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OSCE Y2! > Pain physiology > Flashcards

Pain physiology Flashcards

1
Q

what is the placebo effect?

A

when an inactive substace is used by/on a person who believes it to be real & have genuine outcomes, but which holds no therapeutic value

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2
Q

how do we classify pain?

A

*detecting the source of the pain
*determining the pain’s duration; whether it is acute or chronic

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3
Q

what is visceral pain and an example

A

visceral pain relates to damage of our internal organs; an example of this pain is pain experienced during a heart attack

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4
Q

a difficulty which comes with someone experiencing visceral pain?

A

not being able to determine the exact location of their pain (due to how internal it is)

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5
Q

what receptors are activated during visceral pain?

A

stretch receptors

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6
Q

what is radiation of pain?

A

when pain travels from one part of the body to another

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7
Q

example of radiating pain?

A

during a heart attack; pain is felt in the chest, arms, jaw, etc.

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8
Q

how does radiating pain work?

A

during radiating pain, nerves use shared nerve pathways; to inform the brain of the problem causing the pain. the brain is therefore unable to detect the source of the pain/ correct pain pathway.

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9
Q

what is somatic pain?

A

pain which originates mainly from the skin and membranes (including innages from the brain), but also the bone & muscle

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10
Q

example of somatic pain

A

damaged skin (paper cut); the skin is a vital sensory organ and sensory nerves of the skin are well-mapped to the brain, meaning the brain can determine exactly where the pain is located

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11
Q

what is neurogenic/neuropathic pain?

A

pain associated with the brain and NS

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12
Q

example of neuropathic pain?

A

shingles (a serious infection) which can damage the nerves and nerve fibres. this stops them from sending accurate messages to the brain if any, and results in exaggerated messages meaning pain, which can become chronic.

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13
Q

what is acute pain?

A

*sudden pain
*usually short in duration; up to 3 months
*associated with tissue damage
*usually resolves with healthing
*is proportionate to the injury

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14
Q

what is chronic pain?

A

*permanent dysfunction of pain painways
*often not associated with tissue damage
*persisent pain
*can arise with and without injruy but will continue after healing time
*more commen in women than men
*characterised by hypersensitive nerves

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15
Q

what are nocireceptors?

A

pain receptors (NOCI=PAIN)

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16
Q

characteristics of nocireceptors?

A

*not myelinated
*free nerve ending
*must be activated, e.g., by temperature
*polymodal; they respond to more than one stimulus; they respond to every stimulus

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17
Q

polymodal meaning?

A

the response to more than one stimulus, e.g., nocireceptors respond to more than one stimulus; every stimulus

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18
Q

examples of whhich stimuluses nocireceptors respond to?

A

*thermal; too hot/cold
*chemical; inflammatory mediators
*sensations (pain); cutting/burning/stretching/pressure

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19
Q

why is it a positive that nocireceptors must be activated?

A

because nocireceptors are both highly sensitive and polymodal; respond to every stimuli, meaning if they were always active, they would respond to every sensation, e.g., putting on clothes, holding objects and this would cause us pain all the time

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20
Q

how do nocireceptors work?

A
  • pain receptors are free nerve ending, meaning they are unspecialised and respond to every sensation
  • send all information from the periphery of the body to the brain
  • pain receptors respond when a potentially damaging/threatening stimulus is applied to tissues; extreme temperatures.
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21
Q

what are nerve endings?

A

a free nerve ending is an unspecialised, afferent nerve fibre. these are located on millions of points on the surface of our body and internally, sending messages to the brain when they detect sensations such as pain, temperature excremes, and pain

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22
Q

what are nerve fibres?

A

the axon of neurones

23
Q

what are the two clasess of nerve fibres associated with the transmission of pain?

A

*A-delta fibres (myelinated; big & fast)

*C-fibres (non-myelinated; small & slow)

24
Q

characteristics of A-delta fibres?

A

*carries our fast component of pain
*mainly found in the skin & membranes
*most sensitive to pressure stimuli
*e.g., will pick up the sudden sharp pain following an immediate paper cut
*as they are myelinated, this means pain messages here are transported much faster to the brain

25
Q

characteristics of C-fibres?

A

*conduct slow components of pain
*most sensitive to chemical stimuli
*e.g., chemicals triggered by the on-going inflammatory responses following the initial tissue damage
*as they are non-myelinated, they carry out longer-lasing pain following ititial injury, e.g., throbbing following a jammed finger

26
Q

what are analgesics?

A

also known as painkillers and analgesic drugs; any member of the group of drugs used to achieve releif from painful stimulus’

27
Q

what is an opioid?

A
  • substances which act on opioid receptors to produce morphine-like effects
  • medically, opioids are used for pain relief
  • opioid is a general term for morphine-related drugs
  • opioids act by mimicking the actions of the body’s natural endorphins; acting as a gateway of pain to the brain
28
Q

what is an endorphin?

