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Pathophysiology 212 > Somatosensory Function, Pain, & Headache > Flashcards

Somatosensory Function, Pain, & Headache Flashcards

1
Q

Describe the function of the somatic nervous system

A

The somatic nervous system provides awareness of the body, both conscious and autonomic

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2
Q

What aspects does the somatic nervous system cover?

A
  1. tactile
  2. thermal
  3. position
  4. pain
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3
Q

Describe tactile, thermal, position, & pain

A 
1. Tactile 
Pressure/vibration
Initial response, often total adaptation
2. Thermal (thermoception)
Initial response, partial adaptation
3. Position (proprioception)
Sense of limb/body movement without using vision
4. Pain (nociception)
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4
Q

What is pain?

A

“Unpleasant sensory & emotional sensation associated with actual & potential tissue damage”

  • Warns of impending injury
  • Motivates seeking help
  • Motivates avoidance of future injury
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5
Q

What are the two main pathways of pain?

A

A & B – “fast pain”

  • Large, myelinated
  • Pressure/touch, cold, mechanical pain, heat pain

C – “slow pain”

  • Small, non-myelinated fibers
  • Mechanical/chemical/heat/cold pain
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6
Q

Three Levels of Neurons Involved inSomatic Sensation

A

First-order: detect the sensation

Second-order: in the spinal cord; transmit message to brain

Third-order:
in the brain

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7
Q

What is a dermatome?

A

Region of body wall supplied by single pair of dorsal root ganglia

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8
Q

Pain theories: Specificity theory

A

Pain is a separate modality caused by activity of a specific receptor (nociceptor)

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9
Q

Pain theories: Pattern theory

A

Pain receptors share pathways and/or nerve endings with other sensory modalities
Example: light touch may not cause pain, but heavy touch of same area may.

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10
Q

Pain theories: Gate control theory

A
  • Neural gate mechanisms in spinal cord can block pain info from going to brain by, for example, involving fibers that sense touch
  • Recent research suggests this is a simplistic approach
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11
Q

Pain theories: Neuromatrix theory

A
  • Multifactoral
  • Widely distributed neural network with genetic, cognitive and sensory influences
  • Helps explain phantom & chronic pain
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12
Q

Describe pain threshold

A
  • Point at which a nociceptive stimulus is perceived as painful
  • Uniform from person to person
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13
Q

Describe pain tolerance

A
  • Maximum intensity or duration of pain a person is willing to endure
    Variable:
  • psychological, familial, cultural, environmental
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14
Q

Describe acute pain

A

Short duration; ceases when cause removed
Serves as a warning
1. Early wave
- Hyperexcitability of neurons

  1. Secondary wave
    - Longer lasting
    - Inflammatory reaction to tissue injury
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15
Q

Describe chronic pain

A
  • When pain persists longer than normally expected
  • Highly variable
  • Often not “usual” pain characteristics
  • Peripheral (m/s, organ, vascular)
  • Peripheral-central (neuralgias, PLP)
  • Central (CNS disease/injury)
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16
Q

Possible negative consequences of Chronic Pain

A
  1. Physiological
    - Loss of appetite
    - Sleep disorders
  2. Psychological
    - depression
  3. Familial
  4. Economic
    chronic pain serves no useful purpose
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17
Q

Cutaneous pain

A
  • Arises from skin/subcutaneous tissue
  • Sharp, burning, abrupt/slow
  • Usually localized
18
Q

Deep somatic pain

A

-From deep structures (muscles, tendons, joints, blood vessels)
-Diffuse, radiation
E.g. angina

19
Q

Visceral pain

A
  • From activation of nociceptors of thoracic, pelvic, abdominal viscera (organs)
  • Highly sensitive to distension, ischemia, inflammation (i.e. diseases)
  • Relatively insensitive to cutting/burning
  • Diffuse, often referred
  • Deep/squeezing/sickening
  • Accompanied by nausea, vomiting, emotional changes
20
Q

Referred pain

A

-Originating in viscera; experienced as pain more near body surface
-Alone or concurrent with localized pain from source
Why?
-Visceral and peripheral neurons converge
-Structures develop nearby as embryo

21
Q

Describe pain terms

A

Analgesia: absensce of pain
Hyperalgesia: increased sensitivity to pain
Hypoalgesia: decreased sensitivity to pain
Hyperpathia: unpleasant, prolonged response to pain, explosive
Hyperesthesia: Abnormal increase in sensitivity to sensation
Hypoesthesia: Abnormal decrease in sensitivity to sensations
Paresthesia: Abnormal touch sensation without external stimuli; tingling, pins/needles
Allodynia: Pain produced by stimuli that do not normally cause pain

22
Q

Causes of neuropathic pain & focal/global

A

Causes (pathology of nervous system)
Pressure on nerve
Physical/chemical injury to neuron
Infection/ischemia/inflammation of neuron

Focal: trauma/disease of neuron
Global: endocrine disease (DM), neurotoxic meds, chronic alcoholism

23
Q

Neuropathic pain

A

Occurring without evidence of provocation
Widespread pain
Sensory deficits
Occurring with light touch (example of allodynia)
Burning/stabbing/etc.
Persistent/intermittent

