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Unit 14 Week 4 (Tommy) > The Experience of Pain > Flashcards

The Experience of Pain Flashcards

1
Q

What is IASP?

A

International Association for the study of Pain

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2
Q

What is pain?

A
  • An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
  • It is influenced by biological, psychological, and social factors
  • Pain influences function, social & psychological well-being (includes SENSORY & EMOTIONAL experience)
  • Provides a warning of potential/actual injury
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3
Q

Are pain & nociception the same?

A

NO

Nociception describes the neural processes involved in producing the sensation of pain

Pain cannot be inferred soley from sensory neurons

People LEARN the concept of pain (everyones threshold of pain should be respected)

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4
Q

How can we express pain?

A

Verbal description is only one of several behaviours to express pain; inability to communicate does not negate the possibility that a human or a non-human animal experiences pain.

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5
Q

What are the two dimensions of pain?

A
  1. Sensory/discriminative
    • ​Able to locate local tissue damage
    • NEWER tracts to sensory cortex (SOMATOSENSORY CENTRE)
  2. Affective/aversive
    • ​​Unpleasant & emotional
    • Travels centrally along old spinal cord pathways (to midbrain)
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6
Q

Explain somatosensory centre

A

In post-central gyrus

  • Includes stimuli of touch, temperature, proprioception, pain

1st order neuron = primary afferent (cell body in dorsal root ganglion)

3rd order neurons - project from thalamus to somatosensory cortex

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7
Q

Explain nociceptors

A
  • Nociceptor - The peripheral receptor for the pain system and are POLYMODAL (respond to variety of mechanical, thermal, chemical stimuli)
  • Mechanorecptors - touch receptors (specialised - HIGH threshold)
  • Thermoreceptors - temperature (specialised receptors - HIGH threshold)
  • Nociceptors consist of the free nerve endings of:
    • Aδ (bigger in diameter, myelinated)
      • FAST pain - fast withdawal reflex e.g. withdraw foot when brick dropped
    • C fibres (unmyelinated, smaller in diameter)
      • SLOW pain - “dull” throbbing pain - associated with inflammation, promoted immobilisation of injuryed body part
        • ​e.g. long-term pain after dropping brick on foot
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8
Q

What are visceral nociceptors?

A

Similar to Aδ and C found in the periphery, but respond to distension and ischaemia rather than cutting or thermal damage

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9
Q

Draw cross-section spine with 1st order neuron & second order nociceptors

A
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10
Q

Draw the primary ascending pain pathways

A

Neospinothalamic tract - lateral spinothalamic tract

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11
Q

Draw the secondary ascending pain pathways

A

Spinoreticular tract - arises from deeper laminae, V & VII, most fibres decussate, some ascend ipsilaterally. Terminates in the Reticular Formation of medulla and pons

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12
Q

What are the different types of pain?

A
  • Acute
  • Chronic
  • Nociceptive
  • Neuropathic
  • Referred
  • Rebound
  • Nociplastic
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13
Q

What is nociceptive pain?

A

Pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors

E.g. drop brick on foot

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14
Q

What is neuropathic pain? & types

A

Pain caused by a lesion or disease of the somatosensory nervous system

E.g. MS - demyelination of nerve fibres

  • Neuropathic pain is a clinical description (and not a diagnosis) which requires a demonstrable lesion or a disease that satisfies established neurological diagnostic criteria.
  • Central neuropathic pain
    • ​Pain caused by a lesion or disease of the central somatosensory nervous system.
  • Peripheral neuropathic pain
    • ​Pain caused by a lesion or disease of the peripheral somatosensory nervous system.
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15
Q

What is nociplastic pain?

A

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

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16
Q

What is acute pain?

What is chronic pain?

A

Acute - implies a painful condition with a rapid onset or of a short duration

Chronic - is referred to as a painful condition persisting beyond the normal time of healing (at least 6 months)

17
Q

What can influence how we percieve pain?

A
18
Q

What scales can be used to measure acute pain? & describe them?

