Pain: Status, Definitions & Conflations Part 2 Flashcards
The biological relationship of damage, nociception, and pain that attempts to explain pain conditions like phantom limb pain and complex regional pain syndrome.
Pain Science
T/F - Pain exists with and without the presence of objective physical structural findings or tissue damage.
True
A high-threshold sensory receptor of the peripheral somatosensory nervous system that is capable of transducing and encoding noxious stimuli.
Nociceptor
A central or peripheral neuron of the somatosensory nervous system that is capable of encoding noxious stimulation.
Nociceptive Neuron
A stimulus that is damaging to or threatens damage to normal tissues.
Noxious Stimuli
A neural process of encoding and processing noxious stimuli.
Nociception
Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.
Nociceptive (Hypothesis of Somatic Mechanism) Pain
Increased responsiveness of nociceptive neurons to their normal input, and/or recruitment of a response to normally subthreshold inputs.
Sensitization
To convert something, such as energy or a message, into another form.
Transduce
To convert something, such as a body of information, from one system of communication into another.
Encode
The labelling of nociceptors as pain fibres was not an admirable simplification but an unfortunate ______________.
Trivialization
T/F - It is acceptable to conflate pain and nociception.
False - It is UNACCEPTABLE to conflate pain and nociception.
An individual, unique sensory and emotional experience that requires consciousness. It can be unpleasant for most.
Pain
T/F - Pain can only be reported by the person experiencing it.
False - Pain can be reported by AND/OR OBSERVED IN the person experiencing it.
___________ is a nervous system process that is not conscious and involves chemical and electrical information.
Nociception
T/F - Pain cannot be processed because it is an experience.
True
The free nerve endings of the _______ and C-fibres are the most prevalent, and most studied.
A-delta
T/F - All A-delta and C-fibres are nociceptors.
False - NOT all A-delta and C-fibres are nociceptors.
T/F - Not all nociceptors are A-delta and C-fibres.
True
A-delta and C-fibres are mostly high-threshold ________________, therefore they need more input to function properly.
Mechanoreceptors
A typical neuron consists of a cell body, _________, and a single axon.
Dendrites
The primary afferent axon of proprioception from muscle spindles and golgi tendon organs.
A-alpha
The primary afferent axon of noxious and non-noxious mechanical and thermal stimuli.
A-beta
The primary afferent axon of hair follicle detection and noxious mechanical stimuli.
A-delta
The primary afferent axon of noxious and non-noxious mechanical, thermal and chemical stimuli, including hair follicles.
C-fibre
Hair follicles are also innervated by ________, which are considered slow conducting and high threshold.
C-fibres
T/F - C-fibres have nociceptive function and pick up a stimulus from hair to hair over receptive fields.
False - C-fibres DO NOT have nociceptive function and pick up a stimulus from hair to hair over receptive fields.
When A-beta ( ____ conductors) are not specialized, they can act as free nerve endings and respond to mechanical stimuli, including _______ stimuli.
Fast
Noxious
Fat, myelinated fibres are the _______ and thin, unmyelinated fibres are the _______, when it comes to speed.
Fastest
Slowest
T/F - A-delta and C-fibres are considered the fastest.
False - A-delta and C-fibres are considered the SLOWEST.
A-delta and C-fibres are stimulated by high intensity __________, noxious heat and noxious cold to trigger a signal.
Mechanical
T/F - Noxious stimulus is not equivalent or indicative of pain.
True
Some examples of ________ noxious stimuli include:
- Hammering your nail (mechanical)
- Flame (first degree burns) and ice (thermal)
- Acid (chemical)
External
Some examples of ________ noxious stimuli include:
- Inflammation (chemical or healing processes from tissue damage)
- Progressive inflammatory conditions (e.g. RA, Ankylosing Spondylitis)
- Pronociceptive antibodies (neuroimmune response)
Internal
Nociceptors respond to noxious ____, noxious ____ and high threshold mechanical stimuli as well as a variety of ________ mediators.
