Week 5: Pain Flashcards
Pain is ___
Subjective
Pain __ is the level of stimulation required to activate the ___ __ sufficiently for the in individual to __ pain
Threshold
Nerve ending
Perceive
Pain ___ is the ability to withstand pain or the perception or the ___
Tolerance
Intensity
Pain ___ is relatively constant over time and between individuals
Threshold
Pain ___ varies considerably with past pain experiences and overall state of health
Tolerance
__ is a feeling of discomfort resulting from ___ of ___ ___ in the body when __ damage occurs or is about to occur
Pan
Stimulation
Pain receptors
Tissue
Pain may be felt because of i___, i__, i___, tissue ___, __ of tissue, c___ or b____
Inflammation Infection Ischemia Tissue necrosis Stretching of tissue Chemicals Burns
In skeletal muscle pain may result from __ or ___
Ischemia
Hemorrhage
Organs such as ____, ___, or ___ are characterized by pain receptors in the covering ___ and pain is felt when the ___ is stretched by __
Liver Kidney Brain Capsule Capsule Inflammation
Stretching of t____, ligaments, and j____ c___ also elicit pain
Tendons; joint capsules
Effects of pain might occur secondary to ____ or _____ ____ to guard a joint or painful body part
Inflammation
Joint capsules
In stomach and intestines, pain results from inflammation of the m___, i___,d___, or m____ _____
Mucosa
Ischemia
DISTENTION
Muscle spasm
Pain pathways include _____, __, __, ___,____,_____
Nociceptors Affrent fibers efferent fibers Dermatomes Reflex response Reticular activating system
_____ are free sensory nerves endings that are present in ____ body tissue
Nociceptors
Most
____ are stimulated by t___, ___, or ____ means
Nociceptors
Thermal
Chemical
Physical
____ means extremes in temperature
Thermal
____ refers to pressure
Physical
____ refers to acids or compounds produced in the body such as bradykinin, histamine, or prostaglandin
Chemical
2 afferent fibers that conduct pain impulses m___ _ ____ fibers and the u___ __ fibers
Myelinated A delta
Unmyelinated C
The Afferent m___ _ ___ fiber transmits impulses rapidly
Myelinated A delta
The afferent fiber u___ _ fiber transmits impulses slowly
Unmyelinated
Acute pain is that is sudden sharp and localized, related to thermal and physical stimuli primarily ____ and ____ membranes is transmitted primarily by the ___ __ ___ fiber
Skin
Mucous
Myelinated A delta
Chronic pain experienced as dull, diffuse, burning or aching is transmitted by ___ _ fibers
Unmyleinated C fibers
C fibers relieve chemical, thermal, and physical stimuli from m___, t___, my___ and d___ t__, and s___
Muscle Tendon Myocardium Digestive tract Skin
Afferent fibers travel from the ____ nerves -> d___ r___ g___ -> s___ c___ through the dorsal ___ or su___ ge____
Peripheral Dorsal root ganglia Spinal cord Dorsal horn Substantial gelatinousa
Each spinal nerve conducts nerve impulses from a specific area of the skin called a ____
Dermatome
The s_________ c__ is mapped to correspond to the area of the body so that the source of the pain can be interpreted in the brain
Somatosensory cortex
Dermatomes can be used to test for areas of ___ loss, or pain ___ and thus determine the site of damage after spinal cord injuries
Sensory
Sensation
At a spinal cord synapse a ___ response to sudden pain results in a motor efferent impulse back to the muscle that initiates an _____ muscle ___ to move the body away from the source of the pain
Reflex
Involuntary
Contraction
The arousal state of the ____ in the reticular formation in the p__ and m__ influences the brains awareness of incoming pain stimuli
RAS
Pons
Medulla
Many drugs decrease the _____ thereby decreasing the pain experience
RAS
h_______ plays a role in the response to pain through its connections with the pituitary gland and ___ nervous system
Hypothalamus
Sympathetic
Response to pain usually involves a s____ response and an ___ response such as crying moaning or aching
Stress
Emotional
A p___ response to pain involves rigidity, splinting or guarding an area of the body
Physical
The T___ possesses many types of sensory stimuli as they enter the brain and is important in the e______ response to pain through the l____ s___
Thalamus
Emotional
Limbic system
2 tract of the spinothalmic bundle are the ne___ tract and the pa___ tract
Neospinothalmic
Paleospinothalmic
Fast impulses for a cure, sharp pain travel in the _____ tract of the spinothalmic bundle
Neospinothalmic
Slow impulses for chronic/ dull pain pain travel in the _____ tract of the spinothalmic bundle
Paleospinothalmic
The 2 pathways of the spinothalmic bundle explain why one experiences s___ severe pain followed by d___
Sharp
Duller
The spinothalmic tracts connect with the r___ formation in the brain system, h___, t___ and other structures as they ascent to the somatosensory area in the c__ cortex of the p___ lobe of the brain. It is here that the ____ and characteristics of pain are perceived
Reticular Hypothalamus Thalamus Cerebral Parietal Location
Endorphins include e___, d____, and b__ l___
Enkephalins
Dynorphins
Beta lipotropin
E___ is released from the s__ cord and attached to the ____ receptors on the a____ n__ thus blocking the release of the neurotransmitter at the synapse
Enkephalins
Spinal cord
Opiate receptors
Afferent neuron
S___ is a chemical released in the spinal cord that acts on other neurons in the spinal cord to increase the release of E___
