SM_250a: Acute vs. Chronic Pain Flashcards
Chronic pain is pain lasting ____
Chronic pain is pain lasting > 3 months
Nociceptive pain is ____, while neuropathic pain is ____
Nociceptive pain is due to tissue injury, while neuropathic pain is due to damage to the nervous system
Describe the ascending pain pathway
Ascending pain pathway
- Injury -> cell damage -> cytokines (mainly prostaglandins) released -> afferent neuron goes into dorsal horn of spinal cord -> release of substance P -> activates motor neuron -> cross over -> spinothalamic tract -> thalamus -> somatosensory cortex and other areas of brain
- A delta and C fibers are primary afferent neurons: peripheral nerves that cross over into spinal cord
Thalamus is ___ for pain signals
Thalamus is relay station for pain signals
(spinothalamic tract -> thalamus -> somatosensory cortex and other areas of brain)
Dorsal horn ___ peripheral nervous system
Dorsal horn is NOT in the peripheral nervous system
Modulation is when ____
Modulation is when inhibitory signals from the brain and spinal cord to the dorsal horn of the spinal cord limit transfer of incoming sensory input to the brain
(ability to do this in acute phases of injury leads to a person’s ability to withstand severe pain for a short period of time and control response to any pain stimuli, patients with chronic pain often have some loss of function of descending inhibitory modulation)
Patients with chronic pain often have ____ of descending inhibitory modulation
Patients with chronic pain often have loss of function of descending inhibitory modulation
Plasticity is ____
Plasticity is nervous system’s ability to reorganize itself and adjust its function and activity in response to new situations or changes in their environment
In chronic pain, plasticity is maladaptive because ____
In chronic pain, plasticity is maladaptive because it contributes to a more hypersensitized nervous system responsible for perpetuation of chronic pain
Describe peripheral sensitization
Peripheral sensitization
- Occurs with changes in signaling in the peripheral nervous system
- Reduces threshold for firing of nociceptors in skin
- Can happen acutely or chronically
- May result in allodynia or hyperalgesia
Allodynia is ____
Allodynia is pain to a non-painful stimulus
Hyperalgesia is ____
Hyperalgesia is severe pain to a mildly painful stimulus
Describe the steps in peripheral sensitization
Peripheral sensitization
- Substances released by damaged tissue augment the response of nociceptive fibers
- Electrical activation of nociceptors causes the release of peptides and neurotransmitters that further contribute to the inflammatory response
- Result in hyperalgesia
Central sensitization is a persistent state of ____, ____ threshold for what causes pain, and maintains ____
Central sensitization is a persistent state of high reactivity, lowers threshold for what causes pain, and maintains pain even after initial injury might have healed
Describe central sensitization
Central sensitization
- Rewiring of the nerve connections centrally
- May be in part due to loss of descendung inhibition
- Activity levels in nociceptive afferents that were subthreshold prior to the sensitizing event become sufficient to generate action potentials in dorsal horn neurons contributing to pain sensitivity
- Allodynia
- Hyperalgesia
In central sensitization, activity levels in ____ that were subthreshold prior to the sensitizing event become sufficient to generate action potentials in ____, contributing to pain sensitivity
In central sensitization, activity levels in nociceptive afferents that were subthreshold prior to the sensitizing event become sufficient to generate action potentials in dorsal horn neurons, contributing to pain sensitivity
Central sensitization leads to ____, ____, ____, and ____
Central sensitization leads to heightened sensitivities across all the senses, cognitive deficits, increased anxiety, and sick role behaviors
____ serves as a warning of potential or indicator of actual tissue damage and is a protective mechanism within the body
Perception of pain serves as a warning of potential or indicator of actual tissue damage and is a protective mechanism within the body
Compare acute versus chronic pain
Acute vs. chronic pain
- Acute pain: occurs from injury or trauma, is signal to body that something is injured and needs to be healed, has expected duration of time, resolves once tissue recovers
- Chronic pain: continues past the time of healing for the initial injury, structural changes occur in peripheral nervous system and brain (plasticity), symptoms of unremitting and spontaneous shooting or burning sensations and abnormal sensitivity to normally noxius stimuli on exam
Chronic pain involves messages that are ____ but become the focus of ____ and ____
Chronic pain involves messages that are no longer useful or protective but become the focus of impairment and limitation
Pyschologic components of pain include ____ and ____ factors
Pyschologic components of pain include affective and cognitive factors
- Affective factors: depression, anxiety, anger
- Cognitive factors: catastrophizing, fear, helplessness, decreased self-efficacy, pain coping, readiness to change, acceptance
Triad of ____, ____, and ____ leads to ____ in chronic pain
Triad of pain, depression / anxiety, and sleep disturbances leads to functional impairment in chronic pain
Depressed patients perceive ____ pain
Depressed patients perceive more pain
Acute pain is treated via the ____ mode, which states that ____
Acute pain is treated via the biomedical treatment model, which states that pain is a sensory event reflecting underlying disease or tissue damage
Chronic pain necessitates a ____ model, which involves ____ including ____, ____, ____, ____, and ____
Chronic pain necessitates a biopsychosocial model, which necessitates interdisciplinary treatment including pain psychology, phyical therapy, occupational therapy, relaxation training / biofeedback, and vocational treatment
____ is NOT a goal of treatment of chronic pain
Resolution of pain is NOT a goal of treatment of chronic pain
