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Neuro Block 3 > Pain, Pain Systems, Pain Management > Flashcards

Pain, Pain Systems, Pain Management Flashcards

1
Q

what are the 3 types of pain?

A
  1. acute: immediate sensation
  2. cancer related: caused by a tumor crowding other organs
  3. chronic non-malignant: persists beyond tissue damage
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2
Q

Acute pain will travel in 2 ways?

what fibers does each use?

A

1) slow = felt after a couple of seconds
- uses C fibers
2) fast = immediately after stimuli
- uses A fibers

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3
Q

how is fast pain usually describe by patients?

A

acute

sharp

prickling

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4
Q

how easy is to point out acute fast pain?

is acute fast pain sensed in deeper tissues?

A

easily localized

no

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5
Q

how is slow acute pain described?

is it felt in deeper tissues?

A

throbbing, burning or aching.

yes

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6
Q

ahow is chronic pain described by patients?

in what tissues do we see chronic pain?

A

chronic, throbbing, burning, aching

skin and deeper tissues

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7
Q

define

Nociception:

Nociceptors:

A

Nociception: Pain perception

Nociceptors: Pain receptors

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8
Q

Pain from skin receptors is called?

Pain from deep tissue, skeletal muscle is called?

Pain from visceral receptors is called?

A

Superficial somatic pain

Deep somatic pain

Visceral pain

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9
Q

Transmission of pain stimuli utilizes these neurotransmitters:

A
  1. Substance P
  2. CGRP
  3. Bradykinins
  4. Histamine
  5. Prostaglandins
  6. Serotonin
  7. Potassium (K+)
  8. Neurokinins
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10
Q

Suppression of pain stimuli needs these neurotransmitters?

A

Enkephalins/Endorphins

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11
Q

Pain information is transmitted through what tracts?

A

spinothalamic or trigeminal tracts

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12
Q

Neospinothalamic tract for pain uses which fibers?

Paleospinothalamic tract for pain uses which fibers?

A

A fibers.

C fibers.

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13
Q

C fibers are these type of axons?

A delta fibers are these type of axons?

for both identify myelinated or unmyelinated

A

type IV axons (unmyelinated)

type III axons (myelinated)

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14
Q

what are the Sequence of Events During Pain?

A
  1. Damaged tissue releases prostaglandins, bradykinins, serotonin, and K+.
  2. These stimulate pain fiber receptor endings.
  3. axon reflex phenomenon happens: release of substance P and CGRP (calcitonin-gene releasing peptide) from axon endings.
  4. Substance P and CGRP act on mast cells to release histamine, stimulating pain endings more.
  5. Substance P (and others) also act as vasodilators which contribute to the swelling and inflammation.
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15
Q

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?

A

histamine, serotonin

bradykinin

B1 and B2; B1 because it may increase during inflammation.

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16
Q

Low levels of histamine produce?

Higher levels produce?

A

itching

pain

17
Q

how is pain suppressed?

A

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.

18
Q

what is Gate-Control Theory?

what does it try to explain?

A

C fibers keep the ‘gate’ open, while activation of A fibers closes it.

why we immediately rub an injured area.

19
Q

gate control likely operates at 2 levels, what are these?

A
  1. spinal cord level (between 1st and 2nd order neurons)
  2. thalamus (between 2nd and 3rd order neurons).
20
Q

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?

A

5

C2/C3

auricular branch of CN 10

21
Q

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?

A
  • S1: Primary somatosensory: concerned with localization of pain.
  • SII, Cingulate gyrus, insula: concerned with ‘affective’ perception of pain.
22
Q

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?

A

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.
23
Q

Causes of Back Pain:

A
  1. Injury or overuse of muscles or joint
  2. Nerve compression problems
    • Sciatica or herniation
    • spinal stenosis
    • spondylolysis
    • scoliosis
    • Cauda Equina Syndrome
  3. Spinal tumors, lesions, trauma, stroke
24
Q

what is cauda equina syndrome?

symptoms present where?

what symptoms do we see?

A

compression of cauda equina

below the compression

paralysis, sensory loss, parasthesia, bladder control loss

25
Q

what is this?

A

cauda equina syndrome

26
Q

what is this?

A

compressed disc

27
Q

what is Sciatica?

what nerves does it involve?

A

collection of symptoms. Caused by compression of sciatic nerve

L4, L5, S1, S2, S3

28
Q

what is Referred Pain?

A

severe Visceral pain poorly localized,

visceral pain appears as somatic pain

29
Q

referred pain mapping; pain in these areas reflect in which dermatomes?

  1. Diaphragm
  2. Heart
  3. Appendix
  4. Testes, prostate
  5. Ovaries, uterus
A
  1. C3/C4
  2. T1-T8
  3. T10
  4. T10-T12
  5. T10-T12
30
Q

chornic pain is characterized by what?

what is hyperalgesia?

what is allodynia?

A

spreading, long lasting, spontaneuous

increased pain sensitivity

pain from something that is not painful

31
Q

chronic pain is described as….

A
  • Suffering
  • Sleeplessness
  • Sadness
32
Q

chronic pain is divided into 2…

A
  1. nociceptive: activation of pain receptors
  2. neuropathic: damage or abnormal activity in CNS
33
Q

Pain is treated using analgesics like…..

besides analgesics what else can be used?

A

Analgesics: Aspirin, Acetaminophen, Ibuprofen.

corticosteroids, anti-depressants, opiates

34
Q

What is Aspirin?

what is a side effect of Aspirin?

A

NSAID, Anti-inflammatory, anti-clotting. Blocks production of prostaglandins, leukotrienes, and thromboxanes.

GI irritation and bleeding, ulcers, and Reye’s Syndrome (kids with viral infection leading to destruction of liver)

35
Q

name 2 commercial products for Ibuprofen

what is ibuprofen?

what side effects can it cause?

name a commercial name for Naproxen

what is Naproxen?

what side effects can it cause?

A

advil, motrin

NDAID

GI issues

Aleve

NSAID

GI problems, don’t take with MAO-I

36
Q

what is Acetaminophen?

what side effects can happen?

A

not an NSAID

hepatic toxicity

37
Q

what do NSAIDS do?

how do corticosteroids reduce pain?

used mainly for what?

what side effects can result?

A

inhibit COX-2

block production of arachidonic acid

good anti-inflammatory

osteoporosis, immuno suppression, growth retardation

38
Q

When are anti-depressants used?

what side effects can result?

When are opiates used?

what side effects can result?

A

for neuropathic pain.

constipation, blurred vision

used for sedation to relieve pain

Tolerance and withdrawal symptoms

39
Q

The WHO 3-Step Analgesic Ladder:

what are the 3 steps?

A

step 1 = non-opioids

Step 2 = weak opioids

step 3 = opioids

Neuro Block 3 (24 decks)

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