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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
Q

What ascending tract transmits deep and visceral pain?

A

Spinorecticular tract

26
Q

What are the descending inhibitory pain pathways?

A

Input received from cerebral cortex and ascending paint pathways—> midbrain

  • Periaqueductal gray matter (PAG)
  • Nucleus raphe magnus (NRM)
27
Q

How do the descending inhibitory pain pathways inhibit the pain?

A

Release endorphins (endogenous opioids), serotonin, and NE which inhibit pain transmission at the level of the dorsal horn

28
Q

Head pain is transmitted along what nerve?

A

Trigeminal

29
Q

What are systemic consequences of unmanaged pain?

A

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
Q

What is allodynia?

A

Pain evoked by a stimulus that does not normally cause pain

31
Q

What is hyperalgesia?

A

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
Q

What is peripheral sensitization?

A

Increase in the activity, excitability, and responsiveness of peripheral nerve terminals, leading to primary hyperalgesia

33
Q

What is windup ?

A

Summation of painful stimulation in the spinal cord, mediated by Cfibers contributing to central sensitization

34
Q

What is central sensitization ?

A

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
Q

What is peripheral sensitization?

A

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
Q

In peripheral sensitization, how does the threshold of A-delta and C fibers change?

A

Lower threshold for pain —> primary hyperalgesia

37
Q

What is the MOA of windup pain?

A

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
Q

T/F: central sensitization results in hyperalgesia, allodynia, spontaneous pain, and pain memory

A

True

39
Q

What is pre-emotive analgesia?

A

Prevent peripheral/central sensitization

Decreases total analgesic requirements

40
Q

Topical local anesthetics inhibit what part of the pain pathway?

A

Transduction

41
Q

NSAIDS inhibit what part of the pain pathway?

A

Transduction

Modulation

42
Q

Opioids, A2 agonists, and NMDA antagonists interrupt nociceptive at what part of the pain pathway?

A

Modulation

-opioids and A2 agonists also inhibit perception

43
Q

What types of drugs inhibit transmission of nociception?

A

Local anesthetic

Epidural

44
Q

What are generalized pain behaviors?

A 
Decreased appetite, sleeping time, grooming 
Change in facial expression 
Limping/lameness 
Abnormal pressure 
Licking, scratching, self-mutilation 
Vocalization 
Aggression 
Poor body condition
45
Q

“Praying position” indicates what type of pain in dogs?

A

Abdominal pain

46
Q

A head tilt may indicate what type of pain in dogs?

A

Ear

47
Q

What behavioral changes can you see in a canine with pain?

A

Decreased activity, social withdrawal
Aggression
Guarding of painful site

48
Q

What are behaviors that can be seen in felines that indicate pain?

A

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
Q

What are equine pain behaviors?

A

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
Q

Sweating, rolling, flank-watching or biting, pawing, kicking indicates what type of pain in horse?

A

Colic

51
Q

What are behaviors associated with pain in ruminants ?

A 
Brutish (teeth grinding), hyper salivation 
Abnormal facial expression 
Decreased appetite and rumination 
Decreased milk production 
Isolation from herd 
Vocalizaiton, grunting
52
Q

What biological markers can indicate pain ?

A 
Cortisol 
Glucose 
Catecholamines 
Endorphins, enkephalins 
Lactic acid and free fatty acids
53
Q

T/F: anesthetized animals can experience pain and peripheral and central sensitization are not prevented by general anesthesia

A

True

54
Q

What re signs of pain seen under general anesthesia ?

A

Movement
Trembling
Increase HR/RR
Increase BP

55
Q

What pain scale is commonly used in veterinary pain research where the observer marks a line that is then measured?

A

Visual analog scale

56
Q

What pains scale has been validated for assessing post-op pain in dogs? It measures seven behavioral categories.

A

Glasgow composite pain scale

Max score is 24 or 20 for non ambulatory

57
Q

What are the analgesic strategies ?

A

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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