Topic 4: Pain: Introduction to the Physiological and Psycological Aspects of Pain Flashcards
1
Q
What is pain?
A
a subjective and multidimensional, unpleasant sensory and emotional experience associated with actual or potential tissue damage
2
Q
Is there a purpose behind pain?
A
Yes. There is a reason we experience it. It vital to our ability to survive.
- here to protect us and tell us that something is wrong
3
Q
Two types of pain
A
Acute and chronic
4
Q
What would happen if we couldn’t feel pain?
A
we wouldn’t be able to tell if something is progressing or getting worse
5
Q
What is acute pain?
A
the pain that is more immediate
6
Q
What is chronic pain?
A
the pain that usually lasts longer than three months. Somethings can last years.
- long periods of pain can affect someone physically and emotionally
7
Q
What are the categories of pain?
A
- somatic (tissue) pain
- visceral (tissue) pain
- psychological pain
8
Q
What is somatic tissue pain?
A
- pain that originates from the skin and from the musculoskeletal system
- ligaments, tendons, bones, joints and muscles
- typically localized to a very specific or particular problem site
- related to particular injury or movement, so they will usually remember where its from
9
Q
what is visceral pain?
A
- pain that specifically originates from the internal organs
- can cause referred pain
- pain that’s harder to pinpoint
- person is quite nauseous if they are experiencing this pain
10
Q
what does it mean when pain is referred?
A
- it causes pain somewhere else in the body
11
Q
what is psychological pain?
A
- when we feel the sensation of pain but there is not apparent physical cause of that pain
- no physical cause or damage
- emotional based
- ex. feeling pain where you are emotionally upset
12
Q
When is pain felt?
A
when there is a stimulation of our afferents or sensory nerve endings and specifically when there is a stimulation of our pain receptors (nociceptors)
13
Q
What is a nociceptor?
A
a afferent or sensory nerve endings that when they are stimulated are going to produce a pain sensation.
- A PAIN IMPULSE THAT WILL GET TO OUR BRAIN
14
Q
Three subcategories of nociceptors?
A
- mechanosensitive nociceptor
- thermosensitive nociceptor
- chemosensitive nociceptor
15
Q
What is a mechanosensitive nociceptors?
A
- responding to touch or pressure
- overstress or compress a tissue (toe stepped on)
16
Q
what is the thermosensitive nocioceptors
A
- responding to extreme heat or cold
- ex. touching a hot stove
17
Q
what is the chemosensitive nociceptors?
A
- responding to chemicals
- ex. serotonin or inflammation process chemicals
18
Q
What are the categories of pain?
A
- referred pain (areas away from injured tissue feel pain)
- radiating pain (pain is felt along an involved structure)
19
Q
What causes a referred pain?
A
When there is a mix up of messages. Too many afferent nerve signals try to signal at the same time.
OVERCONVERGENCE
20
Q
why ask to describe the pain?
A
to find out what tissue might be involved
21
Q
What might it mean if someone says they have ‘shooting’ pain
A
- nerve pain
22
Q
What might it mean if someone says they have ‘throbbing’ pain
A
- source might be congestion in joint.
- swelling or fluid build up
23
Q
What might it mean if someone says they have ‘stabbing’ pain
A
- acute injury (immediate)
- ligament or muscle strain
24
Q
What might it mean if someone says they have ‘deep’ pain
A
- can be more bone related (arthritis)
25
What might it mean if someone says they have 'stiff' or 'achy' pain
- chronic inflammation
- muscle or tendon or joint injuries
25
What does morning stiffness that gets better with activity mean?
chronic inflammation with swelling
- ex. arthritis
25
what does pain increasing as day progresses mean?
increased congestion in a joint
26
what does sharp, stabbing pain during activity mean?
acute ligament sprain or muscular strain
27
what does dull, aching pain aggravated by muscle contraction mean?
chronic muscle strain
28
what does pain that subsides during activity mean?
chronic inflammation
29
what does night pain mean?
compression of a nerve or bursa
- also associated with cancer pathologies
30
what does deep/nagging/very localized pain mean?
bone pain
31
what does sharp/burning/numbness pain mean?
nerve pain
32
what does general aching / referred to another area pain mean?
vascular pain
33
What is the acronym to remember what types of questions and what does it mean?
OPQRST
Onset (sudden vs gradual)
Provoke (what makes it better or worse)
Quality (describe what it feels like)
Radiate or refer
Severity (0-10)
Timing (when did it start)
34
What is the physiology of pain?
- noxious stimuli. pricked in the finger, going to stimulate a somatic nociceptor, a mechanosenstive nociceptor.
- pain travels through an afferent nerve ending as what we call an impulse.
