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Phys Agents > Pain Modulation > Flashcards

Pain Modulation Flashcards

1
Q

What is pain

A

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

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2
Q

What are the dualities of pain

A

Physiological experience and psychological experience

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3
Q

What are the goals of pain treatment (3)

A
  1. Resolve the underlying pathology causing pain
  2. Modify the patient’s perception of pain
  3. Allow the patient to maximize their functional abilities
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4
Q

What are the categories of pain (4)

A
  1. Nociceptive
  2. Neuropathic
  3. Psychogenic
  4. Carcinogenic
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5
Q

What is the function of pain (3)

A
  1. Warning for withdrawal
  2. Alerts that something is wrong
  3. Protective function
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6
Q

What are the 2 types of nociceptive pain

A
  1. Somatic

2. Visceral

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7
Q

What is somatic pain

A

Activation of nociceptors found in most body tissue

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8
Q

What is visceral pain

A

Activation of nociceptors found in viscera

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9
Q

Is visceral pain referred or localized

A

Referred

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10
Q

Is all of the viscera sensitive to pain

A

Nope

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11
Q

What are the types of neuropathic pain (2)

A
  1. Peripheral

2. Central

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12
Q

What is psychogenic pain

A

Pain that originates from nonorganic sources and is associated with emotional, cognitive, and behavioral responses

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13
Q

What are the 4 types of pain

A
  1. Acute
  2. Chronic
  3. Referred
  4. Radicular
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14
Q

What is carcinogenic pain

A

Pain caused by cancerous pathology that is severe

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15
Q

What is acute pain

A

Combination of unpleasant sensory, perceptual, and emotional experiences that occur in response to noxious stimulus

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16
Q

Characteristics of acute pain (3)

A
  1. Time limited
  2. Persists as long as noxious stimulus persists
  3. Serve a protective function
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17
Q

What is treatment of acute pain from musculoskeletal injury aimed to (3)

A
  1. Facilitate resolution of underlying problem
  2. Reduce inflammation
  3. Modify the transmission of pain from periphery to CNS
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18
Q

What is chronic pain

A

Continuous long term pain of more the 12 weeks after healing would have occurred

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19
Q

What causes chronic pain (2)

A
  1. Changes in sympathetic NS, adrenal activity, reduced production of endogenous opioids, or sensitization of primary afferents
  2. Increased sensitivity to noxious and non-noxious stimuli`
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20
Q

What is referred pain

A

Pain felt at a location distant from its source

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21
Q

What is radicular pain

A

Pain originating from an irritated nerve root that follows a dermatomal pattern

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22
Q

What are pain receptors called

A

Nociceptors

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23
Q

What are the 4 types of sensors

A
  1. Mechano
  2. Thermo
  3. Noci
  4. Proprio
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24
Q

What are the 2 categories of peripheral sensory receptors

A

Superficial and deep

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25
Q

What are the types of mechanoreceptors (4)

A
  1. Meissner’s corpuscles
  2. Pacinian corpuscles
  3. Merkle cells
  4. Ruffini endings
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26
Q

What are the 2 types of thermoreceptors

A

Cold and hot

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27
Q

What are the 3 types of proprioceptors

A
  1. GTO
  2. Pacinian corpuscles
  3. Ruffini endings
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28
Q

What do meissner’s corpuscles sense

A

Pressure and touch

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29
Q

What do pacinian corpuscles, merkle cells, and ruffini endings sense

A

Skin stretch and pressure

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30
Q

What do GTO sense

A

Change in muscle length and spindle tension

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31
Q

What do deep pacinian corpuscles sense

A

Change in joint position and vibration

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32
Q

What do ruffini endings sense

A

Joint end range and heat

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33
Q

Is the life of a sensor long or short

A

Short

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34
Q

Why is the life of a sensor short

A

The brain decides if we need more or less receptors to modulate sensitization of stimuli

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35
Q

True or False:

Nociceptors respond to all manners of stimuli

A

True

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36
Q

When does a nociceptor send a signal

A

When it is stimulated enough

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37
Q

What is the pain threshold

A

The number of receptors needed to fire

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38
Q

What are the 3 fibers in the peripheral nerve afferent fibers

A
  1. A beta fibers
  2. A delta fibers
  3. C fibers
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39
Q

