Pain, Pain Systems, Pain Management Flashcards
what are the 3 types of pain?
- acute: immediate sensation
- cancer related: caused by a tumor crowding other organs
- chronic non-malignant: persists beyond tissue damage
Acute pain will travel in 2 ways?
what fibers does each use?
1) slow = felt after a couple of seconds
- uses C fibers
2) fast = immediately after stimuli
- uses A fibers
how is fast pain usually describe by patients?
acute
sharp
prickling
how easy is to point out acute fast pain?
is acute fast pain sensed in deeper tissues?
easily localized
no
how is slow acute pain described?
is it felt in deeper tissues?
throbbing, burning or aching.
yes
ahow is chronic pain described by patients?
in what tissues do we see chronic pain?
chronic, throbbing, burning, aching
skin and deeper tissues
define
Nociception:
Nociceptors:
Nociception: Pain perception
Nociceptors: Pain receptors
Pain from skin receptors is called?
Pain from deep tissue, skeletal muscle is called?
Pain from visceral receptors is called?
Superficial somatic pain
Deep somatic pain
Visceral pain
Transmission of pain stimuli utilizes these neurotransmitters:
- Substance P
- CGRP
- Bradykinins
- Histamine
- Prostaglandins
- Serotonin
- Potassium (K+)
- Neurokinins
Suppression of pain stimuli needs these neurotransmitters?
Enkephalins/Endorphins
Pain information is transmitted through what tracts?
spinothalamic or trigeminal tracts
Neospinothalamic tract for pain uses which fibers?
Paleospinothalamic tract for pain uses which fibers?
A fibers.
C fibers.
C fibers are these type of axons?
A delta fibers are these type of axons?
for both identify myelinated or unmyelinated
type IV axons (unmyelinated)
type III axons (myelinated)
what are the Sequence of Events During Pain?
- Damaged tissue releases prostaglandins, bradykinins, serotonin, and K+.
- These stimulate pain fiber receptor endings.
- axon reflex phenomenon happens: release of substance P and CGRP (calcitonin-gene releasing peptide) from axon endings.
- Substance P and CGRP act on mast cells to release histamine, stimulating pain endings more.
- Substance P (and others) also act as vasodilators which contribute to the swelling and inflammation.
Mast cells release what 2 neurotransmitters?
what neurotransmitter causes degranulation of mast cells, causing them to release even more of its neurotransmitters?
What are the Two kinds of bradykinin receptors? which is the more important and why?
histamine, serotonin
bradykinin
B1 and B2; B1 because it may increase during inflammation.
Low levels of histamine produce?
Higher levels produce?
itching
pain
how is pain suppressed?
ascending pain axons stop at the PAG in the midbrain, and the raphe nuclei in the medulla
PAG —axons—> raphe nuclei—axons descend to—> spinal cord where the axons pre-synaptically inhibit pain transmission in the dorsal horn.
what is Gate-Control Theory?
what does it try to explain?
C fibers keep the ‘gate’ open, while activation of A fibers closes it.
why we immediately rub an injured area.
gate control likely operates at 2 levels, what are these?
- spinal cord level (between 1st and 2nd order neurons)
- thalamus (between 2nd and 3rd order neurons).
Pain from head is mostly conveyed by which CN?
Sensation from back of head is supplied by what dermatome?
External acoustic meatus and a small area of the posteromedial auricle are supplied by what?
5
C2/C3
auricular branch of CN 10
the Cerebral Cortex has 2 divisions involved with pain, which are these?
what parts of the brain does each work with?
what do they focus on?
- S1: Primary somatosensory: concerned with localization of pain.
- SII, Cingulate gyrus, insula: concerned with ‘affective’ perception of pain.
Back Pain can be of 2 reasons?
which is most common in individuals over 40? what is the complaint?
In each, the pain results from problems with what?
Mechanical: people over 40 = low back pain
- Pain results from problems with spinal joints, discs, vertebrae, or soft tissues.
Neuropathic:
- Pain results from a stimulus which eventually is no longer there yet the pain is.
Causes of Back Pain:
- Injury or overuse of muscles or joint
- Nerve compression problems
- Sciatica or herniation
- spinal stenosis
- spondylolysis
- scoliosis
- Cauda Equina Syndrome
- Spinal tumors, lesions, trauma, stroke
what is cauda equina syndrome?
symptoms present where?
what symptoms do we see?
compression of cauda equina
below the compression
paralysis, sensory loss, parasthesia, bladder control loss
