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pain > Pain physiology and assessment > Flashcards

Pain physiology and assessment Flashcards

1
Q

Define Pain

A

an unpleasant sensory and emotional experience arising from actual or potential tissue damage

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2
Q

Define acute pain

A

the normal, predicted physiologic response to an adverse chemical, thermal, or mechanical stimulus. associated w/surgery, trauma, or acute illness

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3
Q

What is the biologic purpose of acute pain?

A

alerts person to a noxious environment and activates fight/flight mechanisms

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4
Q

Define chronic pain

A

Pain that persists or progresses over a long period of time and is resistant to medical treatments

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5
Q

What is the biologic purpose of chronic pain?

A

no biological usefulness. becomes disease in its own right

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6
Q

Define hyperalgesia

A

increased response to a stimulus that normally is painful

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7
Q

Define hypoalgesia

A

diminished response to a normally painful stimulus

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8
Q

Define analgesia

A

absence of pain in response to stimulation that normally is painful

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9
Q

Define paresthesia

A

an abnormal sensation, whether spontaneous or evoked (pins/needles)

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10
Q

Define allodynia

A

pain resulting from a stimulus such as light touch that doesn’t normally elicit pain

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11
Q

What are the 4 physiologic processes associated with pain?

A

transduction, transmission, modulation, perception

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12
Q

Describe the onset and quality of fast pain

A

felt within 0.1s, is sharp in character

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13
Q

Describe the onset and quality of slow pain

A

begins after a second or more, is throbbing/aching in nature

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14
Q

Describe characteristics of pain receptors and their stimulation

A

all pain receptors are free nerve endings. they do not adapt to the stimulus. can by stimulated by mechanical (stretch), thermal, or chemical factors

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15
Q

What do prostaglandins and substance P do in relation to pain stimulation?

A

they enhance the sensitivity of pain endings but do not directly excite them

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16
Q

What causes pain?

A

the rate of tissue damage

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17
Q

What is the role of bradykinin in relation to pain?

A

causes the most pain and is the most responsible for causing the tissue damage type of pain.

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18
Q

What are the two classifications of pain?

A

nociceptive or neuropathic

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19
Q

Define nociceptive pain

A

involves the normal neural processing of pain that occurs when free nerve endings are activated by tissue damage or inflammation (somatic/visceral)

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20
Q

Define neuropathic pain

A

involves the abnormal processing of stimuli from the PNS or CNS, and is thought to serve no useful purpose.

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21
Q

What is an example of neuropathic pain?

A

peripheral neuropathy in diabetics

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22
Q

Define transduction as a part of the pain pathway

A

The conversion of a noxious stimulus. Transferred into electrical activity in the peripheral terminals of nociceptor sensory fibers

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23
Q

Define transmission as a part of the pain pathway

A

transmits info

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24
Q

Define modulation as a part of the pain pathway

A

refers to the alteration (augmentation or suppression) of sensory input

25
Q

Define perception as a part of the pain pathway

A

refers to the decoding of afferent input into the brain that gives rise to the individual’s specific sensory experience

26
Q

What type of fibers and tract transmit fast pain?

A

Type Adelta fibers, transmitted in the neospinothalamic tract

27
Q

What type of fibers and tract transmit slow pain?

A

Type C fibers, transmitted in the paleospinothalamic tract

28
Q

Describe 1st order neurons as a mechanism of pain

A

detect stimuli that threaten the integrity of innervated tissue. Get AP to dorsal horn

29
Q

Describe 2nd order neurons as a mechanism of pain

A

located in the spinal cord and process nociceptive info. Get AP to the brain

30
Q

Describe 3rd order neurons as a mechanism of pain

A

project pain info to the brain. Get AP to the cortex

31
Q

Where do fibers of the neospinothalamic tract terminate in the spinal cord?

A

can travel up or down 1-3 segments and terminate on neurons in the dorsal horn.

32
Q

What do fibers of the paleospinothalamic tract terminate in the spinal cord?

