PAIN MANAGEMENT (L2)

Question 1

Pain is determined by: /4

Answer 1

1. Strength of Stimulus - stronger stimulus = less localization ability
2. Position of painful structure - pain is referred distally
3. Depth from surface - more superficial, the more precise.
4. Nature of affected tissue - spinal root nerve or peripheral nerve?

Question 2

an error in sensory cortex perception as to the source of the painful stimulus.

Answer 2

referred pain

Question 3

pain that is referred to a structure within the same dermatome.

Answer 3

segmental referred pain

Question 4

pain that is referred to more than one dermatome - more severe

Answer 4

extrasegmental referred pain.

Question 5

an area of skin in which the sensory nerve is derived from a single nerve root

Answer 5

dermatome

Question 6

All Root pain is referred, but not all referred pain is root pain (T/F)

Answer 6

True

Question 7

Acute pain lasts 3-6weeks (T/f)
Subacute pain lasts 6 weeks to 3-4 months (T/F)
Chronic pain lasts more than 6 months (T/F)

Answer 7

Acute pain = true 3-6 weeks
Subacute pain = false 6 wk -3-6 months
Chronic = false more than 3-6 months

Question 8

Subacute and acute pain is _________. whereas chronic pain is not.

Answer 8

protective

Question 9

Nociceptive pain vs. Neuropathic pain?

Answer 9

Nociceptive = normal pain response. e.g. aching, throbbing, time limited
Neuropathic pain: pain is caused by nerve damage - tingling, shock like or burning, usually chronic.

Question 10

Hyperalgesia vs. Allodynia?

Answer 10

Two forms of Neuropathic pain. Hyperalgesia = normally painful stimuli are increasingly painful
Allodynia = pain response from a normally non-painful stimulus

Question 11

Neuropathic pain

Answer 11

this type of pain is often experienced in parts of the body that appear normal

Question 12

Name 3 different mechanisms for neuropathic pain

Answer 12

Etopic impulses (spontaneous, nerve pinch), Ephatic coupling (neurons within the same peripheral nerve communicate), Sensitivity changes (peripheral or central)

Question 13

some mechanisms of peripheral sensitization?

Answer 13

increasing the afferent nociceptor input via 1) reduced response threshold - chemicals in response to trauma change excitabilllity

2) Recruitment of silent nociceptors, a large portion of A-delta and C fibers insensitive become sensitive.. hard to turn off
3) Phenotype changes: Sensory neuron —> nociceptive neuron

Question 14

some mechanisms of central sensitization?

Answer 14

aspect of neuroplasticity… high activity levels in PNS create activity-dependent increases in the excitability CNS spinal nerves.

1) Chemical property changes (Nociceptive specific neurons behave like wide dynamic range neurons)
2) Neuroanatomical reorganization (nerves are sprouted to connect pain pathways, changes their interpretation of pain)

Question 15

How would we see an enhance withdrawal reflex in a patient?

Answer 15

cross extensor response: in the limb, the response includes stimulation of extension in the opposite limb

Question 16

this process involves the collateral branches of afferent fibers synapsing on inhibitory interneurons that suppress the activity of motor neurons innervating antagonist muscles

Answer 16

reciprocal inhibition

Question 17

What does the vicious cycle model entail

Answer 17

pain stimulates muscle hyperactivity —-> increased sensitivity of muscle spindle afferents —-> increased muscle stiffness —–> stiffness increases metabolite production —-> spasm or fatigue —-> FURTHER DISFUNCTION

Question 18

What does the pain adaptation model a

Answer 18

MINUS: pain increases inhibition of agonist motor units - slows them down to reduce the movements that cause pain
PLUS: antagonist motor units are facilitated
MINUS: overall, the force of the agonist is reduced