Pain PPT McDizzels Flashcards
Josh's guide to McDizzles riveting lecture on pain!!!!!!!! drop your socks grab your cocks you in for a ride!!!!!!!!!!
Fun Fact
Benedictus de Spinoza stated “pain is a localized form of ________”
sorrow
3 psychosocial factors that influence pain?
- intRApersonal (occurs within self)
- intERpersonal (Occurs between individuals)
- Social
where does pain Happen?
“brain”
pain isn’t pain until it gets to the brain
With the gate theory what happens when the gate is open?
pain
With the gate theory what happens when the gate is closed?
no pain
In relation to the DH (dorsal horn) NT (neurotransmitters):
what is found in large calls?
Excitatory amino acids (glutamate and aspartate)
In relation to the DH (dorsal horn) NT (neurotransmitters):
What do small cells contain?
- FRAP (fluoride-resistant acid phosphatase
- sP
- VIP (Vasoactive intestinal polypeptide)
- Somatistatin
- CCK (cholecystokinin)
- GRP (gastrin-releasing peptide
- CGRP (calcitonin-gene-related peptide
- ENK (leuenkephalin)
- DYN (dynorphin)
What are the 3 primary pathways to the brain? (ascending tract)
- Spinothalamic tract (STT)
- Spinoreticular tract (SRT)
- Spinomesencephalic tract (SMT)
Acute pain is a __________ experience!
multdimensional
Somatic events of acute pain are termed in:
- space, time, intensity
- motivational-emotional mechanisms
- Aversive behavior (avoiding behavior)
Psychological components or acute pain are?
- sensory-discriminative
- motivational-affective
- cognitive-evaluative
Visceral Structures (pain): what type of fibers involved
C-afferent fibers
A-delta fibers
(visCerAl)
Visceral Structures (pain): when do the C-afferent and A-delta fibers get activated? (what causes this type of pain)
-disease
-inflammation
-isometric contraction
-ischemia
-rapid distention
(remember these are organs- thus when you get appendicitis you hurt from the inflammation stretching, ischemia etc)
Visceral Structures (pain): C-afferent and A-delta fibers are activated by what?
noxious stimuli
alogenic substances
Visceral Structures (pain): the C-afferent fibers and A-delta fibers act as what???/
transducers
Visceral Structures (pain): the C-fibers and A-delta fibers are conducted to the \_\_\_\_ \_\_\_\_\_\_ or \_\_\_\_\_\_\_\_
dorsal horn
or
medulla
Visceral Structures (pain): The C-fibers and A-delta fibers are conducted to the dorsal horn and medulla, and are influenced by what?
intensity
duration
microenviroment
What are 2 ways to decrease pain?
- augmentation
- inhibition
what is inhibition
- counterirritation
- -rubbing, vibration, more sophisticated methods
what is augmentation?
- sensation by repeated noxious stimuli
- lowering the threshold by alogenic substances
What opens the Gate after nerve injury?
decreased inhibition
increased excitation
what the reduction in inhibitory postsynaptic currents the consequence of (r/t peripheral nerve injury related pain)
decreased GABA responsiveness
what causes the decreased GABA release and consequent reduced inhibition? (r/t teh gate theory)
apoptosis
Neuropathic Pain:
is a ____________ disease
neurodegenerative diseas
Neuropathic Pain:
what type of treatment can about the neuropathic pain?
neuroprotective
and
disease-modifying theraoy
what are the goals of an organized program for pain management?
educate pts
reduce incidence and severity of pain
enhance pt comfort and satisfaction
reduce post-op complications
what are the principles or treatment for pain?
- assessment requires rapport
- unreleived pain has negative effects
- all pain will not be eliminated
- prevention is better than treatment
- communication problems requuire special attention
- unexpected intense pain raises suspicion
what are controllable factors of pain
- HR
- Preload
- Afterload
Pain treatment:
the approach must be what?
- collaborative and interdisciplinary
- individual and proactive
- assessment intense
- formal and structured
what is involved in the pain assessment?
- Pt self report
- numerical or visual analog scale
- cognitive appropriate tools
Pyschological responses to pain include what?
- fear
- anxiety
- unpleasent uneasy feelings
- communication issues
What is known about communication issues and pain?
- 70% hospitalized pts did not discuss pain
- negative social connotations
- insignificant compared to others
- > 66% do not mention pain until severe
What are some adjunct treatments for pain management?
- cognitive behavior techniques
- systemic opioids or NSAIDs
- PCA
- Epidural analgesia
- INTERMTANT NEURAL BLOCKADE
- PHYSICAL AGENTS
- TENS
Contraindications for epidural
- Pt refusal (thats for you jake)
- coagulopathy
- infection at injection site
- uncorrected hypovolemia
Epidural complications
- Hypotension
- total spinal
- Local toxicity
- Headache
- Local site pain
- Zebras (also the red panda)
Continuous epidural analgesia dose, meds, rate etc. (this is just Mcd’s way)
10mL 0.25% bupivicaine (2.5mg/ml=25mg)
100 mcgs fentanyl
8 ml PF NS
After this loading dose maintain rate at 3-5 ml/hr
ITA advantages
excellent analgesia
no sympathetic block
ambulatory pt
ITA (with or without anesthetic) meds and doses
25 mcgs fentanyl
100-150 mcgs (0.2-0.3 ml) astromorph
What is the combined tech??? “the best of both worlds”
Perform ITA
place epidural catheter for later use if needed
Chronic pain:
is prolonged pain for how long?
> 6 months
Chronic pain: is can be _____ or _______ pain?
persistent
or intermittent
(eg. low back pain VS migraines)
Chronic pain:
what happens to endorphins?
May have decreased amount
Chronic pain:
may have a predominance of ____ neuron stimulation
C
Chronic pain:
due to adaptation what will happen to physical signs?
may be normal!
Chronic pain:
what are 9 syndromes that cause chronic pain?
Neuralgias Causalgia Complex regional pain syndrome (RSD) hyperesthesias Myofacial pain syndromes Hemiagnosia phantom leg pain Back d/o Herpes zoster
Chronic pain:
what are 3 chronic back d/o
Low back pain
Spinal stenosis
Lumbar radiculopathy
Music and the experience of pain:
what are the therapeutic use of music?
reduces pain
reduces anxiety
Reduces medication use
Improves pleasantness of recall
Accupunture dates back to when
1500 B.C.
Accupunture is the balance of what?
Yin
yang
What is yin and yang?
Yin- female, cold, death
Yang- Male, warm, Life
(i love how the non-round eyes associate women with cold and death, they are smarter than we though more than just math)
Accupunture
there are >____ points along the “meridians”
360
Accupunture probably works on what?
gate control
Hypnosis and the experience of pain:
what are some misconceptions?
loss of consciousness weakening of the will giving away secrets loosing control to the therapist inability to dehypnotize
Hypnosis and the experience of pain:
phases of Hypnosis!
I) induction
II) deepening and maintenance
III) utilization
IV) Termination
Hypnosis and the experience of pain:
induction techniques
closed eyes deep breathing
progressive relaxation
eye fixation