Cold
Heat
Chemical
T/F - Every nociceptor responds to each of the noxious stimuli.
False - NOT every nociceptor responds to each of the noxious stimuli.
T/F - Application of a high intensity stimulus of one modality may alter the response properties of the nociceptor to other modalities.
True
Mechanical receptors that detect, transduce, and encode tissue damage information from a hammer blow may then become responsive to ____________, along side specific ________ nociceptors already detecting, transducing, and encoding information.
Inflammation
Chemical
Consequences of encoding may be autonomic, such as elevated blood pressure, or __________, such as a motor withdrawal reflex.
Behavioural
T/F - Pain sensation is not necessarily implied when it comes to nociception because the process can occur without reaching conscious levels.
True
Clinically, sensitization may only be inferred indirectly from phenomena such as hyperalgesia or _________.
Allodynia
Increased responsiveness and reduced threshold of nociceptive neurons in the periphery to the stimulation of their receptive fields.
Peripheral Sensitization
Increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold afferent input.
Central Sensitization
Pain due to a stimulus that does not normally provoke pain. It may be seen after different types of somatosensory stimuli applied to many different tissues.
Allodynia
Increased pain from a stimulus that normally provokes pain. Often present in patients with neuropathy.
Hyperalgesia
What does IASP stand for?
International Association for the Study of Pain
T/F - Clinical descriptors such as nociceptive, nociplastic, and neuropathic are types of pain.
False - Clinical descriptors such as nociceptive, nociplastic, and neuropathic are NOT types of pain.
Clinical descriptors are __________ of somatic mechanism.
Hypotheses
An umbrella term used to describe a group of rare genetic diseases, also classified as hereditary sensory autonomic neuropathies.
Congenital Insensitivity to Pain (CIP)
T/F - There are a few kinds of CIP diseases, all of which have the same pathologic mechanism.
False - There are MANY kinds of CIP diseases, NOT all of which have the same pathologic mechanism.
__________ insensitivity to pain highlights the conflation between pain and nociception and the deficit is with ___________, not ____.
Congenital
Nociception
Pain
T/F - You cannot be insensitive to pain if you’ve never learned to feel it.
True
Rather than pain being an alarm, ___________ is the alarm. CIP is what happens when ___________ fails.
Nociception
T/F - There is a lack of qualitative studies of the experiences of patients with CIP, therefore it has been concluded prematurely that those with the diagnosis do not feel pain.
True
Limited studies that do exist record persons with CIP describing head and _______ pain.
Stomach
A term associated with tissue damage (noxious stimulation). May be due to inflammation, poor blood supply to tissues, injury or invasion by cancer.
Nociceptive
The nociceptive “_________” conveys or transduces encoded information about tissue damage to the CNS.
Apparatus
Pain caused by a lesion or disease of the somatosensory nervous system.
Neuropathic (Hypothesis of Somatic Mechanism) Pain
___________ pain is a clinical ___________ (and not a diagnosis) which requires a demonstrable lesion or a disease that satisfies established neurological diagnostic criteria.
Neuropathic
Description
The following are examples of ___________ pain:
- Herpes zoster abd postherpetic neuralgia
- Painful diabetic and other peripheral neuropathies
- Spinal cord injury pain
- Central post-stroke pain
- Failed back surgery syndrome
- Complex regional pain syndrome
- Trigeminal neuralgia
- Multiple sclerosis
Neuropathic
T/F - A radiculopathy is an example of neuropathic pain.
True
More commonly called a “pinched nerve.” Symptoms occur when a nerve is compressed or irritated where it branches away from the spinal cord.
Radiculopathy
A _____________ may cause pain, muscle weakness, numbness and tingling that radiates into the limbs and extremities.
Radiculopathy
___________ pain may be present due to:
- Nociceptive sprouts lesioned within a degenerated disc
- Mechanical compression of the nerve root (may not be visible through imaging)
- Inflammatory mediators
Neuropathic
Mixed drivers can be present with a ____________ disc that does not present with obvious or documented mechanical ___________.
