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RUSVM Anesthesiology > Pain Physiology And Assessment > Flashcards

Pain Physiology And Assessment Flashcards

1
Q

What is physiological pain?

A

Normal response to a noxious stimuli, producing protective behavioral responses to tissue damage

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2
Q

What is acute pain/

A

Sudden onset of pain, which may be severe but disappears when the stimulus is removed

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3
Q

What is chronic pain?

A

Pain that lasts several weeks to months and persists beyond the expected healing time

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4
Q

What type of pain originates from damage to bone, joint, muscle, or skin and is well localized?

A

Somatic pain

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5
Q

What type of pain originates from internal organs due to stretching or twisting of visceral, mesenteries, and ligaments, and is usually poorly localized?

A

Visceral pain

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6
Q

What type of pain originates from injury to the peripheral or central nervous system

A

Neuropathic pain

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7
Q

What type of pain originates from tissue damage?

A

Inflammatory pain

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8
Q

What type of pain originates form one part of the body but perceived as occurring in another

A

Referred pain

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9
Q

What are the 4 parts of the pain pathway

A

Transduction
Transmission
Modulation
Perception

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10
Q

What is transduction?

A

Peripheral pain receptors are activated by a stimulus

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11
Q

What is transmission?

A

Signal communicated via A-delta and C nerve fibers to spinal cord

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12
Q

What is modulation?

A

Nociceptive input is modified at the spinal cord

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13
Q

What is perception?

A

Conscious recognition of pain in cerebral cortex

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14
Q

What receptors respond to stretching, compression, and crushing?

A

Mechanoreceptors

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15
Q

What receptors respond to heat and cold?

A

Thermoreceprors

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16
Q

What receptors respond to neurotransmitters like prostaglandins, autocoids, cytokines, leukotrienes, and nerve growth factor?

A

Chemoreceptors

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17
Q

What are the myelinated fast transmission nerve fibers? What type of pain do they transmit?

A

A delta

Acute, accurately localized, sharp, and rapid onset

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18
Q

What are the nonmyelinated slow transmission fibers? What type of pain do they transmit?

A

C fibers

Chronic, diffuse, dull, burning, aching pain

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19
Q

Afferent peripheral nerves enter the spinal cord through the ___________

A

Dorsal root

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20
Q

What is the name of the nucleus where most pain fibers synapse in the dorsal horn of the spinal cord?

A

Substantial gleatinosa

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21
Q

What two tracts does pain ascend in the spinal cord?

A

Spinothalamic

Spinoreticular

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22
Q

What are the excitatory neurotransmitters that increase pain?

A

Substance P —> NK1 receptor

Glutamate —> AMPA, NMDA, Kainate

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23
Q

What are the inhibitory neurotransmitters that decrease pain?

A

GABA, endogenous opioids

24
Q

What ascending tract transmits localized, superficial pain?

