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Pain

59 flashcardsby Esha
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1
Pain definition
an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage
2
pain is always a _______ experience that is influced to varying degrees by _______, ________, and ______ factors
personal
biological, psychological, and social
3
pain and nociception are _________. Pain cannot be inferred solely from activity in ________ _______
different
sensory neurons
4
throughout their life experiences ...
indiviuals learn the concept of pain
5
a person's report of an experience of pain should be ___________
respected
6
Although pain usually serves an adaptive role, it may have adverse effects on _______ and _______ and ________ wellbeing
function
social
psychological
7
verbal description is .... to express pain. Inability to communicate does not ...
only one of several behaviors
negate the possibility that a human experiences pain
8
______ has become a cornerstone of pain management in clinical practice
neuroscience
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pain neuroscience education definition
the art of helping your patient understand their pain experience
10
Who needs pain education?
Everyone
not everyone needs the same level of education
11
nociception is the neuronal response to _________ (action potentials). The perception of pain may be the consequence of nociceptive stimuli, but pain is ________ and can be experienced in the _________ of nociception. You can try to rule out nociception in the clinic, but you can never disqualify the __________ _____ _______ described by the patient,
stimuli
subjective
absence
experience of pain
12
Pay attention to _______ changes and follow up with a ____________ exam. Modulation of the nervous system is an important aspect of its role in ________
sensory
neurological
survival
13
Pain Classifications
Nociceptive
Nociplastic
Neuropathic
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Central Nervous System
Brain
Brainstem
Spinal Cord
15
Peripheral Nervous System
Cranial Nerves
Spinal Nerves
Peripheral Nerves
16
Peripheral receptors are _______. They do ______ ________, which is the process of stimulus energy becoming information. They are sensory receptors with _____ nerve endings, meaning conduction speed is _____. There are peripheral receptors _______ the body.
Specialized
stimulus transduction
bare
slow
throughout
17
do peripheral receptors know if stimulus is a threat?
No. Just fires
18
nociceptors are triggered with a ________ stimulus
noxious
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Nociceptors are polymodal meaning they are sensistive to different kinds of stimuli such as
mechanical, thermal or chemical
20
The more you fire peripheral nociceptors …
the more sensitive they get
takes less and less stimuli to make them fire
technically good because it prevents us from reinjuring
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What sensitizes the peripheral nociceptors?
histamine and prostaglandins
22
2 Typed of Pain Axons
A delta Fibers
C fibers
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Properties of A delta fibers
lightly myelinated
slower
Discriminative nociception to CNS
24
Properties of C fibers (pain)
unmyelinated
slower
more diffuse nociception to CNS
25
Describe Type A fibers (axon size, myelination, speed, what does it control)
Largest axons
heavily myelinated
fast transmission
motor neur ons that control skeletal muscle
sensory neurons that carry balance, position, discriminatory touch and pressure
26
Describe Type B fibers (axon size, myelination, speed, what does it control)
medium sized axons
myelinated
moderate transmission
motor neurons autonomic to glands and cardiac muscle
sensory neurons that carry nociception, crude touch, temperature, and pressure
27
Describe Type C fibers (axon size, myelination, speed, what does it control)
smallest axons
unmyeinated
slow transmission rates
motor neurons autonomic to glands and cardiac mucle
sensory neurons that carry nociception, temperature, crude touch, and pressure
28
Steps after you step on a piece of glass
Peripheral axon of nociceptor picks up signal
Goes to the dorsal root ganglia adjacent to the spinal cord
Central axon enters the spinal cord at the same level or at 1-2 adjacent levels
Cell body is in the dorsal horn of the spinal cord
Axon crosses midline at anterior white commissure
Ascends ant/lat through the spinal cord and brainstem spinothalamic tract
Cell body located in the thalamus
Axon ascends and terminates in specific sensory areas of the cerebral cortex
Then the brain decides based on many different factors
29
Pain Gate Theory
small and large nerve fibers
small nerve fibers get excited which turns on the pain/projector neuron and tells the brain to experience pain
Pain as an INPUT
30
Gate Control Theory
if other receptors are stimulated instead, it turns off the interneuron and the projector neuron can’t send the pain message to the brain
Like pinching the other side or rubbing your elbow
More likely you are just giving your brain more context to decide to feel pain!
31
When the stimulus first occurs, the _______ _______ are activated. They send a message up _____ _______ axons to the spinal cord. Then, it _______ the spinal cord, and travels up into the _____ where the message is delivered.
