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Patho Final > Somatosensory Modalities, chap 35 > Flashcards

Somatosensory Modalities, chap 35 Flashcards

1
Q

Tactile

A

pressure/vibration

Initial response often total adaptation. Put shirt on but get used to it

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2
Q

Thermal

A

Initial response partial adaptation. Go into the sun and feel it stronger at first, but still feel it

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3
Q

Position

A

(proprioception)

Sense of limb /body movement without using vision

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4
Q

Somatic Nervous system:

A

Provides awareness of the body, both conscious and autonomic

  1. Tactile
  2. Thermal
  3. Position
  4. Pain
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5
Q

Pain

A

An unpleasant sensory and emotional sensation associated with actual or potential tissue damage.

  1. warns of impeding injury
  2. motivates to seek help
  3. motivates avoidance of future injury
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6
Q

Two main pathways of pain:

A

A and B: “fast pain”-

    • large myelinated fibers
    • Pressure/touch…… cold, mechanical/heat pain.

C: “slow pain”

    • small non-myelinated fibers
    • Warm/hot, chemical…… mechanical/ heat/cold pain
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7
Q

3 levels of neurons involved in somatic sensation:

A

1st order- transmit sensory info from perifery to CNS

2nd- communicate sensory paths in spinal cord to thalamus

3rd- from thalamus to cerebral cortex

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8
Q

Dermatome

A

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

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9
Q

Pain Theories: 4

  1. specificity theory
A

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

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10
Q

Pain Theories: 4

  1. Pattern theory
A

Pain receptors share pathways and/or nerve endings with other sensory modalities

ex. light touch may not cause pain, but heavy touch might cause pain in that same area

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11
Q

Pain Theories: 4

  1. Gate control theory
A

combined specificity and pattern.

Neural gate mechanisms in spinal cord can block pain info from going to brain by involving brain fibers that sense touch

Research: simplistic approach

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12
Q

Pain Theories: 4

  1. Neuromatrix
A

Multifactorial: genetic, cognitive, sensory influences of the neural network

helps explain phantom pain

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13
Q

Pain threshhold

A

point at which a nociceptive stimulus is perceived as painful

uniform from person to person

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14
Q

Pain tolerance

A

Maximum intensity or duration of pain a person is willing to endure 3/10?

Variable: psychological, familial, cultural, environmental

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15
Q

Acute Pain

A

short term duration

serves as a warning

  1. Early wave: activates nociceptive stimuli at site of injury and hyperexcites the neurons in the CNS
  2. Second wave: longer lasting
    - -> inflam reaction to tissue injury ex. papter cut hurts at first but goes away bc of inflam process
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16
Q

Chronic Pain

A

when pain persists longer than normal ex ca

Highly variable- often not usual pain characteristics

  1. Peripheral: musculoskeletal
  2. Peripheral-Central: neuralgias, phantom, limb pain
  3. Central: CNS disease/injury
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17
Q

Possible negative consequences of chronic pain

A
  1. Physiological: loss appetite, sleep
  2. Psychological: depression
  3. Familial: everyone suffers
  4. Economic
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18
Q

Cutaneous pain

A

> skin/sc tissue

> sharp, burning, abrupt/slow

> usually localized

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19
Q

Deep Somatic pain

A

> from deep structures: muscle, tendon, bone

> diffuse, radiation

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20
Q

Visceral Pain

A

> from activation of nociceptors of thoracic, pelvic, abd vescera. Very deep!

    • highly sensitive to distension, ischemia, inflam
    • not to cutting and burning
21
Q

Reffered Pain

A

> Originating in viscera: experienced as oain more near body surface ex. heart attach and pain felt in arm

> alone or concurrent with localized pain from source

WHY?
> the visceral and peripheral neurons converge
> structures develop as embryo and stay connected

22
Q

Analgesia

A

Absence of pain

23
Q

Hyperalgesia

A

increased sensitivity to pain

24
Q

Hypoalgesia

A

Decreased sensitivity to pain

25
Q

Hyperpathia

A

Unpleasant, prolonged, response to pain. Explosive. An overreaction

Pain threshold is elevated

26
Q

Hyperesthesia

A

Abnormally increase in sensitivity to sensation

ex. hearing, smells, touch

27
Q

Hypoesthesia

A

Abnormal decrease in sensitivity to sensation

ex, hearing, smells, touch

28
Q

Paresthesia

A

Abnormal touch sensation without external stimuli; tingling, pins/needles

29
Q

Allodynia

A

Pain produced by stimuli that do not normally cause pain.