Serotonin
Enkephalins
Patient who are clinically depressed report pain due to decrease in ____ levels
Serotonin
When the pain gate is _____ pain impulses are transmitted from the p___ to the b___
Open
Periphery
Brain
When the pain gate is _____ it reduces or modifies the passage of pain impulses
Closed
Gate ___ can occur in response to other sensory stimuli along competing nerve pathways that may diminish pain sensations of by modulating or our inhibitory impulses from h____ c___ in the b___
Closure
Higher centers
Brain
____ pain is caused by simulation of p_____ nerve fibers that respond only to stimuli that are approaching or exceeding harmful intensity
Nociceptive
n____ may be v___ or s___
Nociceptive
Visceral
Somatic
N____ pain is caused by damage or disease affecting any part of the NS. Described as Burning, tingling, electrical, stabbing pains
Neuropathic
P____ pain is pain caused by increased or prolonged mental, emotional, or behavioral factors
Psychogenic
S____ pain is located in the skin and deep tissue. These nociceptors pic up sensations related to temperature, vibration, swelling in the skin, joints, and muscles
Somatic
Somatic pain responds well to ___ and a___
NSAIDS
Anergerics
S___ pain usually fades once the injury heals; if lasts longer than can become chronic
Somatic
V___ results from activation of nociceptors in the thoracic abdominal or pelvic vesera. Can be acute or chronic
Visceral
r____ pain is characteristic of v___ damage in the abdominal organs. Pain is in some distance from the actual source
Referred
Visceral
P___ pain may occur after an amputation and is more common if chronic pain occurred before surgery. Usually does not respond to common pain therapies
Phantom
Pain t_____ may be increased with ____ endorphin release
Tolerance
Higher
Anxiety/ stress can result in a ____ pain tolerance. The CNS is at a ___ level of awareness
Lower
Pain perception is s___ but can be compared from day to day in the same person
Subjective
Response to pain
Influenced by personality, emotions, cultural norms
___ adults often won’t say that they have pain, and it may manifest in other behaviors (anxiety, agitation)
Older
___ cannot express pain and can be noticed though facial expressions
Children
COLD SPA to define pain characteristics
C- character/ quality
O- onset
L- location
D- duration
S- symptoms
P- precipitating factors
A- alleviating
Pain drawing
Patient indicated pain level on particular part of body by marking it with a number
Wong- Baker faces pain rating scale
Asses pain in children and infants via facial expression because they can’t communicate their pain
PAINAD
Behavior observation tool developed for patients with advanced dementia
A___ pain indicates tissue damage and is sudden, severe and short term
Acute
Acute pain initiates a p___ s___ response with increased b____, r____ and h__;;;; c____, p___, m__ skin and increased s____ m___ t___;;;; strong emotional response and possible vomiting
Physiological stress BP RR HR Cool Pale Moist Skeletal muscle tension
C__ pain occurs over an extended period of time and may be recurrent. More difficult to treat and perceived to be more generalized
Chronic
Effects of chronic pain
Loss of employment Interference with personal relationships Fatigue Weight loss or gain Periods of acute pain Reduces tolerance to additional pain Irritable ADLs Depression Sleep disturbances
Nausea and vomiting and anxiety/ fear are common with ___ pain
Acute
Patient might be restless or in constant motion when in pain
Children clench fist have have ridged faces
Treatment of pain: remove the ____ as soon as possible
Cause
___ causes the impulses from temperature receptors to close gates and reduce the s__ that causes pain
Ice
Swelling
TENS ____ sensory stimulation at the site _____ pain transmission
Stimulate
Block
Non pharmacological treatment of pain includes ____ ____ therapy
Cognitive behavior
Opiate like chemicals are secreted by the i____ of the CNS; ___ conduction of pain impulses on the CNS
Interneruons
Block
E___, d___, b___ l___ resemble morphine
Enkephalins
Day orphans
Beta lipoproteins
Analgesic drugs:
mild pain- a____, a__, n__
ASA
Acetaminophen
NSAIDS
Side effects: ulcers, nausea, gastric bleeding
Analgesic drugs:
Moderate pain-
C__ and o__
Codeine
Oxycodone
Side effects: respiratory depression and tolerance or addiction
Analgesic drugs:
Severe pain- m__, m___
Morphine
Meperidine
Side effects: respiratory depression and tolerance or addiction
P___ is used after surgery for pain management. Allows patients to administer medication as needed by pressing a button. Lessons consumption
Patient controlled analgesia (PCA)
Adjuncts to analgesics are s___ and a___ for rest and relaxation
Sedatives Anti anxiety (ie lorazepam)
L___ a___ is another way to treat or prevent pain
Local anesthesia
Pharmacological including opioids and non-pharm pain management interventions have been shown to be effective in ____
Children
Non pharm methods for children should be based on d___ s__
Developmental stage;; teach to kid and parent
Risk of adverse events is ___ in elderly
Higher
For older adults _____ treatment are usually less costly and cause fewer side effects
Non pharm
When prescribing pharm or non pharm treatment for older adult consider cause, h___ s___, c___ therapies and m___ s___
Health state
Concurrent therapies
Mental state
