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Module 8 > Pain - Physiology to Pharmacology > Flashcards

Pain - Physiology to Pharmacology Flashcards

1
Q

how does affective (emotional) states influence the magnitude of pain experience

A

presentation of negative pictures caused a decrease in pain tolerance (positive pictures had opposite effect)

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2
Q

what are the different descriptors of pain

A

1-3 = temporal descriptions

  1. acute
  2. chronic
  3. intermittent

4-5 = neurobiological descriptions

  1. inflammatory
  2. neuropathic

6-7 = spatial descriptions

  1. visceral
  2. somatic
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3
Q

what is physiological pain

A

pain proportional to intensity of noxious stimulus

protects againts further injury

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4
Q

what is pathological pain

A

pain greater than apparent noxious stimulus

detrimental

ex. phantom limb pain

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5
Q

what is the pain pathway

A
  1. nociceptor generates an action potential (transduction)
  2. afferent fibre: conducts action potential to CNS (transmission)
  3. spinal cord: processing occurs at the level of the dorsal horn (modulation)
  4. brain: conscious experience of pain
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6
Q

what are the areas in the brain involved in pain perception

A
  1. primary and secondary sensory cortex
  2. thalamus
  3. midbrain
  4. pons
  5. brainstem
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7
Q

what is nociception

A

detection of noxious stimuli that actually or potentially cause damage to organism

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8
Q

what do nociceptors respond to

A
  1. intense mechanical deformation
  2. potentially damaging temperatures
  3. noxious chemical stimulation
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9
Q

what do C fibres respond to

A
  1. tissue damaging stimuli
  2. sharp blow
  3. damaging heat
  4. chemicals released by mechanically damaged tissue (inflammation)
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10
Q

are C fibres myelinated or unmyelinated

A

unmyelinated

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11
Q

are C fibres slow or fast conducting

A

slow

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12
Q

do C fibres respond to dull or sharp pain

A

dull burning pain

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13
Q

are C fibres large or small diameter

A

small

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14
Q

are A fibres large or small diameter

A

large

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15
Q

are A delta fibres myelinated or unmyelinated

A

unmyelinated

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16
Q

are A delta fibres short or fast conducting

A

fast conducting

17
Q

do A delta fibres respond to dull or sharp pain

A

sharp pain

18
Q

what are A delta fibres activated by

A

stimuli that produce strong shearing force in skin (cut, strong blow, tug on a hair)

19
Q

what are the inhibitory influences in the pain perception

A
  1. descending inhibition: descending pathways from periaqueductal grey (PAG) and rostral ventromedial medulla (RVM) contain endogenous opoid pathways –> project to dorsal horn to reduce transmission
  2. gate control: activation of AB fibres with tactile, non-noxious stimuli activates inhibitory interneurones in the dorsal horn –> rubbing alleviates pain
20
Q

what is peripheral sensation

A

inflammatory mediators (PGs, increase nociception activation)

21
Q

what is central sensation

A

repetitive nociception input enhances transmission at level of dorsal horn (NMDA receptor)

22
Q

what is hyperalgesia

A

an increased response to a stimulus which is normally painful

primary or secondary

23
Q

what is allodynia

A

pain due to a stimulus which doesn’t normally provoke pain

24
Q

what occurs during continuing or repeated stimulation of nociceptors

A

become increasingly reactive (hyperexcitable) with continuing or repeated stimulation

sensation of peripheral nociceptors so that they transmit an amplified signal to the spinal relay centre

chemically mediated

25
Q

what is central sensitization

A

over activity of second-order neurons in the dorsal horn leads to enhanced pain transmission

associated with changes within and between neurons

can be transitory or permanent

26
Q

what is analgesia

A

absence if pain or a reduction in intensiry of pain perceived

27
Q

what are analgesic drugs

A

local anaesthetics

opioids

non-steroidal anti-inflammatory drugs

alpha 2 adrenoceptor agonists

ketamine

nitrous oxide

28
Q

what are non-pharmacological methods do reduce pain

A

nursing care

physiotherapy

acupuncture

transcutaneous electrical nerve stimulation (TENS)

29
Q

where are the sites of drug action

A
  1. brain: sensory cortex (opiods interfere with central conscious perception of pain)
  2. spinal cord: dorsal horn (opioids & alpha 2 agonists modulate neurotransmission
  3. afferent fibre: local anaesthetics inhibit transmission
  4. nociceptor: NSAIDs reduce production of inflammatory mediators
30
Q

what is preventative analgesia

A

admin of analgesic drugs throughout the perioperative period

to prevent or limit the development of sensitization induced by pre-, intra- or post-operative noxious stimulation

31
Q

what is multimodal analgesia

A

use of a combination of drugs that act at different points in the nociceptive pathway

more effective analgesia with fewer adverse effects

Module 8 (43 decks)

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