A mild touch that hurts someone

30
Q

Neuropathic pain

A

Causes:
> 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

  1. unexplainable pain
  2. occurring without evidence of provocation
  3. widespread pain
  4. sensory deficits (paresthesia/numb)
  5. occurring with light touch (allodyna)
  6. burning/stabbing ect.
  7. persistent/intermittent
31
Q

Neuralgias

A

> severe, brief, repetitive attacks of lightening-like throbbing pain along spinal cranial nerve

> usually percipitation by stimulation of cutaneous region supplied by nerve

  1. Trigeminal neuralgia (5th)-face and jaw
  2. postheraputic neuralgia (after shingles)
32
Q

Trigeminal Neuralgia (Tix Douloureux)

A

most common, most severe
Facial spasms

Triggers:
> light touch
>movement
>drafts
> eating

possibly d/t trigem nerve damage

33
Q

Postherpetic Neuralgia

A

> chronic pain after shingles (herpes zoster)

  • -dormant in dorsal root ganglia
    • variable pain types

> Triggers:

  • -light touch
    • cold wind
    • clothing can hurt
34
Q

Complex Regional Pain Syndrome (CRPS)

A
  1. rare, has variable changes
  2. Autonomic and vasomotor instability more sensitive than associated injury warrants
  3. begins with one limb then expands
  4. severe pain or hyperalgesia
  5. edema, skin blood flow change
  6. abnormal sensory motor activity

CRPS-1: no definable injury, allodynia
CRPS-2: allodynia/hyperalgesia after injury

35
Q

Headaches

Primary:

Secondary:

A

P:
>migraine/tension-type/cluster/chrinic daily

S:
>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

36
Q

Migraine Headache:

Without aura:

A

> thought to be inherited

> Pulsatile, throbbing, unilateral

> lasts 1-2 days

> aggravated by physical activity

> accompanied by

    • N/V
    • Light/sound sensitivity
    • Visual hallucinations (sparks, flashes, ect)
  • -some ppl without aura may have prodromal symptoms such as fatigue, irritable for hrs or days bfr
37
Q

Migraine Headache:

With aura:

A

> similar symptoms plus pre-symptoms (aura)

> aura develops over 5-20 min, lasts up to one hr
– characteristics vary but are fully reversible

> visual symptoms
–flickering light/spots, loss of vision

> sensory symptoms
– pins/needles, numbness

> speech or neurological disturbances

38
Q

Retinal Migraine

A

Rare
> recurrent, fully reversible scintillations (flash or spark of light), scotomata (area or alteration in feild of vision), blindness in one eye

39
Q

Chronic migraine

A

15 days/month x 3 months

40
Q

Transformed Migraine

A

> similar symptoms to tension-type or sinus ha

> possibly d/t parasympathetic activation.

> increase in frequency

41
Q

Childhood Periodic Syndrome Migraine

A

> often r/t a serious disease process***

> 3 of the following to be diagnosed

  1. abd pain
  2. N/V
  3. throbbing ha
  4. unilateral location ha
  5. aura
  6. relief with sleep
  7. positive family hx
42
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 glutamate, cheese, chocolate

43
Q

Cluster Headache

A
  1. uncommon
  2. possibly hereditary
  3. activation of trigeminal nerve and ANS***
  4. possible hypothalamus involvement
  5. Men > women
  6. 30-70 yo
  7. last for weeks/months –> then remission
  8. rapid onset pain, lasting 15-18min
  9. severe, constant, unilateral
  10. orbital most common area
  11. can radiate to temple, cheeks, gums

Accompanied by:

  1. restless/aggitation
  2. conjunctival redness, lacrimation
  3. nasal congestion, rhinorrhea
  4. facial sweating
  5. Miosis (excessive constricting of pupil), ptosis (lid drooping), eyelid edema
44
Q

Tension headache

A 
> usually dont interfere with daily activities
>dull, aching, diffuse
> not associated with N/V
> possible type of migraine 
> Associated with:
-- scalp/neck muscle tension
-- oromandibular dysfunction
-- stress/anxiety/depression
45
Q

Chronic Daily Headache (CDH)

A
  1. 15+ days/month
  2. no known cause
  3. often resembles other ha types
46
Q

TMJ pain

A

> imbalanced joint movement**
–poor bite, bruxism (teeth grinding), inflam, trauma, degeneration

> pain: face, neck, ears, head

47
Q

Children and pain

A

> respond to nociceptive stimuli as neonates
demonstrate pain memory as infants
reliable/accurate reporters of pain at young age

48
Q

Older adults and pain

A

Common types:

  1. musculoskeletal
  2. Rheumatologic- joints, CT disorders, autoimmune
  3. Neurologic

Unrelieved pain can result can result in:

  1. gait disturbances, muscle waisting
  2. impaired appetite
  3. sleep disturbances
  4. decreased cognition
  5. economic impact

Patho Final (4 decks)

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