- will travel along a primary neuron (first order neuron)
- will hit the spinal cord and an exchange will happen
- at spinal cord. there is a neurotransmitter thats going to pick up the message and then transport it through a second order neuron
- synapse occurs there
- it will travel up the spinal cord through the ascending tracts until it reaches the brain and a specific part of the brain called the thalamus when there is a sensory relay station.
- potentionally go to other parts of the brain in the cerebral cortex where it will get registered as pain
- brain registers action is necessary and body needs to react
- message will them travel back down the spinal cord through the descending tracts and back to the area pricked
35
what is a noxious stimulus?
any stimulus that going to elicit a pain response
36
what is the pain pathway?
nociceptor --> first order neuron--> spinal cord -DL tract (substantia gelatinose) --> second order neuron --> thalamus --> third order neuron --> cerebral cortex
37
What happens if pain goes to the limbic system?
it could alter your mood and attention
37
How pain gets interrupted
- it wont gets to the point where it is registered as pain. (ex. stops in the spinal cord so IT CANNOT GET TO THE SECOND NEURON)
(ex.2: epidural)
37
What is Group II of afferent nerves?
Group II: AB (A beta) fibers
- an afferent nerve ending with a myelin sheath around it. better nerve transmission (largest diameter) (doesn't take much to trigger impulse) (pain travels the fastest here. 35-75m/sec)
ex. temperature, pressure and touch impulses
38
What is Group III of afferent nerves?
Group III: A8 (A delta) fibers
- large diameter, thinly myelinated (signal doesn't travel as fast as AB because of this), 5-30m/sec
ex. carry pain messages that get activated first and start that message going to the brain
39
What is group IV of afferent nerves?
Group IV: C fibers
- chronic pain that happens after (travels along these fibers)
- no myelin (slowest rate)
- 0.5-2m/sec
- ex. transmits lower levels of pain like dull and aching (diffuse) types of pain (the ones that linger)
40
what is coping with pain?
the ability to identify, manage and overcome issues that stress us in any capacity. might be dependent on what is threatening to you specifically
41
what does coping need to do?
reduce the threat value. any sort of stimulus and the associated emotions or the tissue change
42
will you feel more pain if your brain thinks you are in danger?
yes
43
pain comes from a lot of our brains ability to determine the ___________________________________________.
threat value surrounding the situation
44
why do kids overreact when in pain?
their body is not used to it so their brain thinks they are in big danger. the pain felt is more psychological than physical
45
what are some factors that can influence a person's perception of pain?
- physical
- psychosocial
- cognitive
- belief systems
- distraction
- past experiences
- peer pressure "suck it up"
- ethnic background
46
what are the three primary theories around pain control?
1. gate control theory
2. descending pain control (central biasing)
3. B-Endorphin theory
47
what is the gate control theory?
- we have the ability to block pain at the spinal cord level.
- blocks the AB fibers
ex. stubbing your toe and grabbing it (putting pressure on it to block pain) or putting ice
- stimulating touch receptors which travel along AB fibers so they reach the brain faster.
short answer: non painful stimuli can block painful stimuli (nonpainful travels faster)
48
what is the descending pain control theory?
- we have the ability to consciously override pain
- ex. if someone believes a medication is going to relieve the pain, it is psychological and will relieve their pain. (placebo effect)
- 60% of our brain power alone can control pain through the placebo affectwa
49
what do enkephalins do in the descending control?
they block the release of substance P by binding to it
50
what is substance P?
neurotransmitter tat carries the pain message across the synaptic cleft
51
what is the B-Endorphin theory?
- noxious (painful) stimuli of nociceptors resulting in the transmission of pain information along Ad and C afferents can stimulate the release of an endogenous opiate-like chemical called B-endorphin from hypothalamus.
- body's natural pain killers
- can be stimulated from things like acupuncture
ex. runners high
52
what is the most important factor in learning how to cope with pain?
gaining a sense of control over pain
53
psychological pain factors
- previous pain experience
- pain expectations
- pain tolerance levels
- effect of modalities (what a pill looks like allows it to be more effective)
- body part/what the injury looks like
- situation/time of reason/winning/losing
- status of player
54
why is acute pain important?
it is the pain that protects us from further harm
55
how to handle acute pain situations as an AT
- establish control
- establish helping / collaborative relationship between you and the athlete
- establish cooperation with the athlete
- alter the concentration (distraction/attention)
- provide information
- caveat - adrenaline may mask pain
56
psychological techniques to cope with pain
- maintaining a sense of humour
- patient / pain education
- distraction / attention
- visualizations (pain modalities)
- goal setting (reduce swelling to reduce pain)
- relaxation skills
57
can depression result from chronic or acute pain more commonly?
chronic
58
key concepts of pain
- KNOW pain or NO pain
- knowledge is a powerful combative to pain
- knowledge is the great pain liberator
- keep on moving
