Pain Management Quiz #1 Flashcards
Define pain:
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
How the patient perceives it.
What is defined as acute pain?
Pain that has been occurring less than 3 - 6 months.
What is defined as chronic pain?
Pain that has been occurring for greater than 3 - 6 months. Once pain reaches the chronic phase it is extremely hard to stop.
What is nociceptive pain and what are the two classifications of it?
Associated with the stimulation of specific nociceptors and can be either somatic or visceral.
What is somatic pain?
Somatic pain is a type of nociceptive pain that has an identifiable locus as a result of tissue damage causing the release of chemicals from injured cells that mediate pain.
What are 3 characteristics of somatic pain?
- well localized
- sharp in nature
- generally hurts at the point or area of stimulus
What is visceral pain?
Visceral pain is a type of nociceptive pain that is diffuse and can be referred to another area. Usually secondary to a disease process.
What is visceral pain often associated with and what often accompanies it?
It is often associated with distention of an organ capsule or the obstruction of a hollow viscus. It is often accompanied with autonomic reflexes such as N/V/D.
What are 4 descriptions often given by those suffering with visceral pain?
- “dull”
- “cramping”
- “squeezing”
- vague in nature
It radiates and its referred pain.
What are two forms of non-nociceptive pain?
- Neuropathic pain
2. Idiopathic or Psychogenic pain
What causes Neuropathic pain?
caused by damage to peripheral or central neural structures resulting in ABNORMAL processing or painful stimuli. For example diabetic neuropathy.
How is neuropathic pain often described?
- “burning”
- “tingling”
- “shock-like”
- “pins and needles”
- “throbbing”
- “numb sensation”
What is Idiopathic or Psychogenic pain associated with?
associated with chronic pain states and is used to describe pain that has no apparent cause. When neither nociceptive or non-nociceptive mechanisms can be identified as a cause for pain, and psychological symptoms are commonly present.
What is algesia?
increased sensitivity to pain(prostaglandins increase the sensitivity to pain)
What is alogogenic?
pain producing
What is allodynia?
a normally non harmful stimulus is perceived as painful
What is analgesia?
the absence of pain in the presence of a normally painful stimulus.
What is dysesthesia?
an unpleasant painful abnormal sensation, whether evoked or spontaneous.(not necessarily along the nerve structure)
What is hyperalgesia?
a heightened response to a normally painful stimulus.(IV start exaggerated response)
What is neuralgia?
pain in the distribution of a peripheral nerve.(femoral nerve dinged)
What is neuropathy?
an abnormal disturbance in the function of a nerve.(FUNCTION OF A NERVE*)
What is paresthesia?
an abnormal sensation, whether spontaneous or evoked(“FUNNY BONE”, “SHOCK-LIKE” SENSATION along the nerve structure).
Somatic nociceptive pain is defined by 4 processes what are they?
- transduction
- transmission
- perception
- modulation
What is the definition of transduction as related to somatic nociceptive pain?
the transformation of a noxious stimulus(chemical, mechanical or thermal) into an action potential.
What is the definition of transmission as related to somatic nociceptive pain?
the process by which an action potential is conducted from the periphery to the CNS.
What is the definition of perception as related to somatic nociceptive pain?
occurs once the signal is recognized by various areas of the brain, including the amygdala, somatosensory areas of the cortex, hypothalamus, and the anterior cingulate cortex.
What is the definition of modulation as related to somatic nociceptive pain?
involves altering neural afferent activity along the pain pathway; it can SUPPRESS or ENHANCE pain signals.
Peripheral nociceptors that conduct stimuli to the dorsal horn by transduction are categorized according to morphology. What are the three characteristics of morphology?
- diameter
- myelination
- conduction velocity
What are the characteristics of transduction as related to myelinated A-delta fibers?
primary afferent neurons that conduct action potentials at velocities between 6 and 30 m/sec and elicit fast-sharp pain. They respond only to MECHANICS AND CHEMICAL PAIN.
