Week 3: Ch. 4- Pain Flashcards
What is pain?
Unpleasant sensation - Discomfort caused by stimulation of pain receptors
Body defense mechanism - Warning of a problem
Complex mechanisms - Many not totally understood
Subjective scales - Developed to compare pain levels over time
What are some causes of pain?
- Inflammation
- Infection
- Ischemia and tissue necrosis
- Stretching of tissue
- Stretching of tendons, ligaments, joint capsule
- Chemicals
- Burns
- Muscle spasm
SOMATIC VERSUS VISCERAL PAIN
Somatic pain
* From skin (cutaneous)
* Bone muscle
* Conducted by sensory fibers
Visceral pain
* Originates in organs
* Conducted by sympathetic fibers
* May be acute or chronic
_______________ (pain receptors) are free sensory nerve endings
Nociceptors
Nociceptors may be stimulated by:
*Temperature - extremes
*Chemicals - acids, bradykinin, histamine, prostaglandin
*Physical means: pressure
Define pain threshold
- Level of stimulation required to elicit a pain response
- Usually does not vary among individuals
Define pain tolerance
- Ability to cope with pain
- Culturally related
- Varies among individuals
Describe pain fibers
- Afferent fibers
- Myelinated A delta fibers
-Transmit impulses very rapidly
-Acute pain
-Sudden, sharp, localized - Unmyelinated C fibers
-Transmit impulses slowly
-Chronic pain
-Diffuse, dull, burning, or aching sensation
Dermatome
- Area of skin innervated by a specific spinal nerve
- Somatosensory cortex → “mapped” - Corresponds to source of pain stimuli
Reflex response
- Involuntary muscle contraction away from pain source / to guard against movement
- Spinothalamic bundle in the spinal cord
Neospinothalamic tract VS Paleospinothalamic tract
- Neospinothalamic tract → fast impulses; acute pain
- Paleospinothalamic tract → slow impulses; chronic, dull pain
- Spinothalamic tracts connect with reticular formation of brain
Somatic sensory area in the cerebral cortex located in the _________ lobe
parietal
Describe Gate control theory
- Control systems, “gates” built into normal pain pathways
- Can modify pain stimuli conduction and transmission in the ________________________________________
- Gates open - Pain impulses transmitted from ______________ to brain
- Gates closed - Reduces or modifies the passage of _______________________
- Control systems, “gates” built into normal pain pathways
- Can modify pain stimuli conduction and transmission in the spinal cord and brain
- Gates open - Pain impulses transmitted from periphery to brain
- Gates closed - Reduces or modifies the passage of pain impulses
Describe pain control method of ice
Impulses from _________________________ close _______.
Impulses from temperature receptors close gates.
Describe pain control method of Transcutaneous electrical nerve stimulation (TENS)
Increases sensory stimulation at site, blocking pain transmission
Describe pain control method of Opiate-like chemicals (opioids)
- Secreted by interneurons of the CNS (endogenous)
- Block conduction of pain impulses to the CNS
- Resemble morphine - Enkephalins, dynorphins, beta-lipoproteins
How do infants respond to pain?
physiologically
* Examples: tachycardia, increased blood pressure, facial expressions
Describe signs & symptoms of pain
- Pallor and sweating
- High blood pressure, tachycardia
- Nausea, vomiting, fainting. dizziness - May occur with acute pain
- Anxiety and fear - Frequently evident in people with chest pain/trauma
- Clenched fists or rigid faces
- Restlessness or constant motion
- Guarding area to prevent stimulation of receptors
Describe referred pain
- Source may be difficult to determine
- Pain may be perceived at site distant from source
-Characteristic of visceral damage in the abdominal organs
-Heart attack or ischemia in the heart
Describe phantom pain
- Usually in adults
- More common if chronic pain occurred
- Can follow an amputation - Pain, itching, tingling
- Usually does not respond to common pain therapies
- May resolve within weeks - months
- not fully understood
Pain tolerance may be increased by ___1___
~May be reduced because of _______2________
1- endorphin release
2- fatigue or stress
Response to pain is influenced by :
personality, emotions, and cultural norms
Describe acute pain
- Usually sudden, severe, _______________
- Indicates _____________ damage
- May be localized or ______________
- Initiates physiologic stress response ↑ Blood pressure and heart rate; cool, pale, moist skin; ↑ respiratory rate; ↑ skeletal muscle tension
- Usually sudden, severe, short term
- Indicates tissue damage
- May be localized or generalized
- Initiates physiologic stress response ↑ Blood pressure and heart rate; cool, pale, moist skin; ↑ respiratory rate; ↑ skeletal muscle tension
- Vomiting/ strong emotional response may occur
Describe chronic pain
Occurs over extended time; may be recurrent
Usually more difficult to treat than ________ pain
Often perceived to be ___________
Individual may be fatigued, irritable, depressed
Sleep disturbances common
Specific cause may be ______________________.