A

Spinothalamic

25
What ascending tract transmits deep and visceral pain?
Spinorecticular tract
26
What are the descending inhibitory pain pathways?
Input received from cerebral cortex and ascending paint pathways—> midbrain - Periaqueductal gray matter (PAG) - Nucleus raphe magnus (NRM)
27
How do the descending inhibitory pain pathways inhibit the pain?
Release endorphins (endogenous opioids), serotonin, and NE which inhibit pain transmission at the level of the dorsal horn
28
Head pain is transmitted along what nerve?
Trigeminal
29
What are systemic consequences of unmanaged pain?
Stress response —> sympathetic NS release of hormones, and neurotransmitters Cardiovascular -tachycardia, hypertension, increase cardiac work load Respiratory -atelectasis, hyperventilation or hypoventilation, hypoxia GI - delayed gastric emptying, nausea, ileus Renal -oligruia and urinary retention Hematologic -hypercoagulable, and thrombosis risk Immunologic -impaired immune function Muscular -muscle weakness and fatigue Psychological -anxiety, fear, suffering
30
What is allodynia?
Pain evoked by a stimulus that does not normally cause pain
31
What is hyperalgesia?
Increased or exaggerated response to a stimulus that is normally painful —> primary hyperalgesia occurs at site of injury —> secondary hyperalgesia occurs in surrounding undamaged tissue
32
What is peripheral sensitization?
Increase in the activity, excitability, and responsiveness of peripheral nerve terminals, leading to primary hyperalgesia
33
What is windup ?
Summation of painful stimulation in the spinal cord, mediated by Cfibers contributing to central sensitization
34
What is central sensitization ?
An increase in nerve excitability and responsiveness in the central nervous system, particularly the spinal cord, leading to primary and secondary hyperalgesia and allodynia
35
What is peripheral sensitization?
Tissue damage stimulates local inflammatory cells (neutrophils, macrophages, mast cells), nociceptive nerve endings, and sympathetic terminals —>prostaglandins, substance P, cytokines “sensitizing soup” —> increase intracellular Ca2+ and induces intracellular signaling cascade
36
In peripheral sensitization, how does the threshold of A-delta and C fibers change?
Lower threshold for pain —> primary hyperalgesia
37
What is the MOA of windup pain?
Temporal summation and cumulative depolarization Increase dorsal horn excitability Removes normal Mg2+ block on NMDA receptors —> available for glutamate binding and increases pain transmission
38
T/F: central sensitization results in hyperalgesia, allodynia, spontaneous pain, and pain memory
True
39
What is pre-emotive analgesia?
Prevent peripheral/central sensitization Decreases total analgesic requirements
40
Topical local anesthetics inhibit what part of the pain pathway?
Transduction
41
NSAIDS inhibit what part of the pain pathway?
Transduction | Modulation
42
Opioids, A2 agonists, and NMDA antagonists interrupt nociceptive at what part of the pain pathway?
Modulation -opioids and A2 agonists also inhibit perception
43
What types of drugs inhibit transmission of nociception?
Local anesthetic | Epidural
44
What are generalized pain behaviors?
``` Decreased appetite, sleeping time, grooming Change in facial expression Limping/lameness Abnormal pressure Licking, scratching, self-mutilation Vocalization Aggression Poor body condition ```
45
“Praying position” indicates what type of pain in dogs?
Abdominal pain
46
A head tilt may indicate what type of pain in dogs?
Ear
47
What behavioral changes can you see in a canine with pain?
Decreased activity, social withdrawal Aggression Guarding of painful site
48
What are behaviors that can be seen in felines that indicate pain?
Hiding/social withdrawal Decreased appetite Decreased grooming/excessive licking Lameness/reluctance to jump Reluctance to use litter box/“missing” litter box Squinting eyes, lowered ears Aggression, crouching
49
What are equine pain behaviors?
Lameness Standing at back of stall Decreased social interaction/interest Decreased appetite Pain face (lowered ears, angled eye wit intense stare, dilated nostrils, and tension of muzzle)) Colic
50
Sweating, rolling, flank-watching or biting, pawing, kicking indicates what type of pain in horse?
Colic
51
What are behaviors associated with pain in ruminants ?
``` Brutish (teeth grinding), hyper salivation Abnormal facial expression Decreased appetite and rumination Decreased milk production Isolation from herd Vocalizaiton, grunting ```
52
What biological markers can indicate pain ?
``` Cortisol Glucose Catecholamines Endorphins, enkephalins Lactic acid and free fatty acids ```
53
T/F: anesthetized animals can experience pain and peripheral and central sensitization are not prevented by general anesthesia
True
54
What re signs of pain seen under general anesthesia ?
Movement Trembling Increase HR/RR Increase BP
55
What pain scale is commonly used in veterinary pain research where the observer marks a line that is then measured?
Visual analog scale
56
What pains scale has been validated for assessing post-op pain in dogs? It measures seven behavioral categories.
Glasgow composite pain scale Max score is 24 or 20 for non ambulatory
57
What are the analgesic strategies ?
Pre-emptive (if possible) - allows lower dose of anesthetics and analgesics - help prevent central sensitization Multimodal -use multiple analgesics that act on different points in pain pathway

RUSVM Anesthesiology (32 decks)

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