What are the characteristic of transduction as related to non-myelinated C fibers?
conduct at velocities between 0.5 and 2 m/sec. AKA polymodal fibers because they respond to MECHANICAL, THERMAL AND CHEMICAL INJURIES(all types of pain).
How is the pain transmitted via non-myelinated C fibers described?
“dull”
“burning”
“throbbing”
“aching”
When peripheral tissues(skin, bone and viscera) receive chemical, thermal or mechanical stimuli or are traumatized by either surgery or injury, a series of biomechanics events take place in peripheral pain transduction. What is this sequence of event?
Chemical mediators and neurotransmitters stimulate peripheral nociceptors, causing an influx of sodium ions to enter the nerve fiber membranes(depolarization) and a subsequent efflux of potassium ions(repolarization). An action potential results and a pain impulse is generated.
Once an action potential/pain impulse has been generated, what is the sequence of events of the TRANSMISSION phase of nociceptive pain?
Spinothalmic(anterolateral) system:
- primary afferent neurons(a-alpha/c fibers) have cell bodies in the dorsal root ganglia of the spinal cord
- upon entering dorsal horn, these fibers segregate and descend or ascend several spinal segments in the tract of Lissauer.
- after leaving the tract of Lissauer, the axons of the primary afferents enter the gray matter of the dorsal horn where they synapse with second-order neurons and terminate primarily in Rexed’s laminae I, II or V
- second order neurons then cross the midline of the spinal cord through the anterior commissure and ascend in the anterolateral pathway of the spinothalamic tract to the thalamus.
- in the lateral thalamus and the intralaminar nuclei, second-order neurons synapse with third-order neurons, which then send projections to the cerebral cortex
Once the pain signal is recognized by the various areas of the brain, _____ has occurred.
PERCEPTION
What are the two types of second-order neurons?
- Nociceptive neurons
2. Wide-dynamic-range(WDR) neurons
What are the characteristics of Nociceptive neurons?
They receive input solely from primary afferent alpha and C fibers
What are the characteristics of Wide-dynamic-range(WDR) neurons?
Neurons that receive input from both nociceptive(a-alpha and C fibers) and non-nociceptive(A-B) primary afferents. WDR neurons are activated by a variety of stimulants(innocuous and noxious)
What is the sequence of events during TRANSMISSION?
- second order neurons then cross the midline of then spinal cord through the anterior commissure and ascend in the anterolateral pathway of the spinothalamic tract to the thalamus
- in the lateral thalamus and the intralaminar nuclei, second-order neurons synapse with third-order neurons, which then send projections to the cerebral cortex.
When does PERCEPTION occur?
occurs once the signal is recognized by the various areas of the brain
Where does MODULATION occur?
occurs within the descending efferent pathways
The descending efferent modulatory pathways from the brain are considered the body’s _____ _____ or its _____ _____ _____.
- “analgesia system”
- pain control system
Descending axons from the cerebral cortex, hypothalamus, thalamus, periaqueductal gray matter, nucleus raphe magnus and the locus coeruleus via the _____ _____ synapse with and suppress pain transmission to the _____ and the _____ _____ _____ _____.
- dorsolateral funiculis
- brainstem
- spinal cord dorsal horn
Endogenous opioids(_____/_____) play an _____ _____.
- enkephalin/dynorphin
- inhibitory role
Pain modulation is enhanced in the presence of “_____ _____”.
-“Central Sensitization”
inadequately controlled acute pain that RECRUITS BETA NERVE FIBERS…spasticity converts to plasticity
well controlled acute pain prevents and decreases chronic pain
What are the two excitatory neurotransmitters?
- Substance P
- Glutamate
What are the five inhibitory neurotransmitters?
- Glycine
- GABA
- Enkephalin
- Serotonin
- Norepinephrine
What is the definition of nociceptors?
free nerve endings
The Substantia Gelatinosa is located in Lamina Rexed?
II
What is the ion flow of an action potential?
Sodium in/Potassium out
_____ is what the brain does to minimize pain.
modulation