Appetite may be affected > weight gain/loss
Frequently affects ____________________________
Periods of acute pain may accompany chronic pain conditions.
Usually reduces tolerance to additional pain
- Occurs over extended time; may be recurrent
- Usually more difficult to treat than acute pain
- Often perceived to be generalized
- Individual may be fatigued, irritable, depressed
- Sleep disturbances common
- Specific cause may be less apparent.
- Appetite may be affected > weight gain/loss
- Frequently affects daily activities
- Periods of acute pain may accompany chronic pain conditions.
- Usually reduces tolerance to additional pain
Cause of migraines
- Abnormal blood flow and metabolism in the brain
Intracranial headaches : Increased-
pressure inside the skull
Headache [central pain] is caused by:
dysfunction or damage to the brain or spinal cord
Headache [Neuropathic pain] is caused by:
trauma or disease involving the peripheral nerves
Headache [ischemic pain] results from:
a profound, sudden loss of blood flow to an organ or tissue
List which analgesic drugs are used for mild VS moderate VS severe pain
Mild- NSAIDS, acetaminophen
Moderate- Codeine, Oxy, Perc, Vicodin
Severe- Morphine, oxy, methadone
Local anesthesia is Injected or applied to:
skin or mucous membranes
Spinal or regional anesthesia blocks pain from:
legs or abdomen
General anesthesia causes:
loss of consciousness (gas or injection)
Neuroleptanesthesia:
Patient can respond to commands.
& is relatively :
unaware of procedure, no discomfort
The impulses related to acute pain are usually transmitted by:
myelinated A delta fibers.
In which structure do pain impulses ascend the spinal cord?
Spinothalamic tract
According to the gate-control theory, passage of pain impulses may be naturally blocked:
at the synapse by entry of other sensory impulses.
What is the term used to describe the degree of pain that is endured before an individual takes action?
Pain tolerance
What is the definition of endorphins?
Opiate-like blocking agents in the central nervous system
Pain perceived in the left arm during the course of a heart attack is an example of:
referred pain.
A headache that is related to changes in cerebral blood flow is classified as a/an ________ headache.
migraine
What is a common analgesic administered to control a moderate level of pain?
Codeine
Spinal anesthesia -
The drug is injected into _______________________________ of the spinal cord.
cerebrospinal fluid (CSF) or the epidural space
What is the role of nociceptors? They are:
pain receptors that are stimulated by thermal, chemical, or physical means.
Intractable pain is best defined as:
severe pain that cannot be controlled by medication.
Young infants typically respond to pain with :
tachycardia and increased blood pressure.
Ibuprofen is classified as an NSAID and is particularly useful in treating:
pain caused by inflammation.
Which analgesics acts to reduce pain at the peripheral site?
Acetaminophen
Cancer-related pain has been broken down into three basic categories: pain caused by the advance of the disease and resultant damage to the body, pain that is the result of a coexisting disease unrelated to the cancer, and:
pain associated with the treatment of the disease.
Pain that is caused by trauma or disease involving the peripheral nerves is referred to as:
neuropathic pain.
Pain resulting from a profound, sudden loss of blood flow to an organ or tissues in a specific area of the body is referred to as:
ischemic pain.
Which of the following is a characteristic of chronic pain?
It is more difficult to _______________ than is acute pain.
diagnose and treat