A

*a substance made by the body that can releive pain and give a general sense of wellbeing.
*endorphins are peptides (small proteins) that bind to opioid receptors in the CNS.
*an endorphin is a type of neurotransmitter.

29
Q

does the body produce its own kind of opioids?

A

*yes
*the brain makes its own version of opioids called endogeneous opioids
*these are chemicals which act similair to opioid drugs whuch attach to opioid receptors in the brain
*endogeneous opioids help to relieve pain

30
Q

what is the name of the body’s self-made opioids?

A

endogeneous opioids

31
Q

what specific receptors to opioids bind to in the body, and where are they found?

A

‘mu’ receptors which are found on nerves which transmit pain

32
Q

what happens when an opioid binds to a ‘mu’ receptor?

A

*it acts like an endorphin
*inhibits the transmission of the pain signal from one nerve to the next

33
Q

where is there an abundance of ‘mu’ receptors in the body?

A

*the brain
*the spinal cord; associated with processing pain signals
*PAG
*muscles of the GI tract
*smooth linings of the respiratory tract

34
Q

what do morphine drugs do to ‘mu’ receptors?

A

activate them

35
Q

common side effects of opioids?

A

*constipation; slowing peristalsis of the bowl muscles
*depressing respiratory function
*changes in mood
*miosis; reduction in pupil size
*likely hood of dependency
*sleepiness
*nausea & vomitting
*bronchoconstriction
*bradycardia and hypotension

36
Q

do opioids cause euphoria or act like a sedative?

A

both

37
Q

how do opioids cause nausea & vomitting?

A

because opioids such as morphine activate the chemo sensitive trigger zone in the brain. this zone exists within the body to protect us from unpleasant substances & potential toxins; therefore activating the protective reflex; vomiting (to rid the body of the opioid)

38
Q

how does morphine cause respiraotry suppresion?

A

morphine makes the respiatory centre in the brain a lot less sensitive to CO2 than usual, making us believe we requiere less O2 through breathing; decreasing respiratory mechanical drive

39
Q

does morphine supress the cough centre?

A

yes- low-dose oral morphine, such as codeine, is sometimes used in clinical settings to suppress coughing as the drug inhibits coughing by supressing the cough centre in the brain

40
Q

what is vagal tone?

A

activity of the vagus nerve; the main nerves of the parasympathetic NS.

41
Q

opioids impact on the vagal tone?

A

opioids affect the CNS by increasing the vagal tone to the heart. This results in the vasodilation of blood vessels and therefore a decrease in HR & BP.

42
Q

can people with asthma be given morphine?

A

yes but in low doses & with caution; morphine effects smooth muscle by putting it into a spasm. morphine has a direct bronchoconstricot action, meaning if given to someone with asthma or other obstructive respiatory conditions, this can be risky.

43
Q

how does morphine effect the muscles of the bowl?

A

morphine constricts the smooth muscle lining of the bowel, putting it into spasm also and reducing the motility of the GI tract; this reduces peristalsis (and therefors stools) thus causing constipation

44
Q

what is inflammation?

A

*the response to any form of tissue damage
*an inherently protective response; prevents infection & promotes tissue healing
*it can cause further tissue damage in this process
*inflammatory response is driven by a range of inflammatory mediators

45
Q

what inflammatory mediators drive an inflammatory response?

A

bradykinin; sensitive nerve endings to pain, making pain reception more likely

histamine; associated with mainly lergic information (allergy)

prostoglandins; an important family of inflammatory mediators

46
Q

what is substance P?

A

????

47
Q

what are NSAIDs & what do they do?

A

non-steroidal anti-inflammatory drugs are a group of medicines widely used to
*releive pain
*reduce inflammation
*revert pyrexia

48
Q

examples of common NSAIDs?

A

*ibuprofen
*aspirin (low-dose aspirin is not considered an NSAID)
*naproxen
*diclofenac

49
Q

characteristics of paracetamol?

A

*common pain killer used by adults and children
*for mild-moderate pain
*not an NSAID
*allergy is rare
*as little as 10mg can cause overdose
*has little anti-inflammatory action
*however does block prostaglandin production

50
Q

what does it mean if pain is localised?

A

exists in one part of the body and its location is therefore easy to distinguish

51
Q

what is an action potential/electrical impulse

A

when a neurone sends information down it’s axon away from the cell body to the next neurone

52
Q

what is a ‘mu’ receptor?

A

*‘mu’ is the greek letter for M; these receptors are named for morphine.

*‘mu’ are the primary receptors for endogeneous opioids which help regulate the body’s response to pain

53
Q

are endorphins proteins?

A
  • yes
  • they are small peptides which bind to opioid receptors
54
Q

what is an endorphin an example of?

A

a neurotransmiter

OSCE Y2! (13 decks)

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