A

terminate in the laminae II or III of the spinal cord. they make 1-2 local connections before giving rise to 2nd order neurons

33
Q

What is the pathway of 2nd order neurons in both the neospinothalamic and paelospinothalamic tracts?

A

the 2nd order neurons cross to the opposite side and pass to the brain in the anterolateral columns

34
Q

Where do 2nd order neurons of the neospinothalamic tract terminate?

A

some terminate in the reticular substance, but most go to the ventrobasal complex of the thalamus

35
Q

Where do 2nd order neurons of the paleospinothalamic tract terminate?

A

some terminate in the thalamus, but most terminate diffusely in the reticular nuclei of the medulla, pons, mesencephalon, tectal area of the mesencephalon, or the periaqueductal gray region

36
Q

Where do the neurons go from the lower reticular areas of the paleospinothalamic tract?

A

project to the intralaminar nuclei of the thalamus, hypothalamus, and other basal brain regions

37
Q

How would the removal of the somatic sensory areas of the cortex affect pain?

A

still able to perceive pain because pain impulses to lower areas can cause conscious perception of pain

38
Q

What does the cortex determine with pain?

A

the quality of pain

39
Q

What do nerve fibers in the periventricular nucleus and periaqueductal gray nuclei secrete at their nerve endings?

A

enkephalin

40
Q

What do nerve fibers from the raphemagnus secrete at their nerve endings?

A

serotonin

41
Q

What does serotonin do in relation to pain suppression?

A

causes local neurons to secret enkephalin

42
Q

What is the fxn of enkephalin?

A

causes both pre- and post- synaptic inhibition of type C and type Adelta pain fibers where they synapse in the dorsal horns

43
Q

What are the three large molecules that opoid substances originate from?

A

proopoimelanocortin, proenkephalin, prodynorphin

44
Q

What are the major opiate substances?

A

B-endorphin, met-enkephalin, leu-enkephalin, dynorphin

45
Q

Where are the enkephalins and dynorphin found?

A

brain stem and spinal cord

46
Q

Where is B-endorphin found?

A

hypothalamus and the pituitary

47
Q

What is the fxn of the opiate system?

A

pain suppression during times of stress. an important part of an organism’s response to an emergency is a reduction in the responsiveness to pain

48
Q

What are the different types of pain?

A

Cutaneous, somatic, visceral

49
Q

Describe cutaneous pain

A

superficial structures such as skin and subQ. sharp, bright pain, localized accurately

50
Q

Describe somatic pain

A

deep body structures, more diffuse than cutaneous, various stimuli (pressure on bone, ischemia to a muscle, tissue damage)

51
Q

Describe visceral pain

A

pain from an internal organ that’s perceived to originate from a distant area. viscera have few sensory fibers except for pain fibers. highly localized damage to an organ may result in little pain, widespread damage can lead to severe pain

52
Q

Where is visceral (referred pain) localized to?

A

the dermatome of embryological origin

53
Q

What are causes of visceral pain?

A

ischemia, chemical irritation, spasm of hollow viscus, overdistension of hollow viscus

54
Q

Define pain threshold

A

closely associated with the pt at which a stimulus is perceived as painful

55
Q

Define pain tolerance

A

relates more to the total pain experience, it’s the maximum intensity or duration of pain that a person is willing to endure

56
Q

How is inflammation related to pain?

A

It’s used to promote healing. Sensitivity increased so that stimuli to the affected part that wouldn’t normally cause pain now cause pain.

57
Q

What is the fxn of algogenic substances?

A

increases the permeability of capillaries and edema formation when a tissue is damaged/inflammed

58
Q

What is the biocultural model of pain?

A

society influences an individual’s pain experiences

59
Q

What are the consequences of untreated acute pain?

A

increased metabolic rate and blood clotting, impaired immune fxn, negative emotions, and pain receptors become sensitive/long lasting changes

pain (3 decks)

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