A

These are unilateral

  1. Visual analogue scale (VAS)
    • ​​100mm unparked line and “No pain” to “Worst pain imaginable” , put line where they think they sit
    • NEGATIVES
      • ​DOES NOT give instant rating
      • Requires explanation to patient
      • NOT useful when understanding is impaired
  2. Numeric rating scale (NRS)
    • ​​Scale of 0(no pain)-10 (worst pain)
    • GOOD
      • ​Easier & quicker
  3. Categorical verbal rating scale (VRS)
    • Uses WORDS to describe magnitude of pain (None, mild, moderate, severe)
    • GOOD
      • ​Quick, simple, high validity
    • BAD
      • ​LESS precise & less sensitive than VAS
      • Language barrier
  4. Wong-Baker Faces Pain rating scale
    • Created for children to help them communicate their pain
  5. FLACC behavioural Pain scale (score 0-2) - 0 = normal, 2 = evident pain expressed in that area, observe for 2-5 mins with legs uncovered (if asleep do for 5 mins, same and touch body to assess tone)
    • Face
    • Legs
    • Activity
    • Cry
    • Consolability
    • Scores:
      • Relax = 0
      • Mild = 1-3
      • Moderate = 4-6
      • Severe = 7-10
19
Q

What are the multidimensional pain scales?

A
  1. McGill Pain Questionnaire (MPQ)
  2. Brief Pain Inventory (BPI) - shown in image

These are for chronic pain

20
Q

What are the screening tools for neuropathic pain?

A
  1. Leeds Assesment of Neuropathic Signs and Symptoms (LANSS) pain scale
  2. Doleur Neuropathique questionnaire (DN4)
  3. PainDETECT
  4. Neuropathic Pain Score (NPS)
21
Q

Explain the treatment of pain & the ongoing issues in today’s society

A
  • Postoperative analgesia is suboptimal in more than half of all patients undergoing surgery
  • Pain management should begin in the pre-assessment stage. It is important to identify patients who are likely to experience difficult pain control postoperatively
  • Education is of crucial importance. It can reduce patient and carer anxiety, develop realistic expectations, and improve compliance with post discharge pain management.
  • Patients often do not take adequate pain medication due to lack of information or misunderstandings.
  • Need to take into account attiitudes and beliefs, and patients capacity to comply with treatments
  • In general patients should be instructed to take regular analgesics for at least 3 days after surgery.
  • The first postoperative analgesia dose should be taken before the effects of any intraoperative analgesia have worn off.
  • Multimodal analgesia should be prescribed (can attack pain from many different points in the pain pathway)
22
Q

What are all the drug treatments in the treatment of pain?

A
  • Wherever possible regional (peripheral or neuraxial) or local anaesthetic (infiltration) techniques, plus:
  • Paracetamol
  • Nonsteroidal antiinflammatory agents (NSAIDs)
  • Opioids
  • ‘Adjuvants’
    • NMDA antagonists (e.g. ketamine)
    • Gabapentinoids
    • Clonidine, dexmedetomidine (alpha agonists)
    • Dexamethasone (steroids)
23
Q

Explain how opioids work

A

Bind to 4 receptors:

  • μ- (MOP)
  • δ- (DOP)
  • κ-opioid
  • Nociceptin (NOP)

Presynaptically they block calcium channels on nociceptive afferent nerves to inhibit release of neurotransmitters eg substance P and glutamate which contribute to nociception

Postsynaptically opioids open potassium channels, which hyperpolarizes cell membranes (harder to make APs)

24
Q

Explain how NSAIDs work

A

The main MOA is blockade of the production of prostaglandins inhibition of cyclooxygenase (COX) enzymes needed for prostaglandin synthesis

ASPIRIN = only NSAID that irreversibly blocks COX

25
Q

Explain congenital insensitivity to pain (CIP) & cause

A
  • Patient lacks the ability to perceive physical pain.
  • From birth, affected individuals never feel pain in any part of their body when injured
  • Many of them have anosmia, burn injuries, lip deformities from biting etc
  • Due to:
    • Mutation in the SCN9A gene
      • Deformed NaV1.7 sodium channel for transporting sodium in cell, found in:
        • Nociceptors (no pain perception)
        • Olfactory system (anosmia cause)

Unit 14 Week 4 (Tommy) (5 decks)

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