception produces pain but not all pain results from nociception).
Nociceptive pain is caused by …
activation or sensitization of peripheral nociceptors that transduce noxious stimuli.
Neuropathic pain is a result of …
injury or acquired abnormalities of peripheral or central neural structures.
Pain Perception is related to ….
gender and age (May decrease with age and may disappear entirely after the age of 40.)
Epicritic Sensations are characterized by
low-threshold receptors
Epicritic Sensations are generally conducted by …
large myelinated nerve fibers
Protopathic Sensations are detected by …
high-threshold receptors
Protopathic Sensations are conducted by …
smaller, lightly myelinated (alpha-delta) and unmyelinated (C) nerve fibers.
Acute pain is caused by …
- noxious stimulation due to injury
- a disease process
- abnormal function of muscle or viscera
Acute pain is usually …
nociceptive, which serves to detect, localize and limit tissue damage.
The 4 physiological processes involved in acute pain are…
- Transduction (time)
- Modulation (makes)
- Perception (pain)
- Transmission (temporary)
Somatic pain may be …..
superficial or deep
Superficial somatic pain is due to …
nociceptive input arising from skin, subcutaneous tissue, and mucous membranes.
Superficial somatic pain is characterized by …
well localized, sharp, pricking, throbbing, or burning sensations.
Deep somatic pain arises from …
muscles, tendons, joints, or bones.
Deep somatic pain is characterized by …
dull, aching, less localized pain.
Visceral pain is due to …
- disease process
2. abnormal function involving an internal organ or its covering (parietal pleura, pericardium, or peritoneum)
The 4 sub-types of visceral pain are …
- Localized visceral pain (dull, diffuse,usually mid-line causing sweating and changes to blood pressure and heart rate)
- Localized parietal pain (sharp, stabbing, usually localized around organ)
- Referred visceral pain
- Referred parietal pain
When pain fails to resolve because of abnormal healing or inadequate treatment, it becomes ….
chronic pain.
Chronic pain is defined as ….
- pain that persists beyond the usual course of an acute disease
- pain that persists after a reasonable time for healing to occur (1-6 months)
A distinguishing factor of chronic pain is that …
psychological mechanisms and environmental factors frequently play a major role.
A pain pathway is …
the transmission of pain from periphery to cerebral cortex.
Where can cell bodies of primary afferent neurons be found?
Within the dorsal root ganglia of the spinal cord.
First order neurons synapse with …..
second order neurons.
First order neurons synapse with second order neurons in the …
ipsilateral dorsal horn of the spinal cord.
Third order neurons send signals to …
the cerebral cortex.
Second order neurons synapse with …
third order neurons.
Second order neurons synapse with third order neurons in the …
thalamus.
After first order neurons synapse with second order neurons in the ipsilateral dorsal horn of the spinal cord, they…
cross mid-line and ascend in the contralateral spinothalamic tract to reach the thalamus.
The majority of first order neurons send what end of their axons into the spinal cord?
proximal
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?
- cervical
- thoracic
- lumbar
- sacral
First order neurons also synapse with …
- Interneurons
- Sympathetic neurons
- Ventral Horn motor neurons
Pain fibers may ascend or descend one to three spinal segments in _________ _________ before synapsing with second order neurons.
Lissauer’s Tract
Second order neurons are either …
- Nociceptive -specific neurons
2. Wide dynamic range (WDR) neurons
Nociceptive -specific neurons serve only …
noxious stimuli.
WDR (wide dynamic range neurons) receive …
noxious and non-noxious input.
Axons of second order neurons cross mid-line to which side of the spinal cord?
contralateral side
Axons of second order neurons terminate in the ….
spinothalamic tract.
Axons of second order neurons send their fibers to these regions of the brain…
- the thalamus
- reticular formation
- nucleus raphe magnus
- periaqueductal gray
What is classically considered to be the major pain pathway?
the Spinothalamic Tract
The Spinothalamic tract lies …
anterolaterally in the white matter of the spinal cord.