24
Q

Neuralgias

A

Severe, brief, repetitive attacks of lightening-like/throbbing pain along spinal or cranial nerve
Usually precipitated by stimulation of cutaneous region supplied by nerve
So not “neuropathic” as stimulus begins in non-neuronal tissue
Trigeminal neuralgia
Postherpetic neuralgia

25
Q

Trigeminal Neuralgia

A
  • Most common
  • Most severe
  • Facial tics/spasms
  • Triggers:
  • Light touch
  • Movement
  • Drafts
  • Eating
  • Possibly d/t trigeminal nerve damage
26
Q

Postherpetic Neuralgia

A

-Chronic pain after shingles (herpes zoster)
-Varicella-zoster virus causes damage
-Dormant in dorsal root ganglia
-Variable pain types
Triggers
-Light touch
-Cold wind
-Clothing

27
Q

Complex Regional Pain Syndrome (CRPS)

A
  • Rare
  • Autonomic & vasomotor instability more sensitive that -associated injury warrants
  • Begins with one limb, then expands
  • Severe pain or hyperalgesia
  • Edema, skin blood flow changes
  • Abnormal sensorimotor activity
  • CRPS-I: no definable injury to nerve
  • CRPS-II: allodynia/hyperalgesia after injury
28
Q

Describe headaches: Primary & Secondary

A
  1. Primary
    -Migraine/tension-type/cluster/chronic daily
  2. Secondary
    -With/following serious disease
    -Meningitis, cerebral tumor or aneurysm
    -Triggered by disturbed sleep or over-exertion
    Accompanied by neurologic symptoms
    - Mentation changes, visual or limb disturbances
29
Q

Describe migraine headaches

A

-Thought to be inherited
-Without aura (85%)
Pulsatile, throbbing, unilateral
Lasts 1-2 days
-Aggravated by physical activity
-Accompanied by
nausea/vomiting
Light/sound sensitivity
Visual hallucinations (sparks, flashes, etc)

30
Q

Migraine with Aura

A

Similar symptoms plus pre-symptoms (aura)
Aura develops over 5-20 minutes, lasts up to one hour
- Characteristics vary but are fully reversible
Visual symptoms
- Flickering lights/spots, loss of vision
Sensory symptoms
- pins/needles, numbess
Speech or neurological disturbances

31
Q

Retinal Migraine

A
  • Rare

- Recurrent, fully reversible scintillations (light flashes), scotomata (blind spots), blindness in one eye

32
Q

Chronic migraine

A

15+ days/month x 3 months

33
Q

Transformed Migraine

A
  • Similar symptoms to tension-type or sinus headache

- Possibly d/t cranial parasympathetic activation

34
Q

Childhood periodic syndrome Migraine

A 
- Often related to a serious disease process
3 of the following:
-Abdominal pain
-N/V
-Throbbing h/a
-Unilateral location
-Aura
-Relief with sleep
-Positive family hx.
35
Q

Patho of Migraines

A

Not well understood
Trigeminal cranial nerve activation is common
Altered hormonal levels
- Estrogen thought to be related

Possible triggers
- Monosodium glutamine, chees, chocolate, etc.

36
Q

Cluster Headache

A 
Uncommon
Possibly hereditary
Activation of trigeminal nerve and ANS
Possible hypothalamus involvement
Men > women
30-70 years old 
Lasts for weeks/months, then remission
37
Q

Cluster Headache Manifestations

A

-Rapid onset pain, lasting 15-180 minutes
-Severe, constant, unilateral
-Orbital most common area
-Can radiate to temple, cheeks, gums
Accompanied by:
-Restlessness/agitation
-Conjunctival redness, lacrimation
-Nasal congestion, rhinorrhea
-Facial sweating
-Miosis (pupil constriction), ptosis, eyelid edema

38
Q

Tension-Type Headache

A

-Usually don’t interfere with daily activities
-Dull, aching, diffuse
-Not associated with nausea/vomiting
-Possibly type of migraine
Associated with
-Scalp/neck muscle tension
-Oromandibular dysfunction
-Stress, anxiety, depression

39
Q

Chronic Daily Headache (CDH)

A

15+ days/month
No known cause
Often resembles other headache types

40
Q

Tempomandibular Joint (TMJ) Pain

A
  • Imbalanced joint movement
  • Poor bite, bruxism (clenching), inflammation, trauma, degeneration
  • Pain: facial, head, neck, ear
41
Q

Children and Pain

A
  • Respond to nociceptive stimuli as neonates
  • Demonstrate pain memory as infants
  • Reliable/accurate reporters of pain at young age
42
Q

Older Adults and Pain

A
  • Common types
  • Musculoskeletal (OA, back)
  • Rheumatologic (RA)
  • Neurologic (DN, postherpetic neuralgia)
  • Unrelieved pain can result in
  • Gait disturbances, muscle wasting
  • Impaired appetite
  • Sleep disturbances
  • Decreased cognition
  • Economic impact

Pathophysiology 212 (18 decks)

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