What is the diameter, myelination and speed of A beta fibers

A

Diameter: 6-12 um
Myelinated
Speed: >30 m/sec

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40
Q

What is the diameter, myelination and speed of A delta fibers

A

Diameter: 1-6 um
Myelinated
Speed: 30 m/sec

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41
Q

What is the diameter, myelination and speed of C fibers

A

Diameter: 1mm
Nonmyelinated
Speed: 1-4 m/sec

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42
Q

What info do A beta fibers transmit (2)

A

Touch and vibration

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43
Q

What info do A delta fibers transmit (4)

A

Touch, temperature, pressure, and pain

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44
Q

What info do C fibers transmit (4)

A

Pain, touch, pressure, and temperature

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45
Q

Where do A beta fibers originate from

A

Hair follicles

46
Q

Where do A delta fibers originate from

A

Warm/cold receptors, hair follicles, and free nerve endings

47
Q

True or False:

A delta fibers are blocked by opiates

A

False

48
Q

What percent of afferent danger transmitting fibers are C fibers

A

80%

49
Q

What are group III afferent fibers

A

A delta fibers

50
Q

What are group IV afferent fibers

A

C fibers

51
Q

True or False:

C fibers are the largest amount of nociceptors we have

A

True

52
Q

What type of fibers are activated by mechanical trauma

A

A delta and C fibers

53
Q

What is the spinothalamic tract’s main function

A

Primary nociceptive pathway that transmits type/location of pain

54
Q

What is the main function of the spinoreticular tract

A

Motivational, emotional, unpleasant aspect of pain

55
Q

What is the main function of the spinomesencephalic tract

A

Sensorimotor integration of pain

56
Q

What is the main function of the spinohypothalamic tract

A

Autonomic responses associated with pain

57
Q

What are the 6 sub-cortical centers

A
  1. Reticular formation
  2. Periaqueductal gray
  3. Hypothalamus
  4. Pituitary
  5. Thalamus
  6. Limbic system
58
Q

What is the main function of the reticular formation

A

Mediates motor, autonomic, and sensory functions

59
Q

What is the main function of the periaqueductal gray

A

Directs descending inhibition

60
Q

What is the main function of the hypothalamus

A

Controls endocrine functions and vegetative state

61
Q

What is the main function of the Pituitary

A

Master gland for endocrine system

62
Q

What is the main function of the thalamus

A

Final gateway and relay center

63
Q

What is the main function of the limbic system

A

Involved in emotional, motivational, and affective behavior

64
Q

What is the somatosensory cortex

A

Area of the brain that identifies location of pain and central processing center

65
Q

What is the association cortex

A

Responsible for affect that is associated with danger signals and results in pain tolerance

66
Q

Sensation of pain depends upon stimulation of specific nerve endings that are specialized for that sensation

A

Specific theory of pain

67
Q

Sensation of pain results from appropriate intensity or frequency of stimulation of receptors that also respond to other stimuli like touch, pressure, and temperature

A

Pattern theory of pain

68
Q

True or False:

In the pattern theory of pain there is CNS influence on pain perception

A

True

69
Q

Desensitize peripheral receptors activated during the inflammatory process (change how receptors in the periphery are perceived)

A

Peripheral pain modulation

70
Q

What facilitate nociceptor sensitivity

A

Bradykinin, prostaglandin E2, and serotonin

71
Q

Nerve impulses evoked by injury are influenced in the spinal cord by other nerve cells that act like gates

A

Gate control theory of pain

72
Q

Example of gate control theory

A

Hit funny bone and rub the area enough and it will eventually cause the pain to go away as long as you keep rubbing the spot once you stop it will come back

73
Q

Uses feedback loops to inhibit pain transmission at dorsal horn which results in the release of endogenous opioids

A

Supraspinal and descending pain modulation theory

74
Q

Separate opiate binding sites in the CNS and two peptides produced physiologic effects similar to morphine

A

Endogenous opioid system

75
Q

How did they know they were opioids

A

They were blocked by naloxone which is an opioid antagonist

76
Q

What are opiopeptins

A

They control pain by binding with specific opiate receptors in the nervous system

