Pain Patho (Exam 2) Flashcards
Signs and Symptoms of inflammation are produced by
Chemical Mediators
Chemical mediators are present in the _________ and activated by __________
Plasma, Tissue Injury
Chemical Mediators that are present in the plasma and activated by tissue injury
-Histamine
-Arachidonic acid metabolites (Prostaglandins and Leukotrienes)
Arachidonic acid metabolites
-Prostaglandins and Leukotrienes
-Cause the production of our inflammatory mediators
Prostaglandins
-Chemical Mediator that promote inflammation, pain, and fever
-Protect stomach lining
-Platelet function
Prostaglandins: Body Effect
-Protect the lining of the stomach from the effects of acid
-Promote blood clotting by activating platelets
-Affect kidney function—–Dilate blood vessels that lead to the kidneys
What neurotransmitters are we focusing on with thinking about pharmacologic treatment of pain and fever?
-Prostaglandins
Acute pain
-Nociceptive pain
-Normal protective mechanism to tissue injury
-Transient can least seconds to months (no longer than 3)
-Relieved after the chemical mediators stimulating the pain receptors are moved or the area is repaired
-Often stimulates the ANS to produce physical response to pain (Increase HR, BP, diaphoresis, dilated pupils
Chronic Pain
-Last more than 3 months
-Serves no purpose, often seems out of proportion to observable tissue damage
-Can be ongoing or intermittent
-Changes in the PNS and CNS cause dyregulation of noiception and pain modulation
-Dont see vital sign changes but see emontioal and psychosocial issues
Types of pain: Nociceptive verus Neuropathic
Nociceptive (acute) (Outside the CNS)
Neuropathic (Chronic) (within the CNS) (Does not response to pain medication)
Nociceptive pain: Cutaneous/Somatic Pain
Complaints
Location
Examples
-Involves the MS system (Skin, joints, tendons)
-Complaints: Constant and Achy
-Location: Well localized in the skin and subcutaneous tissue.
-Examples: Incision, bone fracture, bony metasteses, joint spinal disease, osteoarthritis, PVR, Chronic stasis ulcers
Nociceptive pain: Visceral pain
Complaints
Location
Examples
-Involves organs. Inflammation sometimes present
Complaints: Cramping, splitting, N/V, Diaphoresis
Location: Internal organs, poorly localized, diffuse, deeps
Examples: Kidney stones, appendicitis, constipation, heart attack
Two Types of Nociceptive Pain
Cutaneous/ Somatic pain
Visceral Pain
Neuropathic Pain
Complaints
Location
Examples
-Involves nerves
-Complaints: Shooting, burning, numb, sharp, motor weakness
-Location: Originates in injury to peripheral nerve. Spinal cord. Brain. Poorly localized
-Examples: Diabetic neuropathy. Tumor related nerve compression, phantom limb pain, central post-stroke pain
Types of pain: Referred
-Pain felt at a distance form the actual pathology
-Common in visceral pain
-Heart attack: Neck jaw and shoulder pain
Types of Pain: Phantom
-Sensation of pain that originates from an amputated part
-Constant
-Most intense right after the amputation
-Generally resolves overtime
Pain: What is it?
Whatever our patient says it is. COMPLEX
Acute pain
Protective. Promotes withdrawal from painful stimuli, allows inured parts to heal and teaches avoidance
Neuroanatomy of Pain: Pathways
-3 Parts of the nervous system involved in the sensation, perception and response to pain
- Afferent Pathways
- Interpretive centers
- Efferent pathways
Afferent pathways
-Begin in the PNS and travels in spinal gates and ends up in our brain
Interpretive Centers
Cortical, Sub-cortical, Brain stem, midbrain, and cerebral cortex
Area that interprets sensation from afferent pathways. Brain interpreting sensation as pain
Efferent pathways
-Pathway that goes back down into the CNS and illicit physical and mental response to pain
-Pull hand away from pain. Don’t walk out broken ankle
-Our response to pain
Nociception
The process of Afferent, Interpretive, and efferent pathways
Nociceptors
Pain receptors
-Free nerve endings in afferent pathway
-When stimulated they cause nocicpeted pain