Degenerative
Compression
Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.
Nociplastic (Hypothesis of Somatic Mechanism) Pain
T/F - Nociplastic pain applies to patients reporting pain without hypersensitivity.
False - Nociplastic pain applies to patients reporting pain WITH hypersensitivity.
The new descriptor is intended to ___________ patients suffering from conditions where altered nociception has been __________ from those where the pain mechanisms are still truly _______. Therefore, the new descriptor does not apply to patients reporting pain without hypersensitivity. As such, it is neither a synonym for idiopathic pain or pain of unknown origin nor a label awarded by exclusion.
Distinguish
Documented
Unknown
Nociplastic is based … on the inference that _______ central nociceptive function may be responsible for the __________ dimension of the experience of pain.
Altered
Biomedical
A term that comes from nociceptive plasticity and supposes changes to the nociceptive apparatus. It distinguishes pain from nociceptive or neuropathic mechanisms.
Nociplastic
Nociplastic acts as a descriptor of the probably mechanism by which altered _______ nociceptive function occurs in at least some chronic pain states.
Central
___________ is characterized by features that suggest altered nociceptive function, such as allodynia and hyperalgesia.
Nociplastic
T/F - Nociplastic pain is the same as idiopathic pain.
False - Nociplastic pain is NOT the same as idiopathic pain.
T/F - Nociplastic pain is not the same as central sensitization.
True
Central sensitization (of nociception) may be the _____________ change that is responsible for such altered function.
Physiological
Experimentally, central sensitization may be induced by prolonged activation of peripheral nociceptors (“_________”) but it may also reflect a response to prolonged non-noxious input from other stressors (“________”).
Bottom-Up
Top-Down
We may not yet have experimental evidence but we do have, firstly, concepts of enhancing and inhibiting nociception through ____________ processes and, secondly, _________ observation.
Neuro-immune
Empirical
___________ pain mechanisms may be present in the following conditions:
- Fibromyalgia
- Chronic fatigue syndrome (CFS)
- Myalgic encephalomyelitis (ME)
- Complex regional pain syndrome (CRPS)
- Chronic lyme disease
- Persistent low back pain
- Irritable bowel disease
Nociplastic
T/F - The labels we use for pain are considered constructs.
True
T/F - The descriptor “nociplastic pain” is the same as the illness label.
False - The descriptor “nociplastic pain” is NOT the same as the illness label.
A diagnostic descriptor for illnesses such as fibromyalgia, chronic low back pain, and CRPS, are distinct and different from the ____________ mechanisms of pain that might be present with these conditions.
Hypothesized
T/F - Never conflate the probably mechanism of pain with a diagnosis that involves so much more.
True
A diagnosis of fibromyalgia is made following a clinical evaluation which includes a history of current __________, attention to past health status and a physical examination, without any confirmatory __________ test.
Complaints
Diagnostic
T/F - Criteria for the diagnosis of fibromyalgia were developed for research purposes, therefore they may not be used to validate a clinical diagnosis.
False - ALTHOUGH criteria for the diagnosis of fibromyalgia were developed for research purposes, they MAY be used to validate a clinical diagnosis.
Specialist confirmation or fulfilling diagnostic criteria is not required for ____________. Most physicians rely on a combination of symptoms and normal _____ testing to diagnose it with less than 10% using criteria.
Fibromyalgia
Blood
T/F - The ACR 2010 diagnostic criteria for fibromyalgia can be used at final assessment to validate a clinical diagnosis with the understanding that symptoms very over time.
False - The ACR 2010 diagnostic criteria for fibromyalgia can be used at INITIAL assessment to validate a clinical diagnosis with the understanding that symptoms very over time.
Some diagnostic criteria for ____________ includes:
- Pain
- Fatigue
- Non-restorative sleep
- Cognitive dysfunction
- Mood disorder
- Pain-related somatic symptoms
- Non-pain related symptoms
Fibromyalgia