77
Q

How do opiopeptins cause presynaptic inhibition

A

Suppress influx of calcium

78
Q

How do opiopeptins cause postsynaptic inhibition

A

Activate outflow of potassium current

79
Q

Low frequency, high intensity stimulation of the peripheral nerves used to enhance the production of endogenous endorphins in the anterior pituitary

A

Motor pain modulation

80
Q

What is the end result of motor pain modulation

A

Stimulation of descending pain control system in dorsal horn

81
Q

Stimulation of C fibers activates PAG region and second system activates the pons

A

Noxious pain modulation

82
Q

What is the end result of the noxious pain modulation

A

Stimulation of descending inhibition system in dorsal horn

83
Q

How long is pain blocked when using the noxious pain modulation

A

30 minutes to an hour

84
Q

Pain is a multidimensional experience that is produced by characteristic patterns of nerve impulses that are determined by heredity

A

Neuromatrix theory

85
Q

What is the neuromatrix theory dumbed down

A

Smile more have less pain

86
Q

Application of medium frequency electrical current that hyperpolarizes membrane further and blocks APs

A

Nerve block pain modulation

87
Q

How long does it take for adaption to begin

A

A few seconds

88
Q

What is hyperalgesia

A

That which hurt now hurts more

89
Q

What is allodynia

A

That which did not hurt now hurts

90
Q

What is the semantic differential scales

A

Word lists and categories that represent various aspects of pain experiences and pt selects most appropriate words for their pain

91
Q

What are non systemic analgesics

A

NSAIDs, acetaminophen, opiates, opioids, and antidepressants

92
Q

What are the effects of NSAIDs (5)

A
  1. Analgesic
  2. Anti-inflammatory
  3. Anticoagulant
  4. Antipyretic
  5. Anticancer
93
Q

How do NSAIDs inhibit pain

A

By inhibiting the conversion or arachidonic acid to cyclooxygenase and prostglandins

94
Q

What are 5 NSAIDs

A
  1. Aspirin
  2. Ibuprofin
  3. Naproxen
  4. Piroxicam
  5. Celecoxib
95
Q

What is acetaminophen

A

Tylenol

96
Q

What is the big problem with acetaminophen

A

Liver damage

97
Q

What are the adverse effects of opiates (8)

A
  1. Sedation
  2. Mood changes
  3. Confusion
  4. Respiratory depression
  5. Postural hypotension
  6. Constipation
  7. Nausea and vomiting
  8. Tolerance and dependence
98
Q

how are spinal analgesics given

A

Epidural

99
Q

What can be injected into the epidural

A

Opiates, local anesthetics, catabolic corticosteroids

100
Q

What does heat do to nerve conduction

A

Increases it

101
Q

What does cold do to nerve conduction

A

Decreases it

102
Q

What are physical agents that stimulate large diameter afferent fibers (3)

A
  1. TENS
  2. Superficial massage
  3. Analgesic balms
103
Q

What are physical agents that decrease pain fiber transmission (4)

A
  1. Cryotherapy
  2. Ultrasound
  3. Iontophoresis
  4. Phonophoresis
104
Q

What are physical agents that stimulate small diameter afferent fibers and descending pain control mechanisms (2)

A
  1. Deep massage

2. TENS

105
Q

What are physical agents that stimulate the release of beta-endrophins through prolonged small diamter fiber stimulation (2)

A
  1. TENS

2. E-stim

106
Q

How long does it take for 5 minutes of cooling for decreased nerve conduction to be reversed

A

15 minutes

107
Q

How long does it take for 20 minutes of cooling for decreased nerve conduction to be reversed

A

30 minutes

108
Q

What are the advantages to physical agents (5)

A
  1. Fewer and generally less severe side effects than medications
  2. Patients do not develop physical dependency
  3. Do not cause sedation that would impair ability to work or drive
  4. Many are able to be applied independently
  5. May help remediate the underlying cause of the pain
109
Q

What is a noxious stimulus

A

An actual tissue damaging potential

110
Q

What is a non noxious stimulus

A

A stimulus that has limited to no potential for injury

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