week 5 - pain concepts & assessments Flashcards
what are the 4 phases of the ascending pain pathway?
- complex transmission from periphery to dorsal root of spinal cord
- terminate in dorsal horn
- signals communicate w/ local interneurons
- neurons w/ long axons ascend to brain
what woud you use OPQRSTSUV for?
acute
what do C fibres transmit?
poorly localised, dull, aching pain
what level does modulation occur in the NS?
all lvls
can there be selective responses to stimuli in the descending pain pathway?
yes
what are 3 ways to describe neuropathic pain?
- shooting
- burning
- electric
define referred pain
pain felt in an area of the body distant from actual source
what is visceral pain often the result of?
stretching from inflammation or spasms of organ tissues
what are C fibres associated w/?
diffuse, dull, persistant pain
what is released during transduction?
chemcal mediators
what is the PAINAD scale for?
pain assessment in advanced dementia
what 4 things are involved in the perception of pain?
- reticular activating system (RAS)
- somatosensory system
- limbic system
- cortical structures
what would you use the numeric rating scale NRS for?
acute
children
what does persistant pain assessment =?
acute + other
what are 3 signs of inflammatory pain?
- redness
- swelling
- heat
what would you use the intitial pain assessment tool for?
acute
give 3 examples of what nociceptors detect
- heat
- pressure
- chemical irritants
what is allodynia?
condition in which normally non-painful stimuli is perceived as painful
what 3 chemical substances can be released during modulation?
- endogenous opioids
- serotonin
- NA
what stimuli are C fibres sensitive to?
mechanical
thermal
chemical
what is visceral pain?
originating from internal organs
what is another name for psychogenic pain?
somatoform
what is transduction?
when a noxious stimulus is detected by nocicepted > converted into electrical signals (AP)
what would you use the visual analogue scale VAS for?
acute
how long does pain need to last to be considered persistant?
> 3-6 months (arbitrary)
comment on
- vital signs
- pt activity
- pt mentioning of pain
- pain behaviour
for acute pain
- high BP, RR, HR
- restless/anxious
- reports pain
- exhibits pain behaviour
comment on the myelination, diameter & conduction speed of C fibres
- unmyelinated
- small
- slow-conducting
what is idiopathic pain?
pain w/ unknown/unclear underlying cause
what is inflammatory pain?
arising from activation of immune response, often due to tissue damage/infection
is the brief pain inventory BPI multidimensional & who what you use it for?
yes
persistent, children, elderly, CALD (culturally & linguistically diverse)
what 3 ways can the descending pain pathway be modulated?
- chemical substances
- gate theory
- actions
what is referred pain due to?
shared nerve pathways
what would you use the pain anxiety symptom scale PASS for?
persistent
what is psychogenic pain?
primarily caused/influenced by psychological factors
what would you use the pain catastrophising scale for?
persistent
what would you use the verbal descripter/rating scale for?
acute
what are the 4 elements of assessment for pain?
- patient self-report
- observation
- interview
- physical examination
is the McGill pain questionnaire MPQ multidimensional & what would you use it for?
yes
persistent
what would you use PQRST for?
acute
what is breakthrough pain?
intense episodes of pain that breakthrough regular pain management regiment
what is modulation in the pain pathway?
3 sentences
signals from brain travelling downwards
amplification/dampening of pain system
release of chemical substances
what are 2 endogenous opioids?
- encephalins
- endorphins
define neuropathic pain
results from damage/dysfunction of the NS inc. nerves
is visceral pain challenging to localise?
yes
can neuropathic pain be chronic?
yes
comment on:
1. vital signs
2. skin
3. pupils
4. pt activity
5. pt mentioning of pain
6. pain behaviour
for chronic pain
- normal
- dry/warm
- normal/dilated
- depressed/withdrawn
- dowsn’t mention pain unless asked
- often absent
what is analgesia?
relief from pain, often through meds/interventions that block pain signals or alter pain perception
what are A-delta fibres associated w/?
acute pain
what do A-delta fibres transmit?
well-localised, sharp pain
why does phantom pain occur?
brain’s attempt to interpret signals from nerves that used to supply missing body part
define pain
unpleasant sensory & emotional experience associated w/ actual or potential tissue damage
protective mechanism
what does the paediatric FLACC scale stand for?
face
legs
activity
cry
consolability
what is the descending pain pathway?
brain > spinal dorsal horn
what is hyperalgesia?
increased sensitivity to painful stimuli
define nociceptive pain
pain caused by activation of nociceptors
localised, well-defined
does chronic pain have sympathetic or parasympathetic NS responses?
parasympathetic
what phase are A-delta & C fibres used?
injury site > spinal cord (transmission)
comment on the myelination, diameter & conduction speed of A-delta fibres
- thinly
- large
- fast-conducting
is neuropathic pain easy to treat?
can be challenging
what would you use the neuropathic/nociceptive discrimination DN4 scale for?
persistent
what would you use the faces pain scale for?
children
what are 3 ways to describe visceral pain?
- dull
- deep
- vague
what are the 4 steps in the nociceptive pain response?
- transduction
- transmission
- perception
- modulation
what is phantom pain?
percieved in a part of the body that has been amputated
is acute pain a parasympathetic or sympathetic NS response?
sympathetic
what did persistant pain used to be called?
chronic
what does PQRST stand for?
provocation/palliation
quality/quantity
region/radiation
severity
timing
what are the 3 phases of transmission?
- injury site > spinal cord
- spinal cord > brain stem & thalamus
- thalamus > cortex
what stimuli are A-delta fibres sensitive to?
mechanical
thermal
what are nociceptors?
specialised sensory receptors that respond to harmful stimuli
what does OPQRSTUV stand for?
onset
provocation/palliation
quality
region/radiation
severity
treatment
understanding
impact
values
what are 3 possible causes of psychogenic pain?
- stress
- anxiety
- depression
what is chronic pain?
persists for an extended period, beyond tissue healing time
significant impact on person’s quality of life
what is acute pain?
sudden, usually related to a specific injury/illness
warning sign, short duration
related to tissue injury
what are the 2 primary types of nerve fibres responsible for transmitting pain signals to the CNS?
- A-delta fibers
- C fibers
what are 7 chemical mediators in pain?
“BOdySHoP Pain’S”
- bradykinins
- others
- substance P
- histamine
- potassium
- prostaglandins
- serotonin
what is perception in the pain pathway?
conscious experience of pain