Pacinian corpuscles
large myelinated
crosses
brain
32
Nociceptors are activated. They send a message up ______ _______ ___________ fibers to the spinal cord. It reports ______ to the spinal cord who then decides to or to not notify the ________. If sufficient input neurotransmitters are released, a message is sent to the ______.
thin slow conducting
directly
brain
thalamus
33
Nociception is neither _________ nor ________ for pain
sufficient nor necessary
34
Common challenges to pain worldview that you may need to educate patient about
pain = tisssue damage
degree of pain = severity of injury
chronic pain = severely damaged tissue
35
chronic pain definition
pain that persists or recurs for longer than 3 months
36
in chronic pain, the pain often becomes the ______ or ________ clinical problem in some patients. It affects _____ of people worldwide. It is impacted by 3 factors:
sole or predominant
20%
biological, psychological, and social
37
chronic pain is not:
caused by reinjury
chronic inflammation
made up
38
chronic pain is caused by
physiological changes in the brain, spinal cord. and sensory system
39
Types of physiological changes associated with chronic pain
Plastic changes in the brain (CNS)
Changes to spinal cord sensitivity (CNS)
Changes to peripheral nociceptor sensitivity (PNS)
40
Neurotags are how we ________ process different stimuli, environments, and situations. They are _____ to each particular individual and dependent on ____ _________. You need that specific neurotag to fire in order to _______ ____.
individually
specific
past experiences
experience pain
41
For pain neurotags, the more it is run the _____ it gets at firing. It becomes _____ sensitive. Over time, looses inhibition of ____ ________ cells/neurotags, so they lose _______. This is when you can start to feel pain just by talking about the experience, or even experience pain in another limb.
better
non member
precision
42
smudging is a _______ inhibition of non member cells, which cause a trigger of the ______ neurotag. The neuro tag gets ____ precise, and the spreading of pain is also ____ precise. Results in ______ inhibition in the brain.
decreased
pain
less
less
decreased
43
In peripheral sensitization, the nociceptor becomes _____ excitable because the __________ _______ change the property of the nociceptor. If the nociceptor is active in the presence of a certain chemical environment, the nociceptor can become _______ to that chemical environment. The spinal cord doesn’t know that there is ________ of the peripheral nociceptor. This change is normal in the presence of ______ ____________ _______ and not normal if it _______ ______ ___ _________ __________.
more
inflammatory mediators
sensitive
overexcitement
acute inflammatory mediators
never returns to baseline exciteability
44
In the spinal cord sensitization, it requires ___ neurotransmitters to send the danger message to the brain. The change that happens is that the longer you have pain, the ______ the spinal cord gets at produing _______ __________. Danger messages are sent to the bain ________ an external stimulus. You can have a sensitized spinal cord ______ experiencing pain - phantom limb pain.
less
better
danger messages
without
without
45
Descending inhibition: the brain receives a danger message from the thalamus and decides the spinal cord is _______
overreacting - not dangerous
46
Descending facilitation - decides the spinal cord is ________. Brain will do what?
under estimating
Brain will excite the spinal cord directly
example: guy with nail in his shoe - no nociception but brain decided to experience pain
47
central sensitization is a nervous system that is stuck in a? There is ______ _______ transmission because of ________ synthesis or action of ________ _______. or loss of _______ ________, which may produce a _______ enhancement of pain sensitivity.
persistent state of heightened reactivity or wind up.
reduced inhibitory
reduced
inhibitory transmitters
inhibtory interneurons
persistent
48
hyperalgesia
increased pain from a stimulus that normally provokes pain
49
Hypoalgesia
diminished pain in response to a normally painful stimulus
50
Hypoesthesia
decreased sensitivity to stimulation, excluding the special senses
51
Allodynia
pain due to a stimulus that does not normally provoke pain
52
referred pain
pain felt in a part of the body other than its actual source
53
windup
repeated inputs or stimuli causing increased response in the dorsal horn (spinal cord)
54
temporal summation
increasing response to repeated nociceptive stimulations of the same intensity level (brain)
55
target site
assessment in area of tissue injury or painful lesion
56
remote site
assessment in undamaged tissue away from the site of a painful lesion
secondary - ipsilateral side
tertiary - contralateral side
57
How do we measure pain?
Visual Analog Scale for Pain (VAS Pain)
Numeric pain rating scale for pain (NRS Pain)
58
Quantitative sensory testing includes
a good neuro exam
Objective, quantifiable stimulus with patient’s subjective responses: thermal or mechanical stimuli
Assess both large and small fiber sensory processing
Can be used to help assess neural function, pain sensitivity, sensory loss or gain
Can help assess pain processing including faciliation and altered inhibition
59
QST assists with _________ _______. Identification of _____ sensory function and _______ pain mechanisms.
Assessments include:
Selection of -
Monitor -
May provide more ______ diagnosis
Differential diagnosis
altered
aberrant
Somatosensory deficits; allodynia, hyperalgesia, hypoesthesia; thermal tactile, vibration changes
Most appropriate treatment
treatment effects
accurate
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