Is the Spinothalamic tract an ascending or descending tract?
ascending
The Spinothalamic tract can be divided into the …
- Lateral Spinothalamic Tract (Neospinothalamic)
2. Medial Spinothalamic Tract (Paleospinothalamic)
The Lateral Spinothalamic Tract carries …
discriminative aspects of pain such as location, intensity and duration.
The Lateral Spinothalamic Tract projects mainly …
to the ventral posterolateral nucleus of the thalamus.
The Medial Spinothalamic Tract projects to …
the medial thalamus.
The Medial Spinothalamic Tract is responsible for …
mediating the autonomic and unpleasant emotional perceptions of pain.
Other than the Spinothalamic Tract, what are alternative pain pathways?
- Spinoreticular Tract
- Spino-Mesencephalic Tract
- Spinohypothalamic and Spinotelencephalic Tracts
- Spinocervical Tract
- Certain pain responsive fibers in the dorsal columns.
Which pain pathway mediates arousal and autonomic response to pain?
Spinoreticular Tract
Which pain pathway may be important in activating anti-nociceptive descending pathways?
Spino-Mesencephalic Tract
Which pain pathway has some projections to the peri-aqueductal gray?
Spino-Mesencephalic Tract
Which two pain pathways activate the hypothalamus and evoke emotional behavior?
- Spinohypothalamic Tract
2. Spinotelencephalic Tract
Which pain pathway ascends uncrossed to the lateral cervical nucleus?
Spinocervical Tract
The Spinocervical Tract ascends uncrossed to the lateral cervical nucleus which relays the fibers to the …
contralateral thalamus.
Where do certain fibers that are responsive to pain in the dorsal columns ascend?
- medially
2. ipsilaterally
Third order neurons are located …
in the thalamus.
Third order neurons send fibers to …
somatosensory areas I and II in the postcentral gyrus of the parietal cortex and the superior wall of the sylvian fissure respectively.
Perception of pain and discrete localization of pain occur in which cortical areas?
somatosensory areas I and II (postcentral gyrus of the parietal cortex and the superior wall of the sylvan fissure respectively)
Most third order neurons from the lateral thalamic nuclei project to …
the primary somatosensory cortex.
Third order neurons from the intralaminar and medial nuclei project to …
the anterior cingulate gyrus.
Third order neurons from the intralaminar and medial nuclei are likely involved in …
mediating the suffering and emotional components of pain.
Nociceptors are characterized by …
- a high threshold for activation
2. encoding the intensity of stimulation by increasing their discharge rates in a graded fashion
Describe noxious sensations.
- fast, sharp, well localized (A fibers-“first pain”)
2. slow, dull, poorly localized (C fibers-“second pain”)
What are the three nociceptor types?
- Mechanonociceptors
- Silent Nociceptors
- Polymodal Mechanoheat Nociceptors
The nociceptor type that responds to pinch and pinprick is …
Mechanonociceptors
The nociceptor type that only responds to the presence of inflamation is …
Silent Nociceptors
The nociceptor type that responds to excessive pressure, extremes of temperature, and noxious substances is …
Polymodal Mechanoheat Nociceptors (bradykinin. histamine, 5-HT, H+, K+, prostoglandins)
Which nociceptor type is most prevalent?
Polymodal Mechanoheat Nociceptors
Which nociceptors are present in both somatic and visceral tissues?
Cutaneous Nociceptors
Primary afferent neurons reach tissues by traveling along …
spinal somatic, sympathetic, or parasympathetic nerves.
Somatic nociceptors include those found in …
skin (cutaneous) and deep tissues (muscle, tendons, fascia, and bone).
Viseral noviceptors include those found in …
internal organs.
The cornea and tooth pulp are unique in that they are almost exclusively innervated by …
nociceptive A Delta and C fibers.
Which nociceptors are less sensitive to noxious stimuli than cutaneous nociceptors?
deep Somatic Nocicpetors
Which nociceptors are easily sensitized by inflamation?
deep Somatic Nocicpetors
Pain arising from these nociceptors is dull and poorly localized.
deep Somatic Nocicpetors
Specific deep Somatic Nocicpetors exist in muscles and joint capsules. They respond to …
- mechanical stimuli
- thermal stimuli
- chemical stimuli
